The following is a summary of “Non-opioid analgesic combinations following total hip arthroplasty (RECIPE): a randomized, placebo-controlled, blinded, multicentre trial,” published in the April 2024 issue of Rheumatology by Steiness et al.

Researchers conducted a prospective study to assess pain relief options in total hip arthroplasty with various paracetamol combinations, ibuprofen, and the analgesic adjuvant dexamethasone.

They used a randomized, placebo-controlled trial to test the effects of different drug combinations on adults. Participants were randomly assigned to receive one of four treatments: paracetamol plus ibuprofen, ibuprofen plus dexamethasone, paracetamol plus dexamethasone, or paracetamol plus ibuprofen plus dexamethasone. The primary outcome being measured was 24-hour IV morphine consumption, which was analyzed in a modified intention-to-treat population. A minimum significant difference of 8 mg was considered. Safety outcomes, including serious and non-serious adverse events, were monitored within 90 days and 24 hours.

The result assigned 1,060 participants between March 5, 2020, and November 15, 2022, of which 1,043 (589 women and 454 men) were included in the modified intention-to-treat population. These patients were classified as 261 (paracetamol + ibuprofen), 262 (ibuprofen + dexamethasone), 262 (paracetamol + dexamethasone) and 258 (paracetamol + ibuprofen + dexamethasone). Median 24h morphine consumption was 24 mg (IQR 12-38) in paracetamol + ibuprofen group, 20mg (12-32) in paracetamol + dexamethasone group, 16mg (10-30) in ibuprofen + dexamethasone group, and the lowest 15 mg (8-26) in paracetamol + ibuprofen + dexamethasone group (Hodges-Lehmann median difference –6 mg [99% CI –10 to –3]; P<0·0001) and paracetamol plus dexamethasone (–4 mg [–8 to –1]; P=0·0013). None of the groups reached the 8 mg minimal important threshold. One or more adverse events were also lowest in paracetamol + ibuprofen + dexamethasone group (n=91, 35%), in ibuprofen + dexamethasone group (n=99, 38%), in paracetamol + dexamethasone group (n = 103, 39%), and in paracetamol + ibuprofen group (165, 63%).

Investigators concluded that the combination of paracetamol + ibuprofen + dexamethasone had the lowest morphine consumption along with the most favorable adverse event profile. 

Source: sciencedirect.com/science/article/abs/pii/S2665991324000201