Opioid-based vs. opioid-free analgesia in hip arthroplasty: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared perioperative opioid-based with opioid-free analgesia in adults undergoing total hip arthroplasty. Of 28 eligible clinical trials, 26 trials involving 1681 patients were analyzed. Opioid-free regimens were associated with lower pain scores at rest and with movement at 12 and 24 hours. The largest reported difference was for movement pain at 12 hours (mean difference -1.43, 95% CI: -2.66 to -0.20, p = 0.022). The authors also reported fewer postoperative side effects, particularly nausea and pruritus, while noting considerable variability and low-to-very-low certainty for pain outcomes.

Key findings

• Movement VAS at 12 hours was lower with opioid-free regimens (MD -1.43, 95% CI: -2.66 to -0.20, p = 0.022).
• Movement VAS at 24 hours was lower with opioid-free regimens (MD -1.18, 95% CI: [-2.25 to -0.10], p = 0.032).
• Resting VAS was lower with opioid-free regimens at 12 hours (MD -1.51, 95% CI: -2.89 to -0.13, p = 0.032) and 24 hours (MD -1.12, 95% CI: -1.94 to -0.29, p = 0.008).
• Opioid-free analgesia reduced postoperative side effects, especially nausea and pruritus; vomiting, headache, urinary retention, antiemetic use, and overall satisfaction did not differ.

Why it matters

Postoperative pain control after hip arthroplasty must be balanced against opioid-related adverse effects. This synthesis suggests opioid-free regimens may provide lower early pain scores while reducing some side effects, informing consideration of analgesic options. However, the reported variability and low-to-very-low certainty for pain outcomes mean the apparent benefit should be interpreted cautiously.

What to keep in mind

Pain-outcome evidence was rated very low to low certainty, and the authors reported considerable variability. Although 28 trials were included, only 26 were analyzed.