Authors: Jens Laigaard et al.
Source: Anesthesia & Analgesia 141(4):765–778, October 2025.
This meta-analysis reviewed 49 randomized controlled trials (68 intervention arms) examining perioperative analgesic interventions aimed at reducing long-term (3–24 months) postsurgical pain following total hip or knee arthroplasty in patients with osteoarthritis. The review evaluated pain both at rest and during movement and applied rigorous bias assessment and sensitivity analyses.
No intervention, including multimodal regimens, regional anesthesia, or NSAID-based protocols, demonstrated a significant long-term reduction in pain at rest. Only duloxetine, evaluated in seven studies with 641 participants, modestly lowered pain scores during movement (mean difference –4.9 mm on a 0–100 visual analog scale), which was statistically significant but below the 10-mm threshold considered clinically meaningful. Most studies exhibited high risk of bias, heterogeneous exclusion criteria, and inconsistent cointerventions, limiting generalizability.
Overall, the findings indicate that despite the intuitive link between acute and chronic postsurgical pain, no perioperative analgesic approach clearly prevents persistent pain following hip or knee arthroplasty. The authors emphasize the need for future trials designed specifically to evaluate long-term pain outcomes rather than focusing solely on immediate postoperative relief.
What You Should Know:
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Persistent postsurgical pain after arthroplasty remains a major challenge despite aggressive perioperative pain control.
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Duloxetine shows a small but clinically marginal reduction in long-term movement pain.
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Future analgesic research should include standardized long-term pain endpoints and minimize study bias to clarify potential preventive effects.
KEY POINTS
- Question: Can perioperative analgesic interventions reduce persistent postsurgical after total hip or knee arthroplasty?
- Findings: Only few, heterogenous trials reported long-term pain outcomes and none of the meta-analyses suggested an important effect.
- Meaning: Currently, no perioperative analgesic interventions can reduce persistent postsurgical pain after total hip or knee arthroplasty for osteoarthritis (low certainty of evidence).
Thank you to Anesthesia & Analgesia for publishing this important synthesis on long-term pain management after joint replacement.