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RECIPE Study: Non-opioid Analgesics following Total Hip Arthroplasty

Patients undergoing total hip arthroplasty using a combination of paracetamol, ibuprofen, and dexamethasone, had optimal responses with the lowest morphine consumption, and fewer adverse events.
The RECIPE trial investigated the benefit and harm of non-opioid therapies (paracetamol, ibuprofen, dexamethasone) in patients following total hip arthroplasty. RECIPE was a blinded, placebo-controlled trial at nine Danish hospitals, with 1060 patients were randomised (1:1:1:1) to receive combinations of oral paracetamol 1000 mg every 6 h, oral ibuprofen 400 mg every 6 h, or a single-dose of intravenous dexamethasone 24 mg in the following groups: paracetamol plus ibuprofen, ibuprofen plus dexamethasone, paracetamol plus dexamethasone, and paracetamol plus ibuprofen plus dexamethasone. The primary outcome was 24 h intravenous morphine consumption.
Median 24 h morphine consumption was:
  • 24 mg (IQR 12–38) in the paracetamol plus ibuprofen group
  • 20 mg (12–32) in the paracetamol plus dexamethasone group
  • 16 mg (10–30) in the ibuprofen plus dexamethasone group
  • 15 mg (8–26) in the paracetamol plus ibuprofen plus dexamethasone group. 
The paracetamol plus ibuprofen plus dexamethasone group had the least 24 h morphine consumption compared with paracetamol plus ibuprofen (p<0·0001) and paracetamol plus dexamethasone (p=0·0013). But none of the comparisons showed differences reaching the minimal important threshold of 8 mg. 
Adverse events (all): 
  • 35% paracetamol plus ibuprofen 
  • 38% ibuprofen plus dexamethasone 
  • 39% paracetamol plus dexamethasone 
  • 63% paracetamol plus ibuprofen 
Combination non-opioid therapy appears to be effective and safe In adults undergoing total hip arthroplasty. Overall serious and non-serious adverse events were similar; but higher rates of nausea, vomiting, and dizziness were seen with paracetamol plus ibuprofen.


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The author has no conflicts of interest to disclose related to this subject