Factors Associated With the Risk of Developing Moderate to Severe Acute Postoperative Pain After Primary Total Knee Arthroplasty: Results From the PAIN OUT Registry

García-Lopez, Jaume; Polanco-García, Mauricio; Montes, Antônio

doi:10.1016/j.arth.2021.02.005

Cited by 16 publications

(11 citation statements)

References 43 publications

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“…Median postoperative pain intensities were high following THA and even higher in TKA. These data are more or less in line with data reported in studies in Portugal [14], Germany [15,16] and a large international multicenter cohort study [17].…”

Section: Plos Onesupporting

confidence: 91%

“…García-López and colleagues demonstrated in a recent study the following factors associated with moderate to severe postoperative pain after TKA: chronic preoperative pain, general anesthesia, opioid use before or after surgery. There were no protective factors observed [ 17 ]. This is partly in line with our results, demonstrating preoperative pain and female gender were associated with severe postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

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Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry

et al. 2022

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Introduction Different multimodal pain management strategies following total hip arthroplasty(THA) and total knee arthroplasty (TKA) surgery are used in clinical practice. The optimal pain management strategy, however, remains unclear. This study aims to evaluate the differences in perioperative multimodal pain management strategies for THA and TKA in the Netherlands, and studies the associations between patient- and therapy related factors and pain outcomes. Methods Data from the Dutch hospitals in the PAIN OUT network were used in this study. Demographic data, pain management strategy including perioperative medication use and anesthetic techniques were recorded and used in a multivariable regression analysis to study the association with maximum pain intensity, the duration of severe pain, pain interference in bed and postoperative nausea. Results In 343 hip arthroplasty patients and 301 knee arthroplasty patients in seven hospitals, respectively 28 and 35 different combinations of analgesic regimens were used. The number of different drugs prescribed was not related to postoperative pain intensity. Female sex, younger age and spinal anesthesia were associated with higher postoperative maximum pain scores (Numeric Rating Scale (NRS) > 5). Hip surgery and ketamine use were associated with lower postoperative pain scores. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and gabapentinoids, higher age, higher body mass index (BMI) and male gender were associated with less postoperative nausea (NRS < 3). Conclusion In conclusion, our study demonstrated a large diversity of analgesic strategies following total joint arthroplasties in the Netherlands. Although no ideal strategy was identified, the use of NSAIDs, ketamine and dexamethasone were associated with less pain and less side effects.

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Section: Plos Onesupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry

et al. 2022

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“…Certain factors were demonstrated in single studies to increase the risk of PPSP. Among these were being a widower; being a housewife; not having higher education; working at a job that requires physical effort; 1 presurgical restricted walking distance; pre-existing knee pain; neuropathic pain; 81 pre-existing chronic pain states; 119 poorer cognitive flexibility; comorbidities such as diabetes mellitus, cancer, and fibromyalgia; 33 revision surgery compared with primary TKA; 79 mechanical complication of prosthesis; 48 and painful postoperative period. 34 Given the paucity of data, future research will be needed to test these associations further.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

Ghoshal

Bhanvadia

Singh

et al. 2023

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Studies have identified demographic, clinical, psychosocial, and perioperative variables associated with persistent pain after a variety of surgeries. This study aimed to perform a systematic review and meta-analysis of factors associated with persistent pain after total knee replacement (TKR) and total hip replacement (THR) surgeries. To meet the inclusion criteria, studies were required to assess variables before or at the time of surgery, include a persistent postsurgical pain (PPSP) outcome measure at least 2 months after a TKR or THR surgery, and include a statistical analysis of the effect of the risk factor(s) on the outcome measure. Outcomes from studies implementing univariate and multivariable statistical models were analyzed separately. Where possible, data from univariate analyses on the same factors were combined in a meta-analysis. Eighty-one studies involving 171,354 patients were included in the review. Because of the heterogeneity of assessment methods, only 44% of the studies allowed meaningful meta-analysis. In meta-analyses, state anxiety (but not trait anxiety) scores and higher depression scores on the Beck Depression Inventory were associated with an increased risk of PPSP after TKR. In the qualitative summary of multivariable analyses, higher preoperative pain scores were associated with PPSP after TKR or THR. This review systematically assessed factors associated with an increased risk of PPSP after TKR and THR and highlights current knowledge gaps that can be addressed by future research.

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“…Despite modern multimodal analgesic protocols, moderate to severe post-surgical pain is common following total knee arthroplasty. This not only interferes with early recovery and mobilisation but may also increase the risk of persistent postoperative opioid use and chronic post-surgical pain [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

et al. 2022

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Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local infiltration analgesia vs. 20 ml with genicular nerves block). This randomised non-inferiority trial compared the analgesic efficacy of genicular nerves block vs. local infiltration analgesia in the first 24 h following total knee arthroplasty. Sixty patients were randomly allocated to receive either ultrasound-guided block of five genicular nerves or local infiltration analgesia. The primary outcome was rest pain numeric rating scale (0-10) at 24 h. Secondary outcomes included pain numeric rating scale (rest and movement) and cumulative opioid consumption during the first 24 h. We analysed 29 patients in the genicular nerves block group and 30 in the local infiltration analgesia group. We found that the median difference (95%CI) in postoperative rest pain at 24 h (non-inferiority criteria, D = 1) was À1.0 (À2.0 to 1.0, p < 0.001). Median difference in cumulative opioid consumption was 0.0 mg (À3.0-5.0, p < 0.001) meeting the non-inferiority criteria, D = 23 mg. We conclude that genicular nerves block of five nerves provides non-inferior analgesia in the first 24 h following surgery compared with local infiltration analgesia, but with a considerable reduction in the local anaesthetic dose.

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Factors Associated With the Risk of Developing Moderate to Severe Acute Postoperative Pain After Primary Total Knee Arthroplasty: Results From the PAIN OUT Registry

Cited by 16 publications

References 43 publications

Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry

Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

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