Gwam Chukwuweike U, Mistry Jaydev B, Mohamed Nequesha S, George Nicole E, Etcheson Jennifer I, Virani Sana, Scalsky Ryan, Singh Shreya, Piuzzi Nicolas S, Delanois Ronald E
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Surg Technol Int. 2017 Nov 9;31:237-242.
Managing postoperative pain can be challenging for arthroplasty surgeons. While pain control modalities, such as adductor canal blockade (ACB), have been proven effective, the multifactorial nature of pain perception may serve as an obstacle for optimizing pain control. This study assesses the effect of patient pre-operative physical status on patient perception of pain. Specifically, we compared 1) lengths of hospital stay (LOS), 2) pain levels, and 3) opioid consumption in patients receiving total knee arthroplasty (TKA) who presented with an American Society of Anesthesiologists physical status score (ASA) of 2 and 3.
A single hospital, single surgeon database was reviewed for patients who had TKA between January 2015 and April 2016. Only patients with an ASA class of 2 or 3 who received ACB were analyzed. This yielded 106 patients with a mean age of 63 years, comprised of 36 men and 70 women. Patients were stratified into those with an ASA class of 2 (n= 58) and those with an ASA class of 3 (n= 48). Electronic medical records were reviewed to obtain demographic and endpoint data. Pain was quantified using Visual Analog Scale (VAS). Continuous variables were compared using the student' s t-test and analysis of variance, while categorical variables were compared using chi-square analysis.
There was no significant difference found between the two groups in LOS (2.25 days vs. 2.19 days; p=0.805), VAS scores (4.95 vs. 5.75; p=0.306), and opioid consumption on day 0 (17.77 morphine eq vs. 23.49 morphine eq; p=0.233) and day 3 (9.11 morphine eq vs. 19.87 morphine eq; p=0.100). However, patients with an ASA score of 2 had a significantly lower opioid consumption on day 1 (32.20 morphine eq vs. 52.70 morphine eq; p=0.049), day 2 (19.21 morphine eq vs. 40.71 morphine eq; p=0.018), and overall (78.30 morphine eq vs. 135.77 morphine eq; p=0.024).
Despite the effectiveness of ACB in controlling pain, patient pre-operative status may affect perception of pain. This study demonstrates that patients with a higher ASA physical status classification consumed more opioid medication postoperatively, despite having similar pain scores and lengths of stay to those with a lower classification. Future studies should assess all ASA classifications and stratify for preoperative opioid consumption and tolerance as a possible confounder.
对于关节置换外科医生而言，管理术后疼痛可能具有挑战性。虽然诸如内收肌管阻滞（ACB）等疼痛控制方式已被证明有效，但疼痛感知的多因素性质可能成为优化疼痛控制的障碍。本研究评估患者术前身体状况对患者疼痛感知的影响。具体而言，我们比较了美国麻醉医师协会身体状况评分（ASA）为2级和3级的接受全膝关节置换术（TKA）患者的1）住院时间（LOS）、2）疼痛水平和3）阿片类药物消耗量。
回顾了一家医院、一位外科医生的数据库中2015年1月至2016年4月期间接受TKA的患者。仅分析接受ACB且ASA分级为2级或3级的患者。这产生了106例平均年龄为63岁的患者，其中包括36名男性和70名女性。患者被分为ASA分级为2级（n = 58）和ASA分级为3级（n = 48）的两组。回顾电子病历以获取人口统计学和终点数据。使用视觉模拟量表（VAS）对疼痛进行量化。连续变量使用学生t检验和方差分析进行比较，分类变量使用卡方分析进行比较。
两组在住院时间（2.25天对2.19天；p = 0.805）、VAS评分（4.95对5.75；p = 0.306）以及第0天（17.77吗啡当量对23.49吗啡当量；p = 0.233）和第3天（9.11吗啡当量对19.87吗啡当量；p = 0.100）的阿片类药物消耗量方面均未发现显著差异。然而，ASA评分为2级的患者在第1天（32.20吗啡当量对52.70吗啡当量；p = 0.049）、第2天（19.21吗啡当量对40.71吗啡当量；p = 0.018）以及总体（78.30吗啡当量对135.77吗啡当量；p = 0.024）的阿片类药物消耗量显著更低。
尽管ACB在控制疼痛方面有效，但患者术前状况可能会影响疼痛感知。本研究表明，ASA身体状况分类较高的患者术后消耗更多的阿片类药物，尽管其疼痛评分和住院时间与分类较低的患者相似。未来的研究应评估所有ASA分类，并将术前阿片类药物消耗量和耐受性作为可能的混杂因素进行分层。
