Efficacy of NSAID and Acetaminophen in the Control of Post-Operative Pain in Patients Undergoing Total Knee Replacement
Condition: Pain; Hispanics; Opioid Use; Multimodal Analgesia; Total Knee Arthroplasty
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      An alternate perioperative pain control protocol composed of intravenous ketorolac and oral
      acetaminophen for patients who underwent total knee replacement was designed with the aim to
      determine its efficacy when compared to pain control with intravenous morphine and oral
      oxycodone combined with acetaminophen. In addition, the study will evaluate the differences
      and similarities in the Hispanic population that could predict protocol efficacy.
    

Detailed description: 
      Acute pain after a surgical procedure may occur secondary to trauma from the procedure itself
      or from procedure-related complications. Appropriate peri-operative acute pain management is
      an important phase of patient's recovery since it's under-treatment can lead to adverse
      outcomes such as: thromboembolic and pulmonary complications, additional time spent in an
      intensive care unit or hospital, hospital readmission for further pain management, needless
      suffering, impairment of health-related quality of life, and development of chronic pain.
      Furthermore, it's over-treatment with opioid medications is associated with an increased risk
      of thromboembolic, infectious and gastrointestinal complications as well as increased length
      of hospital stay, cost of care and risk of opioid addiction.

      Perioperative administration of intravenous (IV) non steroidal anti-inflammatory drugs
      (NSAID), such as ketorolac, has been shown to effectively decrease opioid requirements and
      pain levels while demonstrating tolerable side effects. Its use after total knee replacement
      has been associated with a 27% decrease in the use of morphine. When NSAID is combined with
      acetaminophen 1000mg every six hours, an additional benefit in terms of improved pain scores
      on post-operative day three was shown in patients who underwent total hip or knee
      arthroplasty. Therefore, the purpose of this study is to provide an effective alternative for
      pain management in Hispanic patients who underwent total knee replacement and evaluate the
      role of ketorolac and acetaminophen.
    

Intervention name(s): Opioid based protocol; Opioid sparing protocol
Intervention type(s): Drug; Drug
Intervention description(s): Use of combination of drug dosage frequency and duration of morphine injection with percocet oral as standard postoperative pain control for up to 72 hours as requested by each patient; Use of combination of drug dosage frequency and duration of ketorolac injection with acetaminophen oral as standard postoperative pain control for up to 72 hours as requested by each patient
Other intervention name(s): morphine injection; percocet oral; ketorolac injection; acetaminophen oral
Intervention MeSH terms: Acetaminophen; Ketorolac; Morphine; Analgesics, Opioid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Total Knee Arthroplasty; Postoperative Pain; Opioid Use; Hispanics; Clinical Outcomes; Multimodal Analgesia