Optimal Pain Management Strategy Unveiled in Total Hip Arthroplasty Study

In a significant stride towards refining postoperative pain management strategies following total hip arthroplasty, the RECIPE trial has shed light on an innovative drug combination that showcases promise in reducing morphine consumption and minimizing adverse events. The trial concluded that for adults undergoing total hip arthroplasty, the combination of paracetamol, ibuprofen, and dexamethasone proved to be the most effective in reducing morphine consumption within the first 24 hours after surgery.

The trial results were published in the journal The Lancet Rheumatology.

Total hip arthroplasty often necessitates multimodal postoperative analgesia, yet the optimal drug combination has remained uncertain. Hence researchers conducted a randomized, blinded, and placebo-controlled trial at nine Danish hospitals to investigate the relative benefits and potential harm associated with different combinations of paracetamol, ibuprofen, and the analgesic adjuvant dexamethasone in treating postoperative pain.

The Recipe trial was carried out between March 5, 2020, and Nov 15, 2022, and a total of 1060 participants were enrolled in the trial. Adults scheduled for total hip arthroplasty were randomly assigned to receive various combinations of oral paracetamol 1000mg every 6h, oral ibuprofen 400 mg every 6 h, and a single dose of intravenous dexamethasone 24 mg. The primary outcome assessed was 24-hour intravenous morphine consumption, with a predefined minimal important difference of 8 mg.

Findings:

• The results, encompassing a modified intention-to-treat population of 1043 participants, unveiled intriguing findings.
• The combination of paracetamol, ibuprofen, and dexamethasone demonstrated the lowest 24-hour morphine consumption following surgery.
• Although the differences did not reach the predefined minimal important threshold of 8 mg, the paracetamol plus ibuprofen plus dexamethasone group exhibited a significant reduction in morphine consumption compared to other combinations.
• Moreover, the safety profile of this innovative drug combination proved to be highly favorable. Adverse events were reported in 35% of participants in the paracetamol plus ibuprofen plus dexamethasone group, showcasing a lower incidence compared to 38% in the ibuprofen plus dexamethasone group, 39% in the paracetamol plus dexamethasone group, and a higher incidence of 63% in the paracetamol plus ibuprofen group.
• The adverse events primarily included differences in nausea, vomiting, and dizziness.

This novel approach to postoperative analgesia holds promise in revolutionizing pain management strategies for total hip arthroplasty patients. The combination of paracetamol, ibuprofen, and dexamethasone not only demonstrated efficacy in reducing morphine consumption but also exhibited a safer adverse event profile, marking a significant advancement in optimizing patient care. As the medical community continues to explore innovative solutions for postoperative pain relief, the RECIPE trial's findings provide a valuable contribution to the ongoing discourse, offering a potential paradigm shift in enhancing the recovery experience for individuals undergoing total hip arthroplasty.Top of Form

Further reading: Steiness J, Hägi-Pedersen D, Lunn TH, et al. Paracetamol, ibuprofen and dexamethasone for pain treatment after total hip arthroplasty: protocol for the randomised, placebo-controlled, parallel 4-group, blinded, multicentre RECIPE trial. BMJ Open. 2022;12(9):e058965. Published 2022 Sep 1. doi:10.1136/bmjopen-2021-058965