Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.06.002
Brazilian Journal of Anesthesiology
Scientific Article

Pain after major elective orthopedic surgery of the lower limb and type of anesthesia: does it matter?

Dor após cirurgia eletiva ortopédica de grande porte em membro inferior e o tipo de anestesia: isso importa?

Diogo Luís Pereira; Hugo Lourenço Meleiro; Inês Araújo Correia; Sara Fonseca

http://dx.doi.org/10.1016/j.bjane.2015.06.002 Braz J Anesthesiol, vol.66, n6, p.628-636, 2016
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Abstract

Abstract Background and objectives: Total knee arthroplasty and total hip arthroplasty are associated with chronic pain development. Of the studies focusing on perioperative factors for chronic pain, few have focused on the differences that might arise from the anesthesia type performed during surgery. Methods: This was a prospective observational study performed between July 2014 and March 2015 with patients undergoing unilateral elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) for osteoarthritis. Data collection and pain evaluation questionnaires were performed in three different moments: preoperatively, 24 hours postoperatively and at 6 months after surgery. To characterize pain, Brief Pain Inventory (BPI) was used and SF-12v2 Health survey was used to further evaluate the sample's health status. Results: Forty and three patients were enrolled: 25.6% men and 74.4% women, 51,2% for total knee arthroplasty and48.8% for total hip arthroplasty, with a mean age of 68 years. Surgeries were performed in 25.6% of patients under general anesthesia, 55.8% under neuraxial anesthesia and 18.6% under combined anesthesia. Postoperatively, neuraxial anesthesia had a better pain control. Comparing pain evolution between anesthesia groups, neuraxial anesthesia was associated with a decrease in “worst”, “medium” and “now” pain at six months. Combined anesthesia was associated with a decrease of “medium” pain scores at six months. Of the three groups, only those in neuraxial group showed a decrease in level of pain interference in “walking ability”. TKA, “worst” pain preoperatively and general were predictors of pain development at six months. Conclusions: Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anesthesia.

Keywords

Arthroplasty, General anesthesia, Neuraxial anesthesia, Preoperative pain, Postoperative pain, Chronic pain, Chronic postoperative pain

Resumo

Resumo Justificativa e objetivos: A artroplastia total de joelho e a artroplastia total de quadril estão associadas ao desenvolvimento de dor crônica. Dentre os estudos que avaliam os fatores perioperatórios para a dor crônica, poucos abordam as diferenças que podem surgir do tipo de anestesia feita durante a cirurgia. Métodos: Estudo observacional, prospectivo, feito entre julho de 2014 e março 2015 com pacientes submetidos à ATJ unilateral eletiva ou ATQ para a osteoartrite. A coleta de dados e a avaliação da dor por meio de questionários foram feitas em três momentos distintos: no pré-operatório, em 24 horas de pós-operatório e aos seis meses após a cirurgia. O Inventário Breve da Dor (IBD) foi usado para caracterizar a dor o e o Questionário SF-12v2 foi usado para avaliar melhor o estado de saúde da amostra. Resultados: Foram inscritos 43 pacientes: 25,6% homens e 74,4% mulheres, 51,2% para ATJ e 48,8% ATQ, com média de 68 anos. A cirurgia foi feita em 25,6% dos pacientes sob anestesia geral, em 55,8% sob anestesia neuroaxial e em 18,6% sob anestesia combinada. No pós-operatório, a anestesia neuraxial apresentou melhor controle da dor. Na comparação da evolução da dor entre os grupos, a anestesia neuraxial foi associada a uma diminuição de “pior”, “médio” e “sem” dor em seis meses. A anestesia combinada foi associada a uma diminuição do escore “médio” de dor em seis meses. Dos três grupos, apenas aqueles no grupo neuraxial apresentaram uma diminuição do nível de interferência da dor na “capacidade de caminhar”. ATJ, “pior” dor no pré-operatório e anestesia geral foram preditivos de desenvolvimento de dor aos seis meses. Conclusões: Os pacientes com gonartrose e dor intensa no pré-operatório podem obter benefício de cuidados individualizados no pré e intraoperatório, particularmente de analgesia no pré-operatório e anestesia neuraxial.

Palavras-chave

Artroplastia, Anestesia geral, Anestesia neuroaxial, Dor pré-operatória, Dor pós-operatória, Dor crônica, Dor crônica pós-operatória

References

Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54:226-9.

Traumatology P.S.o.O.a. 2014.

Mancuso CA, Sculco TP, Wickiewicz TL. Patients' expectations of knee surgery. J Bone Joint Surg Am. 2001;83-a:1005-12.

Yoo JH, Chang CB, Kang YG. Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. J Bone Joint Surg Br. 2011;93:337-44.

Bourne RB, Chesworth BM, Davis AM. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res. 2010;468:57-63.

Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2011;26:209-13.

Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal. Eur J Health Econ. 2016;17:87-98.

Cobos R, Latorre A, Aizpuru F. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord. 2010;11:249.

Mota RE, Tarricone R, Ciani O. Determinants of demand for total hip and knee arthroplasty: a systematic literature review. BMC Health Serv Res. 2012;12:225.

Cross 3rd WW, Saleh KJ, Wilt TJ, Kane RL. Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res. 2006;446:34-9.

Hetaimish BM, Khan MM, Simunovic N. Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty. 2012;27:1177-82.

Gothesen O, Espehaug B, Havelin LI. Functional outcome and alignment in computer-assisted and conventionally operated total knee replacements: a multicentre parallel-group randomised controlled trial. Bone Joint J. 2014;96-b:609-18.

Beswick AD, Wylde V, Gooberman-Hill R. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435.

Jeffery AE, Wylde V, Blom AW. It's there and I’m stuck with it”: patients’ experiences of chronic pain following total knee replacement surgery. Arthritis Care Res (Hoboken). 2011;63:286-92.

Pinto PR, McIntyre T, Ferrero R. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One. 2013;8:e73917.

Bonnin MP, Basiglini L, Archbold HA. What are the factors of residual pain after uncomplicated TKA?. Knee Surg Sports Traumatol Arthrosc. 2011;19:1411-7.

Singh JA, Gabriel S, Lewallen D. The Impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthopaedics Rel Res. 2008;466:2717-23.

Wylde V, Hewlett S, Learmonth ID. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566-72.

Macfarlane AJ, Prasad GA, Chan VW. Does regional anesthesia improve outcome after total knee arthroplasty?. Clin Orthop Relat Res. 2009;467:2379-402.

Hu S, Zhang ZY, Hua YQ. A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br. 2009;91:935-42.

Liu J, Ma C, Elkassabany N. Neuraxial anesthesia decreases postoperative systemic infection risk compared with general anesthesia in knee arthroplasty. Anesth Analg. 2013;117:1010-6.

Hunt LP, Ben-Shlomo Y, Clark EM. 90-Day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet. 2013;382:1097-104.

Schug S, P.-Z.E. Chronic pain after surgery or injury. Pain clinical updates. 2011.

Christa Harstall MO. How prevalent is chronic pain?. Pain Clin Updates. 2003;XI(2).

Azevedo LF, Costa Pereira A, Dias C. Tradução, adaptação cultural e estudo multicêntrico de validação de instrumentos para rastreio e avaliação do impacto da dor crónica. Dor. 2007;15:6-65.

Ferreira PL. Development of the Portuguese version of MOS SF-36. Part II -Validation tests. Acta Med Port. 2000;13:119-27.

Ferreira PL. Development of the Portuguese version of MOS SF-36. Part I. Cultural and linguistic adaptation. Acta Med Port. 2000;13:55-66.

Bullinger M, Alonso J, Apolone G. Translating health status questionnaires and evaluating their quality: The IQOLA Project Approach. J Clin Epidemiol. 1998;51:913-23.

Silveira MF, Almeida JC, Freire RS. Psychometric properties of the quality of life assessment instrument: 12-item health survey (SF-12). Cien Saude Colet. 2013;18:1923-31.

Dworkin RH, Turk DC, Farrar JT. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9-19.

Cleeland CS, Ryan KM. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singapore. 1994;23:129-38.

Caraceni A, Cherny N, Fainsinger R. Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care. J Pain Symptom Manage. 2002;23:239-55.

Keller S, Bann CM, Dodd SL. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20:309-18.

Tan G, Jensen MP, Thornby JI. Validation of the brief pain inventory for chronic nonmalignant pain. J Pain. 2004;5:133-7.

Choong PF, Dowsey MM. Update in surgery for osteoarthritis of the knee. Int J Rheum Dis. 2011;14:167-74.

Clement ND, Muzammil A, Macdonald D. Socioeconomic status affects the early outcome of total hip replacement. J Bone Joint Surg Br. 2011;93:464-9.

Lavernia CJ, Alcerro JC, Contreras JS. Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty. Clin Orthop Relat Res. 2011;469:1838-45.

Singh JA, Lewallen DG. Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology (Oxford). 2013;52:916-23.

Singh JA, Lewallen DG. Medical comorbidity is associated with persistent index hip pain after total hip arthroplasty. Pain Med. 2013;14:1222-9.

Dowsey MM, Liew D, Stoney JD. The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients. J Bone Joint Surg Br. 2010;92:513-20.

Jarvenpaa J, Kettunen J, Soininvaara T. Obesity has a negative impact on clinical outcome after total knee arthroplasty. Scand J Surg. 2012;101:198-203.

Memtsoudis SG, Sun X, Chiu YL. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118:1046-58.

Palazzo C, Jourdan C, Descamps S. Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment. BMC Musculoskelet Disord. 2014;15:53.

Nakahara H, Okazaki K, Mizu-Uchi H. Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren’t patients satisfied?. J Orthop Sci. 2015;20:87-92.

Pinto PR, McIntyre T, Ferrero R. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res. 2013;6:691-703.

Hanley MA, Jensen MP, Smith DG. Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain. 2007;8:102-9.

Eisenach JC, Pan PH, Smiley R. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140:87-94.

Peters ML, Sommer M, de Rijke JM. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245:487-94.

Puolakka PA, Rorarius MG, Roviola M. Persistent pain following knee arthroplasty. Eur J Anaesthesiol. 2010;27:455-60.

Brandsborg B, Nikolajsen L, Hansen CT. Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology. 2007;106:1003-12.

Lingard EA, Katz JN, Wright EA. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004;86-a:2179-86.

Lewis GN, Rice DA, McNair PJ. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2015;114:551-61.

Paajanen H, Scheinin T, Vironen J. Commentary: nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5 year register study of 55,000 operations. Am J Surg. 2010;199:746-51.

Nikolajsen L, Sorensen HC, Jensen TS. Chronic pain following Caesarean section. Acta Anaesthesiol Scand. 2004;48:111-6.

Gupta A, Gandhi K, Viscusi ER. Persistent postsurgical pain after abdominal surgery. Tech Reg Anesth Pain Manag. 2011;15:140-6.

Harsten A, Kehlet H, Toksvig-Larsen S. Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. Br J Anaesth. 2013;111:391-9.

Harsten A, Kehlet H, Ljung P. Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty: a randomised, controlled trial. Acta Anaesthesiol Scand. 2015;59:298-309.

Husted H, Lunn TH, Troelsen A. Why still in hospital after fast-track hip and knee arthroplasty?. Acta Orthop. 2011;82:679-84.

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