Dataset Information

Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty.

ABSTRACT:

Background

Little is known about preoperative predictors of postoperative pain and referral to a recuperative pain management service after total knee arthroplasty (TKA).

Questions/purposes

We sought to identify the preoperative predictors of postoperative pain scores, referral to a pain management service, and narcotic usage in patients undergoing primary total knee arthroplasty.

Methods

We performed a prospective cohort study of 97 TKAs from a single surgeon. Pre and 6-week postoperative WOMAC, visual analog pain scale (VAS) scores, narcotic usage, and catastrophizing pain scores were collected.

Results

After adjusting for all other variables, higher age and catastrophizing pain scores were associated with lower odds of postoperative opioid usage. Increasing age and BMI were associated with lower odds of being referred to pain management. There was no relationship between self-reported preoperative pain tolerance and postoperative change in WOMAC or VAS pain scores.

Conclusions

This information may help surgeons advise their patients preoperatively and set expectations during the recovery period.

SUBMITTER: Banka TR

PROVIDER: S-EPMC4342398 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Publications

Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty.

Banka Trevor R TR Ruel Allison A Fields Kara K YaDeau Jacques J Westrich Geoffrey G

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20141101 1

<h4>Background</h4>Little is known about preoperative predictors of postoperative pain and referral to a recuperative pain management service after total knee arthroplasty (TKA).<h4>Questions/purposes</h4>We sought to identify the preoperative predictors of postoperative pain scores, referral to a pain management service, and narcotic usage in patients undergoing primary total knee arthroplasty.<h4>Methods</h4>We performed a prospective cohort study of 97 TKAs from a single surgeon. Pre and 6-we ...[more]

PMID: 25737672

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Project description:ObjectivesA key predictor for developing chronic residual pain after total knee or hip arthroplasty (TKA/THA) is sensitisation. Sensitisation can be defined as an 'increased responsiveness of nociceptive neurons in the nervous system'. Aim of this study is to investigate the effects of preoperative treatment with duloxetine in sensitised knee and hip osteoarthritis (OA) patients on postoperative chronic residual pain up to 1 year after arthroplasty.SettingA multicentre, pragmatic, prospective, randomised clinical trial was conducted in three secondary care hospitals in the Netherlands.ParticipantsPatients with primary knee/hip OA who were planned for TKA/THA were screened using the modified painDETECT Questionnaire. Patients whose painDETECT score indicated that sensitisation may be present were eligible for participation. 111 participants were included and randomly assigned 1:1 to an intervention or control group. The intervention group received additional duloxetine treatment, the control group did not receive any additional treatment but was allowed to continue with any pain medication they were already taking.InterventionsPreoperative oral treatment for 7 weeks with 60 mg/day of duloxetine was compared with usual care.Primary and secondary outcome measuresPrimary outcome measure was pain at 6 months after arthroplasty, assessed with the Pain Subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip disability and Osteoarthritis Outcome Score (HOOS) with a 0-100 scale. Secondary outcome measures were Visual Analogue Scale (VAS), and neuropathic-like pain measured using the modified PainDETECT Questionnaire. Longitudinal data collection included time points directly after duloxetine treatment, 1-day preoperatively, and 6 weeks, 6 months and 12 months postoperatively.ResultsMean improvement in the KOOS/HOOS pain subscale at 6 months postoperatively was 37 (SD 28.1) in the intervention group and 43 (SD 26.5) in the control group. No statistically significant difference was found in change score 6 months postoperatively between the two groups (p=0.280). 12 patients from the intervention group (21%) discontinued duloxetine due to adverse effects.ConclusionsPreoperative targeted treatment with duloxetine in end-stage knee and hip OA patients with sensitisation does not influence postoperative chronic residual pain after TKA/THA.Trial registration numberNTR4744.

Dataset Information

Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty.

Background

Questions/purposes

Methods

Results

Conclusions

Publications

Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty.

Similar Datasets

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