Artikel
Trends in preoperative pain management - a survey of two collectives with coxarthrosis
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Gliederung
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Introduction
Pain management of coxarthrosis can be improved by assessing its trends and problems.
Method
A total of 406 patients with coxarthrosis-related hip arthroplasty in 1990-93 (n=205) and 2002-03 (n=201) were analysed for the duration of coxarthrosis, pharmacotherapy and conditions associated with a higher risk of adverse effects during a nonsteroidal anti-inflammatory therapy (NSAIDs and coxibs).
Results
The majority (1990-93: 73%, 2002-03: 79%) underwent total hip replacement within five years after onset of osteoarthritis related problems. Half of the patients received painkillers. NSAIDs predominated although 75% of the patients in both groups were at risk for gastric and/or renal adverse
effects. Almost every second risk patient in 1990-93 and 2002-03 received an NSAID (including coxibs). In contrast to 1990-93 NSAIDs were prescribed in combination with gastric protective medication in the time period 2002-03. Out of all prescribed NSAIDs in 2002-03, 20% were selective COX-II-inhibitors. There was an increase (+9%) of opioid medication in the latter period.
Discussion
Despite a substantial risk of adverse effects and interactions, which often goes unnoticed, the use of NSAIDs is widespread. Opioid analgetics are increasingly prescribed with a positive effect on osteoarthritis related pain and with a favourable safety profile. The aim is a patient-orientated pain
management with careful consideration of risks and benefits.
