medwireNews: Using electrotherapy after undergoing total knee arthroplasty (TKA) can reduce opioid consumption, while acupuncture can delay the initiation of opioids, indicates a meta-analysis published in JAMA Surgery.
Evidence for the efficacy of other nonpharmacologic pain management strategies – namely, continuous passive motion (CPM), preoperative exercise, and cryotherapy – for modifying opioid use was “limited by the quality of the underlying literature,” say the researchers.
They explain that “[a]s prescription opioid use is under national scrutiny and because surgery has been identified as an avenue for addiction, it is important to recognize effective alternatives to standard pharmacological therapy, which remains the first option for treatment.”
However, the current meta-analysis, which included 39 randomized controlled trials (2391 participants) comparing non-drug approaches to standard care or other nonpharmacologic strategies, highlights the further need for “strong supporting research,” the team writes.
Pooled analysis of two studies showed with moderate certainty that receipt of electrotherapy within 48 hours of surgery was associated with reduced use of opioids, with an average decrease in the morphine equivalent dose of 3.50 mg/kg per 48 hours.
There was also evidence of moderate certainty to show that acupuncture treatment was associated with a significant increase in the time to first use of patient-controlled opioids after surgery, delaying opioid initiation by a mean 46.17 minutes.
Researcher Tina Hernandez-Boussard (Stanford University, California, USA) and colleagues also noted associations between cryotherapy and reduced consumption of opioids and nonsteroidal anti-inflammatory drugs, but the evidence was of “very low certainty.”
In the trials assessing acupuncture and CPM, there did not appear to be a difference between the experimental and control arms with regard to post-TKA opioid use, but again the evidence was of low or very low certainty.
The quality of evidence also limited the conclusions that could be drawn regarding the effect on pain improvement for all evaluated interventions, say Hernandez-Boussard et al.
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