A Randomized, Controlled Trial on the Effect of Anesthesia on Chronic Pain After Total Knee Arthroplasty

Sciberras, Stephen; Vella, Adrian P; Vella, B. Della; Spiteri, Jessica; Mizzi, Christabel; Borg-Xuereb, Keith; LaFerla, Godfrey; Grech, Godfrey; Sammut, Fiona

doi:10.2217/pmt-2021-0081

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…Moreover, the current literature directly cites postoperative pain as a predictor [25,26]. Also, contrary to the literature [23] is our finding that general anesthesia has no correlation to CPSP in our cohort, just as all other data we collected on surgery. Regarding sociodemographic parameters, significant correlations in our data could only be determined for income and age, and this at a very low level.…”

Section: Discussioncontrasting

confidence: 99%

“…Catastrophizing, mental health, preoperative knee pain and pain at other sites were found to be the strongest independent predictors of postsurgical pain in TKA [15]. In addition, a lower educational level [16], female sex and a younger age at the time of surgery [17,18], a preoperative combination of high levels of both anxiety and depressive symptoms [17,19], a higher angiotensin II type 2 receptor level [20], the presence of chronic obstructive pulmonary disease [21], diabetes mellitus or flexion contracture [22], general anesthesia [23], patellofemoral joint overstuffing [22] and postoperative coronal malalignment [24], as well as level of acute postoperative pain [25,26], have also been described as predictors of persistent pain. These numerous publications [15][16][17][18][19][20][21][22][23][24][25][26] with different predictors point to a multifactorial phenomenon.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a lower educational level [16], female sex and a younger age at the time of surgery [17,18], a preoperative combination of high levels of both anxiety and depressive symptoms [17,19], a higher angiotensin II type 2 receptor level [20], the presence of chronic obstructive pulmonary disease [21], diabetes mellitus or flexion contracture [22], general anesthesia [23], patellofemoral joint overstuffing [22] and postoperative coronal malalignment [24], as well as level of acute postoperative pain [25,26], have also been described as predictors of persistent pain. These numerous publications [15][16][17][18][19][20][21][22][23][24][25][26] with different predictors point to a multifactorial phenomenon. To the best of the authors' knowledge, it has not been investigated how strong the correlation of the multiple different known predictors to CPSP is compared to each other on a large scale to date.…”

Section: Introductionmentioning

confidence: 99%

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Time-Dependent Prediction Models for Individual Prognosis of Chronic Postsurgical Pain following Knee Replacement Based on an Extensive Multivariable Data Set

Betz,

Clarius,

Krieger

et al. 2024

JCM

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(1) Background: Clinically useful prediction models for chronic postsurgical pain (CPSP) in knee replacement (TKA) are lacking. (2) Methods: In our prospective, multicenter study, a wide-ranging set of 91 variables was collected from 933 TKA patients at eight time points up to one year after surgery. Based on this extensive data pool, simple and complex prediction models were calculated for the preoperative time point and for 6 months after surgery, using least absolute shrinkage and selection operator (LASSO) 1se and LASSO min, respectively. (3) Results: Using preoperative data only, LASSO 1se selected age, the Revised Life Orientation Test on pessimism, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)—subscore pain and the Timed “Up and Go” Test for prediction, resulting in an area under the curve (AUC) of 0.617 and a Brier score of 0.201, expressing low predictive power only. Using data up to 6 months after surgery, LASSO 1se included preoperative Patient Health Questionnaire-4, Knee Injury and Osteoarthritis Outcome Score (KOOS)—subscore pain (pain) 3 months after surgery (month), WOMAC pain 3 and 6 months, KOOS subscore symptoms 6 months, KOOS subscore sport 6 months and KOOS subscore Quality of Life 6 months. This improved the predictive power to an intermediate one (AUC 0.755, Brier score 0.168). More complex models computed using LASSO min did little to further improve the strength of prediction. (4) Conclusions: Even using multiple variables and complex calculation methods, the possibility of individual prediction of CPSP after TKA remains limited.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Time-Dependent Prediction Models for Individual Prognosis of Chronic Postsurgical Pain following Knee Replacement Based on an Extensive Multivariable Data Set

Betz,

Clarius,

Krieger

et al. 2024

JCM

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“…Regional anesthesia can be used as a tool in the prevention of CPSP because it has been proved to reduce the excitability of neurons involved in peripheral nociceptive pathways [ 33 , 50 ]. Several studies have shown the beneficial results of regional anesthesia techniques in preventing the development of CPSP after hysterectomy, cesarean section, and total knee arthroplasty [ 51 – 53 ] .…”

Section: Discussionmentioning

confidence: 99%

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

et al. 2023

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Background Due to the continued growth of surgical procedures in older adults and the significant impact of chronic postsurgical pain (CPSP), it is crucial to improve our understanding of the occurrence of CPSP as well as the appropriate prevention and treatment. We therefore conducted this study to determine the incidence, characteristics and risk factors of CPSP in elderly patients at both 3 and 6 months after surgery. Methods Elderly patients (aged ≥ 60 years) undergoing elective surgery in our institution between April 2018 and March 2020 were prospectively enrolled in this study. Data on demographics, preoperative psychological well-being, intraoperative surgical and anesthesia management, and acute postoperative pain intensity were collected. At 3 and 6 months after surgery, patients received telephone interview and completed the questionnaires regarding chronic pain characteristics, analgesic consumption, and interference of the pain with activities of daily living (ADL). Results A total of 1065 elderly patients were followed up for 6 postoperative months and included in final analysis. At 3 and 6 months after operation, the incidence of CPSP was 35.6% [95% confidence interval (95% CI) 32.7 − 38.8%] and 21.5% (95% CI 19.0% − 23.9%), respectively. CPSP cause negative impacts on patient’s ADL and most particularly on mood. Neuropathic features were found in 45.1% of the patients with CPSP at 3 months. At 6 months, 31.0% of those with CPSP reported that the pain had neuropathic features. Preoperative anxiety [3 months: Odds ratio (OR) 2.244, 95% CI 1.693 to 2.973; 6 months: OR 2.397, 95% CI 1.745 to 3.294], preoperative depression (3 months: OR 1.709, 95% CI 1.292 to 2.261; 6 months: OR 1.565, 95% CI 1.136–2.156), orthopedic surgery (3 months: OR 1.927, 95% CI 1.112 to 3.341; 6 months: OR 2.484, 95% CI 1.220 to 5.061), higher pain severity on movement within postoperative 24 h (3 months: OR 1.317, 95% CI 1.191 to 1.457; 6 months: OR 1.317, 95% CI 1.177 to 1.475) were associated with a higher risk for CPSP independently at both 3 and 6 months after surgery. Conclusions CPSP is a common postoperative complication in elderly surgical patients. Preoperative anxiety and depression, orthopedic surgery, and greater intensity of acute postoperative pain on movement are associated with an increased risk for CPSP. It should be kept in mind that developing psychological interventions to reduce anxiety and depression and optimizing the management of acute postoperative pain will be effective in reducing the development of CPSP in this population.

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“…Finally, as outcomes regarding postoperative pain and mobilization may differ depending of the type of anesthesia received (Bourget-Murray et al 2022 ; Johnson et al 2016 ; Memtsoudis et al 2019 ; Sciberras et al 2022 ), we conducted a post hoc analysis in patients operated on under general anesthesia only (i.e., after removal of patients who have had a spinal anesthesia). Results of comparisons between the IV-morphine group and the SL-sufentanil group were similar than those obtained on the whole group patients, with in particular a greater morphine equivalents consumption in the SL-sufentanil group and no significant differences in postoperative pain, times to complete the TUG, knee flexions, and lengths of hospital stay (Additional file 1 , Table S1).…”

Section: Case Presentationmentioning

confidence: 99%

Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study

et al. 2022

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Background Postoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilitate recovery after knee arthroplasty in an enhanced recovery program. Case presentation In a prospective observational single-center study, thirty patients operated on for primary knee arthroplasty in the enhanced recovery pathway were included. Patients who received the SSTS (n=15) were compared with those who received an intravenous morphine patient-controlled analgesia (PCA) (n=15). Our recovery program included in particular the use of an adductor canal block, periarticular infiltration of local anesthetic by the surgeon, removal of the venous cannula from the recovery room if possible, the use of an SSTS when available or an IV morphine PCA otherwise, and early physiotherapy. Recovery parameters including the Timed-Up and Go test, pain scores at rest and on exertion, knee flexions, complications, and lengths of hospital stay were not significantly different between the two groups. However, the postoperative opioid consumption in morphine equivalents was significantly greater in the SL-sufentanil group and these patients had their venous cannula removed earlier than in IV-morphine group. Conclusion In our center, the use of a SSTS was suitable for treating postoperative pain after knee arthroplasty, but it did not improve early recovery in comparison with a morphine PCA.

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A Randomized, Controlled Trial on the Effect of Anesthesia on Chronic Pain After Total Knee Arthroplasty

Cited by 6 publications

References 41 publications

Time-Dependent Prediction Models for Individual Prognosis of Chronic Postsurgical Pain following Knee Replacement Based on an Extensive Multivariable Data Set

Time-Dependent Prediction Models for Individual Prognosis of Chronic Postsurgical Pain following Knee Replacement Based on an Extensive Multivariable Data Set

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study

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