%0 Journal Article
%T Analgesic Techniques in Hip and Knee Arthroplasty: From the Daily Practice to Evidence-Based Medicine
%A Denisa Madalina Anastase
%A Simona Cionac Florescu
%A Ana Maria Munteanu
%A Traian Ursu
%A Cristian Ioan Stoica
%J Anesthesiology Research and Practice
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/569319
%X Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II¨CIV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice. 1. Background Primary total arthroplasty of the hip or knee is a common surgery today with an increasing incidence related to age. The mean age at surgery for TKA is 70 years, but there is a tendency worldwide to increase the proportion of younger patients (the age interval between 55 and 64 years) [1¨C3]. To allow comparison between data from different arthroplasty national registers, the term ˇ°age-standardisedˇ± was introduced as a statistically corrected result for age structure of the population [4] and the ˇ°rateˇ± as the number of the knee TKA per 100.000 inhabitants is used. The leaders are USA (221,5) and Austria (186,3), Switzerland (173,6) [5], Germany (132,5) [6]. TKA data from Registers Nordic Association (including the 4 countries Sweden, Norway, Denmark, and Finland) show 151 814 knee prostheses till 2011 [7] with a higher incidence in Denmark (123) in 2007 than in Sweden (115) and Norway (75) [1]. Besides increasing the number and the age of patients receiving prosthetic joint, a number of comorbidities are associated with increasing age. According to a national cohort report from 2009, 32,6% of the patients with TKA had three comorbidities or more and the most common ones are hypertension (67,8%), diabetes (20%), and obesity (19,8%) [8]. Therefore, there was an almost parallel evolution of surgical techniques and methods of analgesia, allowing effective pain control, rapid mobilization of patients with reduced side effects and no damage to existing comorbidities. Effective treatment of postoperative pain continues to be a challenge because it influences the surgical outcome [9] and for prosthetic joints pain management is a must for early mobilization and functionality of the new joints. Relationship between analgesic technique and the immediate and remote postoperative outcome and success of surgery is not new, and postoperative pain assessment using visual analogue scale (VAS) and
%U http://www.hindawi.com/journals/arp/2014/569319/