Effects of Acetaminophen, NSAIDs, Gabapentinoids, and Their Combinations on Postoperative Pulmonary Complications After Total Hip or Knee Arthroplasty

• Published in: Pain medicine (Malden, Mass.) Vol. 21; no. 10; pp. 2385 - 2393
• Main Authors: Ohnuma, Tetsu, Raghunathan, Karthik, Ellis, Alan R, Whittle, John, Pyati, Srinivas, Bryan, William E, Pepin, Marc J, Bartz, Raquel R, Krishnamoorthy, Vijay
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.10.2020
• Subjects: Acetaminophen; Acetaminophen - therapeutic use; Adult; Analgesia; Analgesics; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticonvulsants; Arthroplasty (knee); Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Complications; Dosage and administration; Drug therapy, Combination; Gabapentin; Humans; Inflammation; Joint replacement surgery; Joint surgery; Narcotics; Nonsteroidal anti-inflammatory drugs; Opioids; Pain perception; Pain, Postoperative - drug therapy; Patient outcomes; Postoperative Complications - epidemiology; Respiratory insufficiency; Retrospective Studies; Risk factors; Surgery; Total hip arthroplasty; United States; Acetaminophen; Complications; Total Joint Arthroplasty; NSAIDs; Postoperative Pulmonary; Gabapentinoids
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1093/pm/pnaa017

Abstract Objective Multimodal analgesia has gained popularity in total hip arthroplasty (THA) and total knee arthroplasty (TKA), but large multicenter studies evaluating specific analgesic combinations are lacking. Design A retrospective study using the Premier Healthcare Database (2009–2014). Subjects Adults who underwent elective primary THA or TKA. Methods We categorized day-of-surgery analgesic exposure using eight mutually exclusive categories: acetaminophen (Ac), nonsteroidal anti-inflammatory drugs (Ns), gabapentinoids (Ga; gabapentin or pregabalin), Ac+Ns, Ac+Ga, Ns+Ga, Ac+Ns+Ga, and none of the three drugs. Multilevel models measured associations of the analgesic categories with a composite of postoperative pulmonary complications (PPCs). Results Among 863,139 patients, 75.2% received at least one of the three drugs. In multilevel models, compared with none of the three drugs, Ga use was associated with increased odds of PPCs when used alone (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.27 to 1.44), combined with Ac (aOR = 1.16, 95% CI = 1.08 to 1.26), or combined with Ns (aOR = 1.28, 95% CI = 1.21 to 1.34). In contrast, the Ac+Ns pair was associated with decreased odds of PPCs (OR = 0.86, 95% CI = 0.83 to 0.90) and lower opioid consumption. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery. Conclusions Gabapentinoids, alone and in single combination with either acetaminophen or nonsteroidal anti-inflammatory drugs, were associated with higher PPCs, whereas the Ac+Ns pair was associated with fewer PPCs and an opioid-sparing effect. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery.