Priority 5 from the Hip and Knee Replacement for Osteoarthritis PSP

UNCERTAINTY: What is the best pain control regime pre-operatively, peri-operatively, and immediately post operatively for hip and knee joint replacement surgery for people with OA?  (JLA PSP Priority 5)
Overall ranking 5
JLA question ID 0020/5
Explanatory note Not available for this PSP
Evidence

Up-to-date relevant and reliable systematic review which does not refer to uncertainty but could be extended:  Choi P, Bhandari M, Scott J, Douketis JD. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003071. DOI: 10.1002/14651858.CD003071.  Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007911. DOI: 10.1002/14651858.CD007911.pub2.  Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD009941. DOI: 10.1002/14651858.CD009941.pub2.  Bulley S, Derry S, Moore RA, McQuay HJ. Single dose oral rofecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004604. DOI: 10.1002/14651858.CD004604.pub3. 

Protocol for systematic review: Zou Z, An MM, Xie Q, Chen XY, Zhang H, Liu GJ, Shi XY. Single-dose intra-articular morphine for pain control after knee arthroscopy (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008918. DOI: 10.1002/14651858.CD008918; Moore RA, Derry S, McQuay HJ. Single dose oral dexibuprofen [S(+)-ibuprofen] for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007550. DOI: 10.1002/14651858.CD007550.pub2. 
Health Research Classification System category Musculoskeletal
Extra information provided by this PSP
Original uncertainty examples Osteoarthritis which is age related degeneration has very little chronic neuropathic pain, but repeat joint surgery will leave with the same why?  ~   Does use of dexamethasone perioperatively affect occurrence of chronic pain post arthroplasty)  ~  Pain control before and after surgery  ~  Are opioid analgesics effective and safe in the management of pain continuing for longer than 3 months before and/or after hip and knee replacement surgery?  ~  Are opioid analgesics effective and safe in the management of pain continuing for longer than 3 months before and/or after hip and knee replacement surgery?
Submitted by Uncertainty identified by 2 patient/carers, 21 clinicians, and 2 from Healthtalk Online interviews
Outcomes to be measured Pain
PSP information
PSP unique ID 0020
PSP name Hip and Knee Replacement for Osteoarthritis
Total number of uncertainties identified by this PSP. 123  (To see more about the Top 10, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 27 March 2014