den Hartog Yvon M, Hannink Gerjon, van Dasselaar Nick T, Mathijssen Nina M, Vehmeijer Stephan B
Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands.
Orthopaedic Research Lab, Department of Orthopaedics, Radboud university medical center, Nijmegen, the Netherlands.
BMC Musculoskelet Disord. 2017 Aug 24;18(1):363. doi: 10.1186/s12891-017-1725-8.
In our hospital a fast-track setting including a multimodal pain protocol is used for total hip arthroplasty (THA). Despite this multimodal pain protocol there is still a large range in reported postoperative pain between patients, which hinders mobilization and rehabilitation postoperatively. The goal of this study was to identify which patient-specific and surgical characteristics influence postoperative pain after THA in a fast-track setting.
All 74 patients with osteoarthritis of the hip who underwent primary THA procedure by anterior supine intermuscular approach between November 2012 and January 2014 were included in this prospective cohort study. The protocol for pain medication was standardized. Postoperative pain determined with the Numeric Rating Score was collected at 17 standardized moments. Linear mixed models were used to examine potential patient-specific and surgical factors associated with increased postoperative pain.
Pain patterns differed substantially across individuals. Adjusted for other variables in the model, preoperative use of pain medication (regression coefficient 0.78 (95% CI 0.28-1.26); p = 0.005) and preoperative neuropathic pain scored by DN4 (regression coefficient 0.68 (95% CI 0.15-1.20); p = 0.02) were the only factors significantly associated with higher postoperative pain scores.
The knowledge of which factors are associated with higher postoperative pain scores after THA in a fast-track setting may help optimizing perioperative postoperative pain management and preoperative education of these patients.
The study was retrospectively registered in the ISRCTN registry under identifier ISRCTN15422220 (date of registration: July 25, 2017).
在我们医院，全髋关节置换术（THA）采用了包括多模式疼痛方案的快速康复模式。尽管有这种多模式疼痛方案，但患者术后报告的疼痛程度仍有很大差异，这阻碍了术后的活动和康复。本研究的目的是确定在快速康复模式下，哪些患者特异性和手术特征会影响THA术后疼痛。
本前瞻性队列研究纳入了2012年11月至2014年1月期间采用仰卧位前路肌间隙入路行初次THA手术的所有74例髋关节骨关节炎患者。疼痛药物治疗方案标准化。在17个标准化时间点收集用数字评分量表确定的术后疼痛情况。采用线性混合模型来检查与术后疼痛增加相关的潜在患者特异性和手术因素。
个体间疼痛模式差异很大。在模型中对其他变量进行调整后，术前使用止痛药物（回归系数0.78（95%CI 0.28 - 1.2）；p = 0.005）和用DN4评分的术前神经性疼痛（回归系数0.68（95%CI 0.15 - 1.2）；p = 0.02）是与术后疼痛评分较高显著相关的唯一因素。
了解在快速康复模式下THA术后哪些因素与较高的疼痛评分相关，可能有助于优化这些患者的围手术期术后疼痛管理和术前教育。
该研究于2017年7月25日在ISRCTN注册中心进行回顾性注册，标识符为ISRCTN15422220。
