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Perioperative non-opioid analgesia strategies after high tibial osteotomy: a systematic review of prospective studies

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Little is known about the optimal analgesia regimen after HTO. Thus, this study systematically reviewed the literature on clinical and patient-reported outcomes of pain management strategies for patients after HTO.

Methods

A comprehensive search of the PubMed, Cochrane CENTRAL, and CINAHL databases was conducted from inception through September 2023. Studies were included if they evaluated pain reduction with analgesia strategies after HTO and were excluded if they did not report pain control outcomes.

Results

Five studies with 217 patients were included. Patients with a multimodal intraoperative injection cocktail to the knee, femoral nerve block (FNB), or adductor canal block (ACB) for HTO had significant improvement in visual analog scale (VAS) and numerical rating scale (NRS) scores in the first 12 h postoperatively compared to controls. Patients on duloxetine had significantly lower NRS scores at 1, 7, and 14 days postoperatively and significantly lower nonsteroidal anti-inflammatory drug (NSAID) usage throughout the two-week postoperative period than the control group. Patients receiving an ACB had significantly lower opioid consumption than controls at 12 h postoperative. In patients with an FNB or ACB, no significant difference in quadriceps strength or time to straight leg raise postoperatively was observed compared to controls.

Conclusion

A multimodal periarticular injection cocktail, FNB, or an ACB effectively reduces pain on the first day after HTO, with an ACB able to reduce opioid consumption on the first postoperative day. Duloxetine combined with an ACB effectively decreases pain for two weeks postoperatively while reducing NSAID consumption in patients after HTO.

Level of evidence

IV.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA

    Anna M. Ifarraguerri, Dana P. Piasecki, James E. Fleischli & Bryan M. Saltzman

  2. OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA

    Anna M. Ifarraguerri, Dana P. Piasecki, James E. Fleischli & Bryan M. Saltzman

  3. Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA

    Anna M. Ifarraguerri, Dana P. Piasecki, James E. Fleischli & Bryan M. Saltzman

  4. Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 111-1130, New York, NY, 10032, USA

    David P. Trofa

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Contributions

All authors meet the full four-point ICMJE criteria for authorship. AMI was involved in data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, and writing—review and editing. DPT participated in writing—review and editing. DPP and JEF were responsible for writing—review and editing, supervision, and project administration. BMS contributed to conceptualization, writing—review and editing, supervision, and project administration.

Corresponding author

Correspondence to Bryan M. Saltzman.

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Conflict of interest

Author BMS receives research support from Arthrex, Inc. publishing royalties, and financial or material support from Nova Science Publishers. JEF received research support from both Arthrex and Smith and Nephew.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

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Ifarraguerri, A.M., Trofa, D.P., Piasecki, D.P. et al. Perioperative non-opioid analgesia strategies after high tibial osteotomy: a systematic review of prospective studies. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-04000-x

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