Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

摘要: Importance There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective To systematically review and meta-analyze evidence interventions for postoperative management Data Sources Database searches MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register Controlled Trials (CENTRAL), Systematic Reviews, Web Science (ISI database), Physiotherapy Evidence (PEDRO) database, ClinicalTrials.gov period between January 1946 April 2016. Study Selection Randomized clinical trials comparing with other combination standard care were included. Extraction Synthesis Two reviewers independently extracted data from selected articles using a standardized form assessed risk bias. A random-effects model was used analyses. Main Outcomes Measures Postoperative consumption opioids analgesics. Results Of 5509 studies, 39 randomized included meta-analysis (2391 patients). The most commonly performed continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, acupuncture. Moderate-certainty showed that electrotherapy reduced use (mean difference, −3.50; 95% CI, −5.90 −1.10 morphine equivalents milligrams per kilogram 48 hours; P  = .004; I2  = 17%) acupuncture delayed opioid 46.17; 20.84 71.50 minutes first patient-controlled analgesia;  = 19%). low-certainty improved −1.14; −1.90 −0.38 on visual analog scale at 2 days;  = .003;  = 0%). Very cryotherapy associated reduction −0.13; −0.26 −0.01  = .03;  = 86%) improvement −0.51; −1.00 −0.02 scale;  = 62%). Low-certainty or very motion exercise had no consumption: mean differences −0.05 (95% −0.35 0.25) (  = .74;  = 52%) 6.58 −6.33 19.49) 1 weeks  = .32,  = 87%), difference −0.14 −1.11 0.84) Western Ontario McMaster Universities Arthritis Index Scale  = .78,  = 65%). Conclusions Relevance In this meta-analysis, arthroplasty consumption.