Department of Anesthesiology, St Luc Hospital University, Catholic University of Louvain, Av Hippocrate 10, 1200, Brussels, Belgium,
Clin Orthop Relat Res. 2014 May;472(5):1409-15. doi: 10.1007/s11999-013-3389-5.
Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain.
QUESTIONS/PURPOSES: In this prospective observational study, we examined the relationship between postoperative pain trajectories and persistent pain, specifically neuropathic pain, at 3 months after knee arthroplasty.
Over a 1-year period, all patients undergoing elective unilateral knee arthroplasty for osteoarthritis by one surgeon were invited to participate in the study, provided they had not had prior knee surgery and their American Society of Anesthesiologists grade was 3 or lower; 128 patients fulfilled these criteria. Patients filled in a diary questioning postoperative pain at rest and during mobilization and maximal pain from Day 1 until Day 8 after surgery. At 3 months, the patients were questioned concerning the presence of persistent pain and its nature and intensity using the Douleur Neuropathique 4 [Neuropathic Pain 4] and Brief Pain Inventory questionnaires. At 3 months, 112 of the 128 patients (87%) were successfully contacted.
At 3 months, 47 of the 112 (42%) patients were totally pain free and 65 (58%) reported persistent pain at the surgical site. Among the latter, 12 patients (11%) presented with a neuropathic component and more severe persistent pain. Pain trajectories highlighted higher acute pain scores for maximal pain (from Day 1 until Day 8) and for pain at mobilization (from Day 3 until Day 8) in patients with neuropathic persistent pain (p < 0.05 at all time points compared with the no persistent pain group).
Postoperative pain trajectories constructed from patient's pain diary suggest that a subgroup of patients who will present with higher pain at 3 months after knee arthroplasty might be identified early in the postoperative period and might benefit from preventative treatment.
Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
膝关节置换术后持续性疼痛是主要的不满意来源。术后疼痛轨迹可以动态观察术后疼痛的缓解情况，并有助于识别持续性疼痛的风险患者。
问题/目的：在这项前瞻性观察研究中，我们检查了膝关节置换术后 3 个月时术后疼痛轨迹与持续性疼痛（特别是神经病理性疼痛）之间的关系。
在 1 年期间，邀请由一位外科医生进行择期单侧膝关节置换术的所有骨关节炎患者参与研究，前提是他们以前没有膝关节手术，美国麻醉医师协会（ASA）分级为 3 级或更低；符合这些标准的患者有 128 名。患者在日记中询问术后静息和运动时的疼痛以及术后第 1 天至第 8 天的最大疼痛。3 个月时，使用 Douleur Neuropathique 4 [神经性疼痛 4]和 Brief Pain Inventory 问卷询问患者是否存在持续性疼痛及其性质和强度。在 3 个月时，成功联系到 128 名患者中的 112 名（87%）。
在 3 个月时，112 名患者中有 47 名（42%）完全无痛，65 名（58%）报告手术部位持续性疼痛。在后一组中，12 名患者（11%）存在神经性成分和更严重的持续性疼痛。疼痛轨迹突出显示，患有神经性持续性疼痛的患者在最大疼痛（从第 1 天到第 8 天）和运动时疼痛（从第 3 天到第 8 天）的急性疼痛评分更高（与无持续性疼痛组相比，所有时间点均为 p<0.05）。
从患者疼痛日记中构建的术后疼痛轨迹表明，在膝关节置换术后 3 个月出现更高疼痛的亚组患者可能在术后早期被识别，并可能受益于预防性治疗。
三级，诊断研究。有关证据水平的完整说明，请参阅作者说明。
