Pinto Patrícia R, McIntyre Teresa, Araújo-Soares Vera, Costa Patrício, Ferrero Ramón, Almeida Armando
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.
ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
J Pain Res. 2017 May 9;10:1087-1098. doi: 10.2147/JPR.S126467. eCollection 2017.
Acute pain is an expected result after surgery. Nevertheless, when not appropriately controlled, acute pain has a very negative impact on individual clinical outcomes, impairing healing and recovery, and has clear consequences on health care system costs. Augmenting knowledge on predictors and potentially modifiable determinants of acute postsurgical pain can facilitate early identification of and intervention in patients at risk. However, only a few studies have examined and compared acute pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study was to compare THA and TKA in acute postsurgical pain intensity and its predictors.
A consecutive sample of 124 patients with osteoarthritis (64 undergoing THA and 60 TKA) was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1, and acute postsurgical pain experience was examined at T2. Additionally, the same hierarchical regression analysis was performed separately for each arthroplasty type.
TKA patients reported higher levels of acute postsurgical pain compared with THA (=8.490, =0.004, =0.527, 95% confidence interval, 0.196-0.878). In the final THA predictive model, presurgical pain was the only variable approaching significant results ([57]=1.746, β=0.254, =0.086). In the final TKA predictive model, optimism was the only predictor of pain ([51]=-2.518, β=-0.339, =0.015), with emotional representation ([51]=1.895, β=0.254, =0.064) presenting a trend toward significance.
The current study is the first examining THA and TKA differences on acute postsurgical pain intensity and its predictors using a multivariate approach. Results from this study could prove useful for the design of distinct interventions targeting acute postsurgical pain management depending on whether the site of arthroplasty is the hip or the knee. Finally, the current results also support the argument that these two surgeries, at least with regard to acute pain, should be approached separately.
急性疼痛是手术后的预期结果。然而，如果控制不当，急性疼痛会对个体临床结局产生非常负面的影响，损害愈合和恢复，并对医疗保健系统成本产生明显影响。增加对急性术后疼痛的预测因素和潜在可改变决定因素的了解，可以促进对有风险患者的早期识别和干预。然而，只有少数研究对全髋关节置换术（THA）和全膝关节置换术（TKA）后的急性疼痛进行了检查和比较。本研究的目的是比较THA和TKA术后急性疼痛强度及其预测因素。
对124例骨关节炎患者（64例行THA，60例行TKA）进行连续抽样，在手术前24小时（T1）和手术后48小时（T2）进行评估。在T1时评估人口统计学、临床和心理因素，在T2时检查术后急性疼痛经历。此外，对每种关节置换类型分别进行相同的层次回归分析。
与THA相比，TKA患者术后急性疼痛水平更高（=8.490，=0.004，=0.527，95%置信区间，0.196 - 0.878）。在最终的THA预测模型中，术前疼痛是唯一接近显著结果的变量（[57]=1.746，β=0.254，= .086）。在最终的TKA预测模型中，乐观是疼痛的唯一预测因素（[51]= - 2.518，β= - 0.339，=0.015），情绪表征（[51]=1.895，β=0.254，=0.064）呈现出显著趋势。
本研究是首次使用多变量方法研究THA和TKA在术后急性疼痛强度及其预测因素方面的差异。本研究结果可能有助于根据关节置换部位是髋关节还是膝关节，设计针对术后急性疼痛管理的不同干预措施。最后，目前的结果也支持这两种手术至少在急性疼痛方面应分别进行处理的观点。
