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Wang Q, Hu J, Ye S, Yang J, Kang P. Efficacy of Oral Nefopam on Multimodal Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial. J Arthroplasty 2024; 39:2061-2067. [PMID: 38403077 DOI: 10.1016/j.arth.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Multimodal analgesia is central to pain management after total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding oral nefopam to multimodal analgesia for post-TKA pain management. METHODS In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to either the nefopam or the control group. After surgery, patients in the nefopam group received 200 mg of celecoxib, 150 mg of pregabalin, and 40 mg of nefopam twice daily to control postoperative pain. Patients in the control group received 200 mg of celecoxib, 150 mg of pregabalin, and a placebo. Oxycodone hydrochloride (10 mg) was used as the rescue analgesic. If the pain remained poorly controlled, 10 mg of morphine hydrochloride was injected subcutaneously as a secondary rescue analgesic. The primary outcome was the postoperative consumption of oxycodone and morphine as rescue analgesics. Secondary outcomes were postoperative pain assessed using the visual analogue scale (VAS), functional recovery assessed by the range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates. RESULTS Patients in the nefopam group had significantly lower postoperative oxycodone and morphine consumption within 24 hours after surgery and during hospitalization, lower VAS pain scores at rest and during motion within 24 h after surgery, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. However, the absolute reduction in 0 to 24 h opioid consumption, VAS pain scores, and knee range of motion did not exceed the reported minimal clinically important difference. Both groups had similar indicators of liver function and complication rates. CONCLUSIONS Adding oral nefopam to multimodal analgesia resulted in statistically significant improvements in opioid consumption, VAS pain scores, and functional recovery. However, the amount of improvement may not be clinically important.
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MESH Headings
- Humans
- Nefopam/administration & dosage
- Nefopam/therapeutic use
- Double-Blind Method
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Arthroplasty, Replacement, Knee/adverse effects
- Male
- Female
- Aged
- Middle Aged
- Prospective Studies
- Oxycodone/administration & dosage
- Oxycodone/therapeutic use
- Celecoxib/administration & dosage
- Celecoxib/therapeutic use
- Pain Measurement
- Pain Management/methods
- Treatment Outcome
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Administration, Oral
- Pregabalin/therapeutic use
- Pregabalin/administration & dosage
- Morphine/administration & dosage
- Morphine/therapeutic use
- Drug Therapy, Combination
- Analgesia/methods
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian Hu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shuwei Ye
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengde Kang
- Department of Orthopedic surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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2
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Betz J, Locatelli EVT, Harkness BM, Perez-Blanco M, Everist SJ, Chen S, Stutzman R, Chamberlain W, Nanji A, Lapidus J, Aicher SA, Galor A. Prospective cohort study investigating frequency and risk factors for acute pain 1 day after refractive surgery. BMJ Open Ophthalmol 2024; 9:e001624. [PMID: 39019581 PMCID: PMC11256057 DOI: 10.1136/bmjophth-2023-001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/06/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND/AIMS To examine demographic and clinical factors associated with ocular pain 1 day after refractive surgery. METHODS Prospective study of individuals undergoing refractive surgery. Participants rated their ocular pain on a 0-10 numerical rating scale (NRS) presurgery and 1 day after surgery. Presurgery, participants completed questionnaires on demographics, comorbidities, medications and dry eye and ocular pain symptoms; and an anaesthetised Schirmer test was performed. Acute ocular pain 1 day after surgery was defined as an NRS score of worst pain since surgery ≥3 and this group was compared with individuals with NRS scores<3. RESULTS 251 individuals underwent refractive surgery (89% laser-assisted in situ keratomileusis, n=222; 11% PRK, n=29). Mean age was 35±8 years (range 19 to 60); 60% (n=150) self-identified as female, 80% (n=203) as White, and 36% (n=89) as Hispanic. Thirteen (5%) individuals reported ocular pain (NRS ≥3) prior to surgery and 67% (n=168) reported ocular pain 1 day after surgery (nine individuals had pain at both time points). Factors that were associated with pain 1 day after surgery included Hispanic ethnicity (adjusted relative risk (aRR) 1.42, 95% CI 1.21 to 1.68, p<0.001) and the presence of eye pain presurgery (aRR 1.10, 95% CI 1.02 to 1.18, p=0.02). CONCLUSION A majority of individuals report moderate or greater pain within 24 hours of refractive surgery. Hispanic ethnicity and eye pain prior to surgery were associated with self-reported acute postsurgical pain.
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Affiliation(s)
- Jason Betz
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
- Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Elyana Vittoria Tessa Locatelli
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
- Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Brooke M Harkness
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Maricarmen Perez-Blanco
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Steven J Everist
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, Oregon, USA
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard Stutzman
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Winston Chamberlain
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Afshan Nanji
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jodi Lapidus
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Sue A Aicher
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, Oregon, USA
| | - Anat Galor
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
- Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
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3
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Mont MA, Lin JH, Spitzer AI, Dasa V, Rivadeneyra A, Rogenmoser D, Concoff AL, Ng MK, DiGiorgi M, DySart S, Urban J, Mihalko WM. Cryoneurolysis Associated With Improved Pain, Function, and Sleep in Patients Following total Knee Arthroplasty: Use of a New Real-World Registry. J Arthroplasty 2024:S0883-5403(24)00653-3. [PMID: 38942249 DOI: 10.1016/j.arth.2024.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/26/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is performed on approximately 790,000 patients annually in the United States and is projected to increase to 1.5 million by 2050. This study aimed at assessing the use of preoperative cryoneurolysis on patients undergoing TKA by analyzing: (1) pain severity; (2) opioid use; (3) functional status; and (4) sleep disturbance (SD) over 6 months following discharge. METHODS Patients enrolled in the Innovations in Genicular Outcomes Registry between September 2021 and February 2024 were followed for 6 months. Our analyses included patients undergoing unilateral primary TKA with no preoperative opioid prescription, who either received cryoneurolysis, or did not. Baseline patient demographics were collected before TKA and tabulated. Pain management was assessed via the Brief Pain Inventory-Short Form instrument for pain severity. SD was measured using the patient-reported outcomes measurement information system questionnaire. Each outcome measure was assessed prior to TKA, weekly, and at monthly follow-up. Data were analyzed by a generalized linear mixed-effect regression model to compare cryoneurolysis versus control patients, with a P < .05 as significant. RESULTS There were 80 patients who were treated with preoperative cryoneurolysis, while 60 control patients did not have treatment. Patients receiving cryoneurolysis experienced significantly lower pain severity and SD over the 6-month follow-up than control patients (P = .046). Cryoneurolysis was also associated with a trend toward greater functional improvement that did not reach statistical significance (P = .061). Further, patients who underwent cryoneurolysis were 72% less likely than control group patients to take opioids over 6 months following discharge (P < .001). CONCLUSIONS Preoperative cryoneurolysis therapy in opioid-naive patients undergoing TKA is associated with improved pain, decreased opioid use, and improved SD for 6 months postoperatively. Cryoneurolysis, a nonopioid pain relief modality administered preoperatively, demonstrated substantial benefits in patients who underwent TKA.
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Affiliation(s)
| | | | | | - Vinod Dasa
- Louisiana State University Health Services Center, New Orleans, Louisiana
| | | | - David Rogenmoser
- Mid State Orthopaedic & Sports Medicine Center, Alexandria, Louisiana
| | | | | | | | | | | | - William M Mihalko
- University of Tennessee Health Science Center, Campbell Clinic Orthopaedics, Memphis, Tennessee
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4
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Zhang C, Zhang Z, Lin Y, Xin Y, Li H, Lin Y, Huang Y, Yang Y, Bai G, Huang Z, Fang X, Li W, Zhang W. A Novel Infrapatellar Fat Pad Preservation Technique in Total Knee Arthroplasty Reduced Postoperative Pain and Wound Complications. Orthop Surg 2024. [PMID: 38894546 DOI: 10.1111/os.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/18/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains controversial. This study aimed to evaluate a novel IPFP preservation technique-"the medially pedicled IPFP flap"-for reducing postoperative pain, wound complications, and improving functional recovery after TKA. METHODS A retrospective analysis was conducted on TKA cases at our institution from 2018 to 2021, including those with IPFP preservation (medially pedicled flap) versus IPFP complete resection. Patient demographics, perioperative parameters (blood loss, operative time, length of hospital stay, visual analogue scale [VAS] score, white cell count [WBC], C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], and wound oozing), and postoperative follow-up data (VAS, Knee Society [KSS], or Knee Society functional assessment [KSFA] scores) were compared between groups. Independent sample t-tests were used to compare continuous data and chi-squared tests were used to compare categorical data between groups. RESULTS Six hundred thirty patients were included, with 278 in the medial pedicled IPFP flap group (preservation group) and 352 in the IPFP resection group (resection group). The operative time was significantly shorter in the preservation versus resection group (125.5 ± 23.2 vs 130.3 ± 28.7 mins, p = 0.03), as was the length of hospital stay (8.4 ± 2.7 vs 9.2 ± 2.3 days, p < 0.01). Regarding pain, the preservation group had significantly lower VAS scores on postoperative day 2 (2.0 ± 0.8 vs 2.4 ± 1.2, p < 0.001) and day 3 (1.5 ± 0.5 vs 1.8 ± 1.0, p < 0.001). CRP and ESR levels on postoperative day 5 were also significantly lower in the preservation group. Wound oozing rates were significantly lower in the preservation versus resection group (0.7% vs 2.8%, p = 0.04). No significant differences existed in VAS, KSS, or KSFA scores at the last follow-up. CONCLUSION The novel IPFP preservation technique significantly improved surgical exposure, shortened operative time and length of hospital stay. It also reduced wound pain and oozing compared to IPFP resection.
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Affiliation(s)
- Chaofan Zhang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Zeyu Zhang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Yunzhi Lin
- Department of Stomatology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Stomatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yishan Xin
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Hongyan Li
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Yiming Lin
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Ying Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Ye Yang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Guochang Bai
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Zida Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Xinyu Fang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Wenbo Li
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
| | - Wenming Zhang
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, China
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Yhim HB, Yoo S, Park SK, Kim Y, Lim YJ, Kim JT. The Effect of Postoperative Single-Injection Adductor Canal Block in Total Knee Arthroplasty Under Spinal Anesthesia With Intraoperative Dexmedetomidine Infusion. Arthroplast Today 2024; 27:101366. [PMID: 38665389 PMCID: PMC11043871 DOI: 10.1016/j.artd.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
Background Single-injection adductor canal block (SACB) is one of the multimodal pain managements in total knee arthroplasty. The effect of an intrathecal local anesthetic is prolonged with an intraoperative dexmedetomidine infusion. Currently, SACB's effect along with the prolonged spinal anesthesia effect by dexmedetomidine has not been studied elsewhere. Methods Seventy-eight patients were randomized to either the SACB group (n = 39) or the control group (n = 39). Spinal anesthesia and continuous infusion of dexmedetomidine were performed intraoperatively. The SACB was performed using 15 mL of either 0.5% ropivacaine or normal saline in postanesthesia care unit postoperatively. Primary endpoint examined the average numerical rating scale (NRS) pain scores at 2, 6, 12, and 24 hours after SACB while resting or moving. The secondary outcomes were the morphine equivalent, postoperative nausea and vomiting score, quadriceps strength, and overall satisfaction score. Results The SACB group showed a lower average NRS pain score until 24 hours than the control group (2.4 vs 3.3 resting, 3.4 vs 4.1 moving). Resting and moving NRS scores at 6 and 12 hours were significantly lower in the SACB group, whereas no difference was found at 2, 24, and 48 hours, regardless of movement. The satisfaction score was higher in the SACB group than in the control group (9 [7.3-10.0] vs 7 [5.3-8.8]), and morphine equivalent at 2 hours was lower in the SACB group (2 [1-3]) than in the control group (2.9 [1.6-4]). Conclusions SACB provided an additional analgesic effect in patients undergoing total knee arthroplasty under spinal anesthesia with continuous dexmedetomidine intravenous infusion.
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Affiliation(s)
- Hyung-Been Yhim
- Department of Anesthesiology and Pain, Seoul Now Hospital, Pyeongchon, Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University Medical Center, Seoul, Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Tan M, Chen B, Li Q, Wang S, Chen D, Zhao M, Cao J. Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty: A Randomized Clinical Trial. Clin J Pain 2024; 40:373-382. [PMID: 38506437 PMCID: PMC11081475 DOI: 10.1097/ajp.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these. METHODS Patients undergoing TKA were randomly assigned to 1 of 3 groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary end point was the Numeric Rating Scale (NRS) score at movement at 24 hours postsurgery. Secondary end points included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion, effective PCNA utilization, and opioid consumption at various postsurgery time points. RESULTS Of the 94 valid data sets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary end point (H=7.003, P =0.03). Post hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2 to 4]) compared with the ACB group (4 [3 to 5], Bonferroni-adjusted P =0.03). Regarding secondary end points, both the FNB and FTB groups had significantly lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other end points. DISCUSSION Continuous FTB provides postoperative analgesia comparable to FNB but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.
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Affiliation(s)
- Minghe Tan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Bozhou Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Qingshu Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Siqi Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Daiyu Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Maoji Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University
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7
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Liu QR, Dai YC, Ji MH, Liu PM, Dong YY, Yang JJ. Risk Factors for Acute Postsurgical Pain: A Narrative Review. J Pain Res 2024; 17:1793-1804. [PMID: 38799277 PMCID: PMC11122256 DOI: 10.2147/jpr.s462112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Acute postsurgical pain (APSP) has received growing attention as a surgical outcome. When poorly controlled, APSP can affect short- and long-term outcomes in patients. Despite the steady increase in awareness about postoperative pain and standardization of pain prevention and treatment strategies, moderate-to-severe APSP is frequently reported in clinical practice. This is possibly because pain varies widely among individuals and is influenced by distinct factors, such as demographic, perioperative, psychological, and genetic factors. This review investigates the risk factors for APSP, including gender, age, obesity, smoking history, preoperative pain history, pain sensitivity, preoperative anxiety, depression, pain catastrophizing, expected postoperative pain, surgical fear, and genetic polymorphisms. By identifying patients having an increased risk of moderate-to-severe APSP at an early stage, clinicians can more effectively manage individualized analgesic treatment protocols with a combination of pharmacological and non-pharmacological interventions. This would alleviate the transition from APSP to chronic pain and reduce the severity of APSP-induced chronic physical disability and social psychological distress.
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Affiliation(s)
- Qing-Ren Liu
- Department of Anesthesiology, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Yu-Chen Dai
- Department of Anesthesiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Mu-Huo Ji
- Department of Anesthesiology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, People’s Republic of China
| | - Pan-Miao Liu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China
| | - Yong-Yan Dong
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China
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8
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Zhao D, Li P. Efficacy of adding infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) to adductor canal block and local infiltration analgesia in total knee arthroplasty: A retrospective cohort study. J Orthop Surg (Hong Kong) 2024; 32:10225536241265445. [PMID: 38896879 DOI: 10.1177/10225536241265445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE Local infiltration analgesia (LIA), adductor canal block (ACB), and infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) are popular multimodal analgesia techniques used during total knee arthroplasty (TKA). This study aimed to explore the efficacy of adding the IPACK technique to ACB and LIA in patients undergoing TKA. METHODS In this retrospective cohort study, patients who underwent primary unilateral TKA were divided into two groups based on their date of admission. Sixty-three patients underwent IPACK, ACB and LIA (IPACK group) during surgery, while 60 patients underwent ACB and LIA (control group). The primary outcome was the postoperative administration of morphine hydrochloride as a rescue analgesic. Secondary outcomes included time to first rescue analgesia, postoperative pain assessed using the visual analog scale (VAS), functional recovery assessed by knee range of motion and ambulation distance, time until hospital discharge, and complication rates. RESULTS The two groups were similar in average postoperative 0-to-24-h morphine consumption (11.8 mg for the control group vs 12.7 mg for the IPACK group, p = .428) and average total morphine consumption (18.2 mg vs 18.0 mg, p = .983) during hospitalization. There were also no significant differences in the secondary outcomes. CONCLUSIONS The addition of IPACK to ACB and LIA did not provide any clinical analgesic benefits. Orthopedic surgeons and anesthesiologists are justified in using ACB and LIA without IPACK for TKA.
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Affiliation(s)
- Dongmei Zhao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengcheng Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute West China Hospital, Sichuan University, Chengdu 610041, China
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9
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Melis EJ, Vriezekolk JE, van der Laan JCC, Smolders JMH, van den Bemt BJF, Fenten MGE. Long-term postoperative opioid use in orthopaedic patients. Eur J Pain 2024; 28:797-805. [PMID: 38108651 DOI: 10.1002/ejp.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/26/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The prevalence of long-term opioid use after orthopaedic surgery varies from 1.4% to 24% and has mostly been studied with prescription data, making it difficult to estimate the size and impact of the problem. This study aims to assess the prevalence and predictors of long-term postoperative opioid use in a high volume and tertiary orthopaedic centre by using online patient reported measures. METHODS This Dutch prospective cohort study was conducted among adult patients who underwent any type of orthopaedic surgery from June to August 2021. Six months after surgery patients were invited to complete an online survey on current opioid use and patients' willingness to taper opioids. The demographics, clinical factors and preoperative opioid use were extracted from the patient file. RESULTS In total, 607 patients (mean age 61.2 years, 63.4% female) completed the survey. Seventy-six patients (12.5%) used opioids 6 months after surgery of which 20 (3.3%) did not use opioids before surgery. The median (Q1-Q3) postoperative daily dose after 6 months was 29.9 mg (10.0-76.1) morphine equivalents. Most of them (88.2%) wanted to taper opioids. Affected body region (OR's: 6.84-12.75) and pre-operative opioid use (OR = 35.33) were significant predictors of long-term opioid use. CONCLUSION The prevalence of long-term postoperative opioid use was 12.5%; one in thirty patients became a new long-term opioid user. Pre-operative opioid use and affected body region were predictive for long-term opioid use. These findings, together with the observation that long-term opioid users want to taper opioids, emphasize the relevance of prevention, recognition and tapering support in the perioperative setting. LEVEL OF EVIDENCE Level II. SIGNIFICANCE Short-term opioid use can unintentionally progress to long-term opioid use. The prevalence of long-term opioid use after orthopaedic surgery varies widely and is mostly prescription-based, making it difficult to estimate the magnitude of the problem. This study assessed long-term postoperative opioid use in a full breadth orthopaedic population using patient reported measures, making conclusions much more robust. The prevalence of long-term postoperative opioid use in this study was 12.5%.
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Affiliation(s)
- Eward J Melis
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Johanna E Vriezekolk
- Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - José M H Smolders
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maaike G E Fenten
- Department of Anaesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Anaesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Bolander RP, Pierce AG, Mangal RK, Hernandez VH, Stulberg SD. Characterization of the Relative Change in Objective and Subjective Metrics by Baselining Patients Who Have Wearable Technology Before Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00303-6. [PMID: 38604282 DOI: 10.1016/j.arth.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Wearable sensors and associated supporting technologies (ie, patient applications) can provide both objective (joint position, step counts, etc.) and subjective data (ie, pain scores and patient-reported outcome measures) to track a patient's episode of care. Establishing a subjective and objective baseline of a patient's experience may arguably be beneficial for multiple reasons, including setting recovery expectations for the patient and demonstrating the effectiveness or success of the intervention. METHODS In this pilot study, we characterized a subset of patients (n = 82 from 7 surgeons) using a wearable sensor system at least 6 days before total knee arthroplasty and provided postsurgical data up to 50 days postintervention. The 5-day average before surgery for total step counts (activity), achieved flexion and extension on a progress test (functional limit) and visual analog scale daily pain score were calculated. The difference from baseline was then calculated for each patient for each day postsurgery and reported as averages. RESULTS On average, a patient will experience a relative deficit of 4,000 steps immediately following surgery that will return to near-baseline levels 50 days postintervention. A 30° deficit in flexion and a 10° deficit in extension will return at a similar rate as steps. Relative pain scores will worsen with an increase of approximately 3 points immediately following surgery. However, pain will decrease by 2 points relative to baseline between 40 and 50 days. CONCLUSIONS The results of this pilot study demonstrate a method to baseline a patient's presurgical subjective and objective data and to provide a reference for postsurgical recovery expectations. Applications for these data include benchmarking for evaluating intervention success as well as setting patient expectations.
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Affiliation(s)
| | - Andrew G Pierce
- FIU Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Rohan K Mangal
- Division of Arthroplasty & Adult Joint Reconstruction, University of Miami, Miami, Florida
| | - Victor H Hernandez
- Division of Arthroplasty & Adult Joint Reconstruction, University of Miami, Miami, Florida
| | - Samuel D Stulberg
- Department of Joint Replacement and Implant Surgery, Northwestern Memorial Hospital, Chicago, Illinois
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11
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Dawson M, Hage W, Nita C, Bell L, Gorman J, Jonker L. Evaluation of reduced ('Lite') compression versus brief bandaging to manage post-operative pain after total knee arthroplasty surgery; a single-centre randomised controlled trial. Int J Orthop Trauma Nurs 2024; 54:101100. [PMID: 38626558 DOI: 10.1016/j.ijotn.2024.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Investigate efficacy of reduced compression bandage for the control of pain after total knee arthroplasty. PATIENTS & METHODS Prospective, single-centre, randomised controlled trial involving data for 56 out of 94 consented patients; 29 standard care versus 27 Andoflex TLC Calamine Lite. Comparison of standard care (non-compression bandage applied for up to one day) versus Andoflex TLC Calamine Lite (25-30 mmHg) two-layer compression bandage worn for five days. Outcomes measured with validated pain (McGill, 10-cm visual scale) and functionality (KOOS) tools. RESULTS At day 5 post-surgery, the median pain level was 3.0 cm vs 4.0 cm (p-value 0.47, Mann-Whitney U test) respectively. Generic pain levels, pain types, and knee functionality did not differ between the interventions at days 3/5/12 and week 6 post-surgery. An exception was the degree of 'tender' pain at day 12, which was significantly lower in the Andoflex TLC Calamine Lite arm (p-value 0.041, Mann-Whitney U test). Binary logistic regression analysis showed that application of Andoflex TLC Calamine Lite, administration of oxycodone, and male sex were all significantly associated with less 'tender' pain. CONCLUSION Reduced compression bandaging does not affect overall pain levels post knee arthroplasty surgery, but may alleviate pain experienced as 'tender', highlighting the different types of pain that may be experienced. Patients' need for, and the use of, opioid medication (oxycodone) is a significant confounding variable when assessing adjuvant therapy to control pain. The applicability of reduced compression bandaging may therefore be limited and is less efficient than medical pain control.
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Affiliation(s)
- Matt Dawson
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK.
| | - William Hage
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK.
| | - Cristian Nita
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK.
| | - Lucy Bell
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK.
| | - Janice Gorman
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK.
| | - Leon Jonker
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK; University of Cumbria, Carlisle, CA1 2HH, UK.
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12
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Chaiperm C, Tanavalee C, Kampitak W, Amarase C, Ngarmukos S, Tanavalee A. Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial. J Knee Surg 2024; 37:282-290. [PMID: 36972681 DOI: 10.1055/a-2062-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
A continuous adductor canal block (cACB) for pain control in total knee arthroplasty (TKA) is always performed by an anesthesiologist. A surgeon-performed cACB during surgery is somewhat questionable in terms of feasibility, reproducibility, and efficacy. This study was divided into two phases. In Phase 1 study, an experimental dissection of 16 cadaveric knees to expose the saphenous nerve and related muscles around the adductor canal was conducted. The extent of dye after injection via a catheter inserted into the adductor canal at the time of TKA was evaluated. In Phase II, a randomized controlled trial study comparing clinical outcomes between surgeon-performed (Group 1) and anesthesiologist-performed cACB (Group 2) during TKA in 63 patients was evaluated. The visual analogue scale (VAS) at rest and during movement at several time points and functional outcomes during hospitalization were compared. The Phase I study demonstrated surgeon-performed cACB during surgery feasible and reproducible with consistent dye extension into the adductor canal after injection via a catheter. In the Phase II study, 29 patients of Group 1 and 30 patients of Group 2 completed the evaluation with no differences in baseline parameters. The VAS during movement at 24 and 36 hours, quadriceps strength, time up and go test, and knee motion at different time points, and total morphine consumption showed no differences between both groups. There were no procedure-related complications. The surgeon-performed cACB during surgery was feasible and reproducible with similar VAS scores and functional outcomes during hospitalization to anesthesiologist cACB. Level of evidence is Level I, prospective randomized trial.
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Affiliation(s)
- Chayut Chaiperm
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Orthopaedics, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Chotetawan Tanavalee
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wirinaree Kampitak
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chavarin Amarase
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Srihatach Ngarmukos
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aree Tanavalee
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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13
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Sreckovic S, Ladjevic N, Milicic B, Tulic G, Milovanovic D, Djukanovic M, Kadija M. Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks. Front Med (Lausanne) 2024; 10:1335405. [PMID: 38274441 PMCID: PMC10810136 DOI: 10.3389/fmed.2023.1335405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Peripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP). Methods This prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA. Results 166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg). Conclusion Peripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.
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Affiliation(s)
- Svetlana Sreckovic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nebojsa Ladjevic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Tulic
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Darko Milovanovic
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Marija Djukanovic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Marko Kadija
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
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14
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Li Y, An M, Ding Y, Wang C, Qiu Y. Oxycodone-acetaminophen versus celecoxib for postoperative pain in knee osteoarthritis patients after total knee arthroplasty: a randomized, controlled study. Arch Orthop Trauma Surg 2023; 143:6753-6762. [PMID: 37344688 DOI: 10.1007/s00402-023-04943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Oxycodone-acetaminophen is a synergic combination of semisynthetic opioid agonis and analgesic/antipyretic agent, which improves analgesic efficacy. This randomized, controlled study intended to evaluate the analgesic efficacy and tolerance of oxycodone-acetaminophen compared to celecoxib alone in post-total knee arthroplasty (TKA) knee osteoarthritis patients. METHODS One hundred and six knee osteoarthritis patients were randomized into oxycodone-acetaminophen group (N = 54) and celecoxib group (N = 52) at a 1:1 ratio. Each patient orally received oxycodone-acetaminophen (5 mg/325 mg, four times per day) or celecoxib (200 mg, twice per day) from 2 h to day (D) 3 after TKA; meanwhile, each patient received 2-day patient-controlled analgesia (PCA). The primary outcome was pain visual analog scale (VAS) score at rest; other assessments were the secondary outcomes. RESULTS Pain VAS scores at rest at D1, D2, D3, and pain VAS scores at flexion at D0.5, D1, D2, D3 were lower in oxycodone-acetaminophen group compared to celecoxib group (all P < 0.050). Besides, extra (P < 0.001) and total (P < 0.001) PCA consumption were declined in oxycodone-acetaminophen group compared with celecoxib group. Furthermore, patients' satisfaction score at D3 (P = 0.012) and D7 (P = 0.043) was higher in oxycodone-acetaminophen group versus celecoxib group. Hospital for special surgery knee score (HSS) at preoperation, M1, and M3 did not differ between the two groups (all P > 0.050). The incidences of all adverse events were not varied between oxycodone-acetaminophen and celecoxib groups (all P > 0.050). CONCLUSION Oxycodone-acetaminophen exerts superior analgesic efficacy, patients' satisfaction, and similar tolerance compared to celecoxib in post-TKA knee osteoarthritis patients.
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Affiliation(s)
- Yating Li
- Department of Anesthesia, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 59 Kerqin South Road, Hohhot, 010020, China
| | - Min An
- Department of Anesthesia, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 59 Kerqin South Road, Hohhot, 010020, China
| | - Yumei Ding
- Department of Anesthesia, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 59 Kerqin South Road, Hohhot, 010020, China
| | - Caixia Wang
- Department of Anesthesia, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 59 Kerqin South Road, Hohhot, 010020, China
| | - Yi Qiu
- Department of Anesthesia, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 59 Kerqin South Road, Hohhot, 010020, China.
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15
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Musbahi O, Collins JE, Yang H, Selzer F, Chen AF, Lange J, Losina E, Katz JN. Assessment of Residual Pain and Dissatisfaction in Total Knee Arthroplasty: Methods Matter. JB JS Open Access 2023; 8:e23.00077. [PMID: 38058510 PMCID: PMC10697603 DOI: 10.2106/jbjs.oa.23.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background Residual pain after total knee arthroplasty (TKA) refers to knee pain after 3 to 6 months postoperatively. The estimates of the proportion of patients who experience residual pain after TKA vary widely. We hypothesized that the variation may stem from the range of methods used to assess residual pain. We analyzed data from 2 prospective studies to assess the proportion of subjects with residual pain as defined by several commonly used metrics and to examine the association of residual pain defined by each metric with participant dissatisfaction. Methods We combined participant data from 2 prospective studies of TKA outcomes from subjects recruited between 2011 and 2014. Residual pain was defined using a range of metrics based on the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain score (0 to 100, in which 100 indicates worst), including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). We also examined combinations of MCID and PASS cutoffs. Subjects self-reported dissatisfaction following TKA, and we defined dissatisfied as somewhat or very dissatisfied at 12 months. We calculated the proportion of participants with residual pain, as defined by each metric, who reported dissatisfaction. We examined the association of each metric with dissatisfaction by calculating the sensitivity, specificity, positive predictive value, and Youden index. Results We analyzed data from 417 subjects with a mean age (and standard deviation) of 66.3 ± 8.3 years. Twenty-six participants (6.2%) were dissatisfied. The proportion of participants defined as having residual pain according to the various metrics ranged from 5.5% to >50%. The composite metric Improvement in WOMAC pain score ≥20 points or final WOMAC pain score ≤25 had the highest positive predictive value for identifying dissatisfied subjects (0.54 [95% confidence interval, 0.35 to 0.71]). No metric had a Youden index of ≥50%. Conclusions Different metrics provided a wide range of estimates of residual pain following TKA. No estimate was both sensitive and specific for dissatisfaction in patients who underwent TKA, underscoring that measures of residual pain should be defined explicitly in reports of TKA outcomes. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Omar Musbahi
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Imperial College London, London, United Kingdom
| | - Jamie E. Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Heidi Yang
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonia F. Chen
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Lange
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts
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16
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Wang Q, Ma T, Wang L, Zhao C, Kang P. Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double-blinded Randomized Study. Orthop Surg 2023; 15:2283-2290. [PMID: 37403525 PMCID: PMC10475677 DOI: 10.1111/os.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA. METHODS This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann-Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test. RESULTS The control and acetaminophen groups were comparable in postoperative 0-24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications. CONCLUSIONS In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Ting Ma
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Liying Wang
- Operating RoomWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Chengcheng Zhao
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Pengde Kang
- Department of Orthopedic SurgeryWest China Hospital, Sichuan UniversityChengduChina
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17
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Reinhard J, Pulido LC, Schindler M, Schraag A, Greimel F, Grifka J, Benditz A. No Success without Effort: Follow-Up at Six Years after Implementing a Benchmarking and Feedback Concept for Postoperative Pain after Total Hip Arthroplasty. J Clin Med 2023; 12:4577. [PMID: 37510694 PMCID: PMC10380292 DOI: 10.3390/jcm12144577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is still ranked among the operations with the highest postoperative pain scores. Uncontrolled postsurgical pain leads to prolongated hospital stays, causes more frequent adverse reactions and can induce chronical pain syndromes. In 2014, we implemented a standardized, multidisciplinary pain management concept with continuous benchmarking at our tertiary referral center by using the "Quality Improvement in Postoperative Pain Management" (QUIPS) program with excellent results over a period of two years. The initial study ended in 2016 and we aimed to evaluate if it was possible to obtain the excellent short-term results over a period of six years without any extra effort within the daily clinical routine. MATERIALS AND METHODS In a retrospective study design, we compared postoperative pain, side effects and functional outcome after primary THA for 2015 and 2021, using validated questionnaires from the QUIPS project. In contrast to the implementation of the pain management concept in 2014, the weekly meetings of the multidisciplinary health care team and special education for nurses were stopped in 2021. Data assessment was performed by an independent pain nurse who was not involved in pain management. RESULTS Altogether, 491 patients received primary THA in 2015 and 2021 at our tertiary referral center. Collected data revealed significantly worse maximum and activity-related pain (both p < 0.001) in combination with significantly higher opioid consumption in comparison to implementation in 2015. Though the patients reported to be less involved in pain management (p < 0.001), the worse pain scores were not reflected by patient satisfaction which remained high. While the participation rate in this benchmarking program dropped, we still fell behind in terms of maximum and activity-related pain in comparison to 24 clinics. CONCLUSION Significantly worse pain scores in combination with higher opioid usage and a lower hospital participation rate resemble a reduced awareness in postoperative pain management. The significantly lower patient participation in pain management is in line with the worse pain scores and indirectly highlights the need for special education in pain management. The fact patient satisfaction appeared to remain high and did not differ significantly from 2015, as well as the fact we still achieved an acceptable ranking in comparison to other clinics, highlight the value of the implemented multidisciplinary pain management concept.
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Affiliation(s)
- Jan Reinhard
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Loreto C Pulido
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Melanie Schindler
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Amadeus Schraag
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
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18
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Nishimoto J, Shiraoka T, Takiguchi Y, Imamura R, Hirohama K, Tanaka S, Inoue Y, Obayashi S, Tanaka R. Derivation of a clinical prediction rule for chronic post-surgical pain after total knee arthroplasty considering biopsychosocial factors: A prospective cohort study. Knee 2023; 42:364-372. [PMID: 37150024 DOI: 10.1016/j.knee.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Biopsychosocial factors are involved in the occurrence of chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). The purpose of this study was to develop a clinical prediction rule (CPR) that considers biopsychosocial factors to predict which patients are more likely to develop CPSP after TKA. METHODS CPSP after TKA was dichotomized into CPSP and non-CPSP groups using the Likert scale and Minimal clinically important difference, and binomial logistic regression analysis was performed. Cut-off values were then calculated using the extracted factors and dichotomized variables. The cut-off values and dichotomized variables were then used to derive a CPR that discriminates between groups with and without CPSP. RESULTS Seventy-one TKA patients were included in the study. Binomial logistic regression analysis revealed that Central Sensitization Inventory (CSI) and Pittsburgh Sleep Quality Index (PSQI) were associated with CPSP. The cut-off values for CSI and PSQI were 26 and 7, respectively. The CPSP scale was created using the cut-off values of CSI and PSQI, with a score of 0 for being below the cut-off values of both CSI and PSQI, 1 for being above the cut-off values of either CSI or PSQI, and 2 for being above the cut-off values of both CSI and PSQI. Furthermore, the area under the curve (AUC) for CPR created by the presence of CPSP and using the CPSP scale was significant (AUC = 0.766; P = 0.001). CONCLUSION The combination of the two tests, CSI and PSQI, suggested the possibility of predicting CPSP after TKA.
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Affiliation(s)
- Junji Nishimoto
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - Taketo Shiraoka
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, Saitama, Japan
| | | | - Ryota Imamura
- Department of Rehabilitation, Hiroshima Clinic, Hiroshima, Japan
| | - Kenta Hirohama
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Shigeharu Tanaka
- Faculty of Health and Social Services, Kanagawa University of Human Services, Kanagawa, Japan
| | - Yu Inoue
- Research Institute of Health and Welfare, Kibi International University, Okayama, Japan; Department of Rehabilitation, Kurashiki Heisei Hospital, Okayama, Japan
| | - Shigeru Obayashi
- Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
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19
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Wang Q, Zhao C, Hu J, Ma T, Yang J, Kang P. Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:354-362. [PMID: 36856693 DOI: 10.2106/jbjs.22.00614] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Periarticular local infiltration analgesia (LIA) is largely utilized for controlling pain after total knee arthroplasty (TKA). The present work aimed to assess the efficacy of a modified LIA cocktail for patients undergoing TKA. METHODS Magnesium sulfate (MgSO4) and sodium bicarbonate (NaHCO3) were added to a conventional LIA cocktail comprising ropivacaine, epinephrine, and dexamethasone. After the safety of this modified cocktail was tested in rats, its efficacy and safety were evaluated in a prospective, double-blinded study including 100 individuals randomized to receive periarticular infiltration of the modified cocktail or a conventional cocktail. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes were the time until the first rescue analgesia, postsurgical pain (on a visual analog scale [VAS]), functional recovery (assessed by range of knee motion and ambulation distance), time to discharge, and complication rates. RESULTS Adding NaHCO3 to the local anesthetics caused some instantaneous precipitation in all cases. Administering the modified cocktail to rats did not obviously damage the injected area of the nerve or surrounding tissues. Administration of the modified cocktail to patients was associated with markedly reduced postsurgical morphine use in the initial 24 hours (4.2 ± 5.0 versus 14.6 ± 8.9 mg, p < 0.001), reduced total morphine use (9.8 ± 8.4 versus 19.6 ± 11.4 mg, p < 0.001), prolonged time to the first rescue analgesia, lower VAS pain scores at rest and during motion at 12 and 24 hours following the operation, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. The modified and conventional cocktail groups had similar rates of complications. CONCLUSIONS The present modification of a conventional cocktail significantly prolonged analgesia and reduced opioid consumption, which may substantially improve pain control in arthroplasty. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chengcheng Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian Hu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ting Ma
- Anesthesia and Surgery Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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20
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Wang Q, Zhang W, Xiao T, Wang L, Ma T, Kang P. Efficacy of Opioids in Preemptive Multimodal Analgesia for Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial. J Arthroplasty 2023; 38:65-71. [PMID: 35940353 DOI: 10.1016/j.arth.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preemptive multimodal analgesia is a commonly used technique to control pain following total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of pre-emptive opioids for pain management in patients who underwent TKA. METHODS In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to the oxycodone or control group. At 2 hours before surgery, patients in the oxycodone group received 400 mg celecoxib, 150 mg pregabalin, and 10 mg extended-release oxycodone hydrochloride. Patients in the control group received 400 mg celecoxib, 150 mg pregabalin, and placebo. The primary outcome was postoperative consumption of morphine hydrochloride as rescue analgesia. Secondary outcomes were time to first rescue analgesia, postoperative pain assessed by the visual analogue scale, functional recovery assessed by range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates. RESULTS The 2 groups were similar in mean postoperative 0 to 24 hour morphine consumption (11.4 mg for control versus 12.4 mg for oxycodone group, P = .419) and mean total morphine consumption (18.2 versus 19.8 mg, P = .227). There were no statistical differences in secondary outcomes. CONCLUSIONS In our study, preemptive opioid administration did not provide clinical benefits over placebo. Orthopaedic surgeons should consider not using pre-operative opioids in patients undergoing TKA.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wanli Zhang
- Public Laboratory Technology Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Xiao
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liying Wang
- Anesthesia and Surgery Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Ma
- Anesthesia and Surgery Center, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, China
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21
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Schindler M, Schmitz S, Reinhard J, Jansen P, Grifka J, Benditz A. Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study. J Clin Med 2022; 11:jcm11237204. [PMID: 36498779 PMCID: PMC9741301 DOI: 10.3390/jcm11237204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. METHODS A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. RESULTS The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. CONCLUSIONS The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.
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Affiliation(s)
- Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
- Correspondence:
| | - Stephanie Schmitz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Petra Jansen
- Department of Sport Science, University of Regensburg, 93053 Regensburg, Bavaria, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
- Department of Orthopedics, Klinikum Fichtelgebirge, 95615 Marktredwitz, Bavaria, Germany
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22
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Hussen I, Worku M, Geleta D, Mahamed AA, Abebe M, Molla W, Wudneh A, Temesgen T, Figa Z, Tadesse M. Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study. Ann Med Surg (Lond) 2022; 81:104321. [PMID: 36147153 PMCID: PMC9486444 DOI: 10.1016/j.amsu.2022.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background The most frequent obstetric surgery both in Ethiopia and around the world is the cesarean section (CS). Postoperative pain that is not well managed can have a major negative impact on surgical patient morbidity, delaying healing and the return to normal daily activities. Even though the cesarean section is one of the most commonly performed operations, postoperative pain after cesarean section and associated factors has not been studied. Objective To assess the magnitude and factors associated with postoperative pain after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Methods From February 1 to September 30 in 2021, a hospital-based cross-sectional study was undertaken among women who underwent cesarean deliveries at Hawassa University Comprehensive Specialized Hospital. The patient's medical file was read, and information was gathered from them using a structured questionnaire and checklist. The information was prepared for analysis by being cleaned, coded, and put into EPI Data version 3.1 before being exported to SPSS version 20. The prevalence rate and socio-demographic details were displayed using descriptive statistics. Bivariate and multivariable logistic regression analysis was done to identify the associated factors. Variables with a p-value of <0.05 were considered statistically significant. Results The magnitude of moderate to severe post-operative pain after a cesarean section was 89.8% (95% CI 84.7, 93.5). Duration of procedure (AOR: 3.62, 95% CI: 1.33, 15.85), type of anesthesia (AOR: 2.38, 95% CI: 1.31, 8.71), and type of analgesics administered (AOR: 2.3, 95% CI: 1.28, 19.21) were significantly associated with moderate to severe post-operative pain. Conclusion In this study a significant number of parturient in this study reported moderate to severe post-cesarean pain within 24 h. The duration of the procedure, the type of anesthesia used, and the type of analgesics administered were all found to be significantly associated with postoperative pain after cesarean section. The magnitude of post-operative pain after a caesarean section was 89.8%. About 84.2% reported moderate to severe pain at 24 h after surgery. Duration of procedure was significantly associated to postoperative pain. Anesthesia type used was found to be significantly associated to postoperative pain.
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Affiliation(s)
- Ibrahim Hussen
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Misganaw Worku
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dereje Geleta
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abbas Ahmed Mahamed
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Corresponding author.
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Aregahegn Wudneh
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tasfaye Temesgen
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Zerihun Figa
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Muhiddin Tadesse
- Department of Anesthesiology, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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23
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Hamilton TW, Knight R, Stokes JR, Rombach I, Cooper C, Davies L, Dutton SJ, Barker KL, Cook J, Lamb SE, Murray DW, Poulton L, Wang A, Strickland LH, Van Duren BH, Leal J, Beard D, Pandit HG. Efficacy of Liposomal Bupivacaine and Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Periarticular Anesthetic for Patients Undergoing Knee Replacement: A Randomized Clinical Trial. JAMA Surg 2022; 157:481-489. [PMID: 35385072 PMCID: PMC8988023 DOI: 10.1001/jamasurg.2022.0713] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Question Among patients undergoing knee replacement surgery, does liposomal bupivacaine and bupivacaine hydrochloride administered at the surgical site improve postoperative recovery at 72 hours and postoperative pain from 6 to 72 hours compared with bupivacaine hydrochloride alone? Findings In this randomized clinical trial of 533 patients undergoing knee replacement surgery, no difference in the coprimary outcomes of Quality of Recovery 40 score at 72 hours or pain visual analog scale score area under the curve from 6 to 72 hours was detected between patients receiving liposomal bupivacaine and bupivacaine hydrochloride and those receiving bupivacaine hydrochloride alone. In addition, liposomal bupivacaine was not found to be cost-effective. Meaning This study found that liposomal bupivacaine did not improve postoperative recovery or pain compared with bupivacaine hydrochloride alone among patients undergoing knee replacement surgery. Importance More than half of patients who undergo knee replacement surgery report substantial acute postoperative pain. Objective To evaluate the efficacy and cost-effectiveness of periarticular liposomal bupivacaine for recovery and pain management after knee replacement. Design, Setting, and Participants This multicenter, patient-blinded, pragmatic, randomized clinical superiority trial involved 533 participants at 11 institutions within the National Health Service in England. Adults undergoing primary unilateral knee replacement for symptomatic end-stage osteoarthritis were enrolled between March 29, 2018, and February 29, 2020, and followed up for 1 year after surgery. Follow-up was completed March 1, 2021. A per-protocol analysis for each coprimary outcome was performed in addition to the main intention-to-treat analysis. Interventions Two hundred sixty-six milligrams of liposomal bupivacaine admixed with 100 mg of bupivacaine hydrochloride compared with 100 mg of bupivacaine hydrochloride alone (control) administered by periarticular injection at the time of surgery. Main Outcome and Measures The coprimary outcomes were Quality of Recovery 40 (QoR-40) score at 72 hours and pain visual analog scale (VAS) score area under the curve (AUC) from 6 to 72 hours. Secondary outcomes included QoR-40 and mean pain VAS at days 0 (evening of surgery), 1, 2, and 3; cumulative opioid consumption for 72 hours; functional outcomes and quality of life at 6 weeks, 6 months, and 1 year; and cost-effectiveness for 1 year. Adverse events and serious adverse events up to 12 months after randomization were also assessed. Results Among the 533 participants included in the analysis, the mean (SD) age was 69.0 (9.7) years; 287 patients were women (53.8%) and 246 were men (46.2%). Baseline characteristics were balanced between study groups. There was no difference between the liposomal bupivacaine and control groups in QoR-40 score at 72 hours (adjusted mean difference, 0.54 [97.5% CI, −2.05 to 3.13]; P = .64) or the pain VAS score AUC at 6 to 72 hours (−21.5 [97.5% CI, −46.8 to 3.8]; P = .06). Analyses of pain VAS and QoR-40 scores demonstrated only 1 statistically significant difference, with the liposomal bupivacaine arm having lower pain scores the evening of surgery (adjusted difference −0.54 [97.5% CI, −1.07 to −0.02]; P = .02). No difference in cumulative opioid consumption and functional outcomes was detected. Liposomal bupivacaine was not cost-effective compared with the control treatment. No difference in adverse or serious adverse events was found between the liposomal bupivacaine and control groups. Conclusions and Relevance This study found no difference in postoperative recovery or pain associated with the use of periarticular liposomal bupivacaine compared with bupivacaine hydrochloride alone in patients who underwent knee replacement surgery. Trial Registration isrctn.com Identifier: ISRCTN54191675
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Affiliation(s)
- Thomas W Hamilton
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie R Stokes
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cushla Cooper
- Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Loretta Davies
- Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Karen L Barker
- National Institute for Health Research-Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS (National Health Service) Foundation Trust, Oxford, United Kingdom
| | - Jonathan Cook
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah E Lamb
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David W Murray
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Lisa Poulton
- Surgical Interventional Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Ariel Wang
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Louise H Strickland
- Oxford Orthopaedic Engineering Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernard H Van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David Beard
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom
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24
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Keeney JA. CORR Insights: Are There Distinct Statistical Groupings of Mental Health Factors and Pathophysiology Severity Among People with Hip and Knee Osteoarthritis Presenting for Specialty Care? Clin Orthop Relat Res 2022; 480:310-312. [PMID: 34939953 PMCID: PMC8747594 DOI: 10.1097/corr.0000000000002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- James A Keeney
- Associate Professor, University of Missouri, Columbia, MO, USA
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25
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Hardy A, Gervais-Hupé J, Desmeules F, Hudon A, Perreault K, Vendittoli PA. Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both. BMC Musculoskelet Disord 2021; 22:978. [PMID: 34814889 PMCID: PMC8611950 DOI: 10.1186/s12891-021-04847-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. METHODS We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36-0.66], p-value < 0.01). CONCLUSION Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.
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Affiliation(s)
- Alexandre Hardy
- Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
| | - Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada.
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada.
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.
- Duval Orthopaedic Clinic, Laval, Quebec, Canada.
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