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Epidural analgesia (a form of pain control) for the pain relief following hip and knee replacement

Choi P, Bhandari M, Scott J, Douketis JD
Published Online: 
30 April 2013

Epidural analgesia may give good pain relief after hip or knee replacement surgery, but this benefit must be weighed against the possibility of adverse effects and complications. Hip and knee replacements are common operations to improve mobility and quality of life. After surgery, good pain relief is essential to enable patients to start walking again. Epidurals (pain medicine injected into the spinal canal) are commonly used. However, this pain relief method may delay the start of blood thinners, which prevent life-threatening blood clot formation (thrombosis) in veins, because there is also a risk of bleeding at the epidural injection site if blood thinners are used at the same time. This review found that an epidural comprising local anaesthetic with or without a strong opioid might give better pain relief than an epidural with only strong opioids; the benefit may be felt only in the first four to six hours after surgery. Aside from pain relief, there was insufficient information to draw conclusions on other benefits or harms arising from epidural analgesia.