Using four different clinical tools as predictors for pain after total hip arthroplasty: a prospective cohort study

Supplemental low-dose esketamine to propofol versus propofol alone on perioperative characteristics in children undergoing surgery: a prospective randomized controlled trial

BACKGROUND

Limited data exist regarding the use of the esketamine-propofol combination (esketofol) in pediatric surgery. This study aimed to investigate the effect of esketofol versus propofol alone on the perioperative characteristics of children undergoing minor surgery.

METHODS

Eighty-four children aged two to six years were randomly assigned to either the propofol group or the esketofol group. Intraoperative outcomes included bispectral index, dosage of anesthetics, and extubation time. Postoperative outcomes comprised oropharyngeal airway usage, time to orientation, time to eye-opening, length of stay in the post-anesthesia care unit, the need for rescue opioids, pain rating using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Pediatric Anesthesia Emergence Delirium Score, nausea and vomiting, and psychotomimetic symptoms. The FLACC pain score was the primary outcome, and the remaining parameters were considered secondary outcomes.

RESULTS

The FLACC Score (2 [1, 3.3] vs. 4 [3, 5.3], P<0.001) and frequency of rescue opioids (14.3% vs. 33.3%, P=0.040) were significantly lower, while Bispectral Index (BIS) was higher (P<0.001) in the esketofol group compared with the propofol group. Moreover, the time to orientation and length of stay in the post-anesthesia care unit (PACU) were significantly longer in the esketofol group compared with the propofol group (P=0.029 and P=0.025, respectively). The other outcomes were similar between the two groups.

CONCLUSIONS

Esketofol reduces postoperative pain and the need for rescue opioids, but it extends recovery time in the PACU and increases BIS without affecting other outcomes.

Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy

PURPOSE

To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees.

METHODS

Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction.

RESULTS

There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p < 0.001). Mean final KOOS pain scores were 76.1 ± 15.2 for the betamethasone group, 70.8 ± 12.6 for the celecoxib group and 78.7 ± 11.6 for the control group. No differences in scores were observed among groups (n.s.). In the control group, a negative correlation was observed between PSQ score and KOOS-pain scores at the end of the follow-up in addition to a positive correlation between PSQ score and rescue analgesia consumption at the first postoperative week. The optimal cutoff value for PSQ score to predict insufficient improvement in KOOS-pain subscale was 5.0 points.

CONCLUSIONS

A cutoff value of pain sensitivity questionnaire score above 5.0 points was determined to identify patients with higher sensitivity to pain who underwent arthroscopic partial meniscectomy. These patients reported relatively increased pain and consumed more rescue analgesics postoperatively unless treated with a single intraoperative corticosteroids injection or oral non-steroidal anti-inflammatories. Therefore, surgeons can use pain sensitivity questionnaire score as a preoperative tool to identify patients with high sensitivity to pain and customize their postoperative analgesics protocol to better fit their pain levels.

LEVEL OF EVIDENCE

II.

Short-Term and Long-Term Pain After Total Hip Arthroplasty: A Prospective Cohort Study

BACKGROUND

Postoperative pain has a major influence on older adults' rehabilitation. There is a lack of knowledge regarding how older adults return to daily living after discharge.

AIMS

The primary aim of this study was to examine the association between moderate to severe pain during the first 5 postoperative days and pain 1 year after discharge in older adults after total hip arthroplasty (THA).

DESIGN

This was a prospective cohort study.

METHODS

The study was conducted from August 2019 to February 2020, in a University Hospital in Denmark and included a 5-day diary and a telephone interview postoperatively. The following main areas were investigated: pain levels, pain management, side effects from opioids, mood, fatigue, quality of sleep, and functional level. Associations between moderate to severe pain levels at 5 days after surgery and persistent pain at 1 year were evaluated through correlation analyses.

RESULTS

A total of 70 THA older adults returned the diary postoperatively. Thereafter, 62 participated in a 1-year follow-up interview. No associations were found between pain levels 5 days postoperatively and after 1 year. Fifteen older adults reported hip pain was present still 1 year after surgery, and 14 patients still used analgesics on daily basis. No correlation was found between levels of pain and quality of sleep 1 year after surgery.

CONCLUSIONS

No association was found between older adults with moderate to severe levels of pain during the first 5 days postoperatively and 1 year after surgery. Proactive follow-up strategies for older adults after discharge following THA may be indicated to promote optimal rehabilitation.