Assessing Preoperative Pain Sensitivity Predicts the Postoperative Analgesic Requirement and Recovery after Total Knee Arthroplasty: A Prospective Study of 178 Patients

Palanisami, Dhanasekara Raja; Reddy, Deepak Ananda; Huggi, Vishal; Rajasekaran, Raja Bhaskara; Rajkumar, Natesan; Rajasekaran, Shanmuganathan

doi:10.1016/j.arth.2020.07.029

Cited by 5 publications

(5 citation statements)

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“…Prospective identification of these challenges, including the application of standardized cognitive and psychosocial assessments, can allow for appropriate preoperative referral, patient optimization, and future study of risk mitigation strategies [15,18,52,75,78,80,88]. To this end, various predictive tools for postoperative pain are being explored [88][89][90][91]. Patient-centered education and expectation management during the pre-admission phase of care are effective strategies for improving postoperative pain control, limiting postoperative opioid use, decreasing complications and readmissions, and increasing postoperative function and quality of life [15,18,[92][93][94][95][96][97][98].…”

Section: Patient Pain History Evaluation and Educationmentioning

confidence: 99%

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

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Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Patient Pain History Evaluation and Educationmentioning

confidence: 99%

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…15,16 There is only one study that investigated the pain condition using an algometer. 7 In that study, patients with higher preoperative VAS scores had higher acute postoperative pain, requiring a higher dosage of analgesics in the immediate postoperative period, which predicted PT evaluation. Additionally, these authors emphasized that patients with a low PT should be counseled preoperatively and should receive more meticulous treatment of analgesics perioperatively.…”

Section: Discussionmentioning

confidence: 84%

“…6 To our knowledge, only one study has investigated the pain condition using an algometer and postoperative pain and the analgesic requirement on the day of surgery and during the postoperative period. 7 Unlike the above-cited study, in this study we evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the PT.…”

mentioning

confidence: 99%

Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold

et al. 2021

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We evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the pain threshold (PT). Overall, 120 patients who were assessed preoperatively with an algometer were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo total knee arthroplasty (TKA) with a tourniquet (group 1, 60 patients) and without tourniquet (group 2, 60 patients). Primary outcome measures were visual analog scale (VAS) pain scores at 24, 36, and 48 hours postoperatively and functional assessment with Knee Society Score (KSS) test at 1 year postoperatively. No significant differences were observed between groups in terms of gender (49 females and 8 males in group 1 vs. 53 females and 6 males in group 2; p = 0.201) and age (68.9 years in group 1 vs. 68.7 years in group 2; p = 0.811). There was no significant difference between groups in all the VAS and KSS 1 and KSS 2 scores. PT measurements ranged from 2.5 to 11.5 with a mean of 7.69 ± 1.70 and a median of 8. Total 54 patients with a median value of < 8 were defined as the low-PT group, and 62 patients with a median value of ≥ 8 were defined as the high-PT group. When the groups were evaluated according to using the tourniquet, 21 patients were operated on with a tourniquet and 33 patients without it in the low-PT group, while 36 patients were operated on with a tourniquet and 26 patients without it in the high-PT group. There was no significant difference in pain or functional scores between patients when comparing with-tourniquet and without-tourniquet or when comparing the low- and high-PT groups. This showed that the use of a tourniquet during TKA was not associated with either early-stage pain or 1-year postoperative functional outcomes according to algometer evaluation.Level of evidence: Level 1 prospective randomized study.

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“…With regard to regional anesthesia, a double-blinded RCT demonstrated that spinal anesthesia with mepivacaine yielded a more predictable return of motor function than low-dose bupivacaine; both interventions had a similar safety profile 34 . Finally, a prospective study of 178 patients revealed that a preoperative assessment of pain sensitivity predicts postoperative analgesic requirements 35 . It is important to keep in mind that considerable variability exists in baseline pain sensitivity between patients.…”

Section: Anesthesia and Pain Managementmentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa

Pannu

Higuera-Rueda

2021

Journal of Bone and Joint Surgery

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The global rebound from the COVID-19 pandemic may be on its way. Despite the difficulties, the orthopaedic community has demonstrated during the last year its commitment to the improvement of health care through innovation and the constant evaluation of practices and treatments for knee conditions. Health Policy and EconomicsA large nationwide insurance database study revealed that net losses were greater for patients with higher Elixhauser Comorbidity Index (ECI) scores 1 . The U.S. Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) payment models may deincentivize the treatment of sicker patients. As more insurance companies adopt bundled payment models such as CJR, it is important to note that Medicare risk-adjustment equations involving patient-reported outcomes cannot be applied without caution to patient-reported outcomes of commercially insured patients undergoing total knee arthroplasty (TKA). Significant differences in outcomes have been shown between Medicare and commercially insured patients when using Medicare risk-adjustment algorithms 2 . Although the volume of revisions has increased, the Medicare orthopaedic physician fee reimbursement for aseptic and septic TKA revision has not kept up with inflation. After adjusting for it, from 2002 to 2019, the mean aseptic revision reimbursement declined 24.83% for 2-component revision and 24.21% for 1-component revision, and septic revision reimbursement decreased even further, by 23.29% for explantation and 33.47% for reimplantation 3 . Lastly, it appears that the public reporting of TKA and total hip arthroplasty (THA) risk-standardized readmission and complication rates is associated with improved outcomes after the surgical procedure 4 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G781).

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Assessing Preoperative Pain Sensitivity Predicts the Postoperative Analgesic Requirement and Recovery after Total Knee Arthroplasty: A Prospective Study of 178 Patients

Cited by 5 publications

References 42 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold

What’s New in Adult Reconstructive Knee Surgery

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