Cited by 167Anesthesia and Pain ManagementTotal Knee Arthroplasty OutcomesPain Management and Opioid Use

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Predictors for moderate to severe acute postoperative pain after total hip and knee replacement

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Liu, Spencer S., Buvanendran, Asokumar, Rathmell, James P., Sawhney, Mona, Bae, James J., Moric, Mario, Perros, Stephen, Pope, Ashley J., Poultsides, Lazaros, Valle, Craig J. Della, Shin, Naomi S., McCartney, Colin J. L., Ma, Yan, Shah, Mahendrakumar, Wood, Monica J., Manion, Smith C., Sculco, Thomas P.·2012·International Orthopaedics

DOI 10.1007/s00264-012-1623-5PMC PMC3479283

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Abstract

Purpose The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement. Methods A total of 897 patients were identified from electronic medical records. Preoperative information and anaesthetic technique was gained by retrospective chart review. The primary outcomes were moderate to severe pain (pain score ≥ 4/10) at rest and with activity on postoperative day one. Logistic regression was performed to identify predictors for moderate to severe pain. Results Moderate to severe pain was reported by 20 % at rest and 33 % with activity. Predictors for pain at rest were female gender (OR 1.10 with 95 % CI 1.01-1.20), younger age (0.96, 0.94-0.99), increased BMI (1.02, 1.01-1.03), TKR vs. THR (3.21, 2.73-3.78), increased severity of preoperative pain at the surgical site (1.15, 1.03-1.30), preoperative use of opioids (1.63, 1.32-2.01), and general anaesthesia (8.51, 2.13-33.98). Predictors for pain with activity were TKR vs. THR (1.42, 1.28-1.57), increased severity of preoperative pain at the surgical site (1.11, 1.04-1.19), general anaesthesia (9.02, 3.68-22.07), preoperative use of anti-convulsants (1.78, 1.32-2.40) and anti-depressants (1.50, 1.08-2.80), and prior surgery at the surgical site (1.28, 1.05-1.57). Conclusions Our findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.

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“It has been shown that chronic preoperative use of anticonvulsants and anti-depressants is the independent predictor for acute pain after TKA.5 We are concerned that imbalance in these unknown preoperative factors among the three study groups would have contributed to their results.”
Influential
Early Postoperative Pain Control and Inflammation for Total Knee Arthroplasty: A Retrospective Comparison of Continuous Adductor Canal Block versus Single-Shot Adductor Canal Block Combined with Patient-Controlled Intravenous Analgesia
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Background
Retracted
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“11 (11) 11 (10) 11 (10) 11 (12) Weight 82 (14) 82 (15) 80 (15) 81 (15) General anesthesia, n = 135 Sex, female/male 15 (47) 16 (53) 15 (50) 24 (56) 17 (53) 14 (47) 15 (50) 19 (44) Age 63 (11) 63 (12) 66 (12) 62 (10) Use of analgesics, none/any 7 (22) 7 (23) 11 (37) 14 (33) 25 (78) 23 (77) 19 (63) 29 (67) ASA I/II/III…”
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“Da mesma forma, foram omitidas informações sobre restrição absoluta ao leito; transferência para a recuperação pós-anestésica; presença de sondas, drenos, cateteres e curativo cirúrgico; monitorização; vigilância e segurança pós-operatória; controle da dor; medidas específicas para controle de náuseas, vômitos, confus…”
BackgroundInfluential
Factors associated with success and failure of patient-controlled oral analgesia after total hip and knee arthroplasty: a historical comparative cohort study
Vorobeichik, L., Hoydonckx, Y., Kumar, P., Buzon-Tan, A., Walker, S., Kirkham, K. R., Ilangomaran, D., Venkatraghavan, L., Prabhu, A. J., & Bhatia, A. (2020) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-020-01864-5 · Cited by 3
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BackgroundMethodResultInfluential
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“In a study of patients undergoing orthopedic procedures such as hip and knee replacements, preoperative opioid dependence was predictive of severe postoperative pain (29).”
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Cathepsin S Upregulation Measured in the Peripheral Blood Mononuclear Cells Prior to Surgery Points to Postoperative Pain Development in Patients with Hip Osteoarthritis
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“10,11 These data provide additional motivation for the use of neuraxial anesthesia or plexus block.”
Method
EFFECT OF REHABILITATION REGIMEN FOR IMPROVING FUNCTIONAL OUTCOME AFTER TOTAL HIP REPLACEMENT SURGERY IN MANSOURA UNIVERSITY HOSPITALS
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Background
Comparing Local Infiltration and Continuous Femoral Nerve Block for Pain Relief After Total Knee Arthroplasty
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“They had attempted to control most of known factors affecting postoperative pain after TKA, such as age, gender, body mass index, preoperative pain intensity, type of surgery, and so forth.”
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Predicting poor postoperative pain control after elective spine surgery
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Implantação do protocolo de recuperação rápida em pacientes submetidos à artroplastia total do quadril em um hospital público do Estado de São Paulo
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Friðriksson, B. M. (2013)
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Risk Assessment for Chronic Pain and Patient Satisfaction After Total Knee
Ma, Y., & Bae, J. J. (2016)
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Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception
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Authors: Liu, S. S., Buvanendran, A., Rathmell, J. P., Sawhney, M., Bae, J. J., Moric, M., Perros, S., Pope, A. J., Poultsides, L., Valle, C. J. D., Shin, N. S., McCartney, C. J. L., Ma, Y., Shah, M., Wood, M. J., Manion, S. C., & Sculco, T. P.
Affiliations: Hospital for Special Surgery (US)
Rush University Medical Center (US)
Harvard University (US)
Sunnybrook Health Science Centre (CA)
Cornell University (US)
Corresponding author: Liu, Spencer S.
ORCID: Buvanendran, Asokumar
Rathmell, James P.
Moric, Mario
Valle, Craig J. Della
McCartney, Colin J. L.
Ma, Yan
Wood, Monica J.
Sculco, Thomas P.
Venue: International Orthopaedics
Publisher: Springer Science and Business Media LLC
Published: 2012-07-29
Volume: 36
Issue: 11
Pages: 2261-2267
ISSN: 0341-2695 (ISSN-L)
1432-5195
DOI: 10.1007/s00264-012-1623-5
PMC: PMC3479283
OpenAlex: W1979180225
Cited by: 167
References: 24
Citations by year: 2026: 6 · 2025: 6 · 2024: 13 · 2023: 10 · 2022: 11 · 2021: 17 · 2020: 13 · 2019: 14 · 2018: 9 · 2017: 18 · 2016: 20 · 2015: 8 · 2014: 15 · 2013: 6 · 2012: 1
FWCI: 9.80
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: International Orthopaedics (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Hospital for Special Surgery
National Institutes of Health (RR024996)
National Center for Research Resources (UL1RR024996)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: postoperative pain, total hip arthroplasty, total knee arthroplasty, preoperative risk factors, general anesthesia, opioid use, antiepileptic drugs, body mass index, preoperative pain, patient stratification, analgesia
MeSH terms: Activities of Daily Living, Aged, Cross-Sectional Studies, Female, Hip Joint, Humans, Knee Joint, Male, Middle Aged, Pain Measurement, Pain, Postoperative, Postoperative Pain, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Factors, Sex Factors, Triage, Treatment Outcome, Practice Guidelines as Topic, Patient Selection, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Pain Management

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Predictors for moderate to severe acute postoperative pain after total hip and knee replacement

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