Donauer Katharina, Bomberg Hagen, Wagenpfeil Stefan, Volk Thomas, Meissner Winfried, Wolf Alexander
Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University, University Medical Center, Homburg/Saar, Germany.
Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Center, Homburg/Saar, Germany.
Pain Pract. 2018 Nov;18(8):1036-1047. doi: 10.1111/papr.12708. Epub 2018 Jun 25.
Total hip and knee replacements are common surgeries, and an optimal pain treatment is essential for early rehabilitation. Since data from randomized controlled trials on the use of regional anesthesia in joint replacements of the lower extremities are conflicting, we analyzed the international PAIN OUT registry for comparison of regional anesthesia vs. general anesthesia regarding pain and morphine consumption on the first postoperative day.
International Classification of Diseases-9 (ICD-9) codes were used to identify 2,346 cases of knee arthroplasty and 2,315 cases of hip arthroplasty between 2010 and 2016 from the PAIN OUT registry. Those were grouped according to anesthesia provided (general, regional, and a combination of both). On the first day after surgery, pain levels and opioid consumption were compared. Adjusted odds ratios (ORs [and 95% confidence intervals (CIs)]) were calculated with logistic regression, and propensity matching was used as a sensitivity analysis.
After adjustment for confounders, regional anesthesia was associated with reduced opioid consumption (OR 0.20 [95% CI 0.13 to 0.30], P < 0.001) and less pain (OR 0.53 [95% CI 0.36 to 0.78], P = 0.001) than was general anesthesia in knee surgery. In hip surgery, regional anesthesia was only associated with reduced opioid consumption (OR 0.17 [95% CI 0.11 to 0.26], P < 0.001), whereas pain was comparable (OR 1.23 [95% CI 0.94 to 1.61], P = 0.1). Results from a propensity-matched sensitivity analysis were similar.
In total knee arthroplasty, regional anesthesia was associated with less pain and lower opioid consumption. In total hip arthroplasty, regional anesthesia was associated with lower opioid consumption, but not with reduced pain levels.
全髋关节置换术和全膝关节置换术是常见手术，最佳疼痛治疗对早期康复至关重要。由于关于下肢关节置换术中使用区域麻醉的随机对照试验数据相互矛盾，我们分析了国际PAIN OUT注册库，以比较区域麻醉与全身麻醉在术后第一天的疼痛和吗啡消耗量。
使用国际疾病分类第9版（ICD - 9）编码，从PAIN OUT注册库中识别出2010年至2016年间的2346例膝关节置换术病例和2315例髋关节置换术病例。这些病例根据所提供的麻醉方式（全身麻醉、区域麻醉以及两者联合）进行分组。在术后第一天，比较疼痛程度和阿片类药物消耗量。采用逻辑回归计算调整后的比值比（OR[及95%置信区间（CI）]），并使用倾向匹配作为敏感性分析。
在对混杂因素进行调整后，与全身麻醉相比，区域麻醉在膝关节手术中与阿片类药物消耗量减少相关（OR 0.20[95%CI 0.13至0.30]，P<0.001）且疼痛较轻（OR 0.53[95%CI 0.36至0.78]，P = 0.001）。在髋关节手术中，区域麻醉仅与阿片类药物消耗量减少相关（OR 0.17[95%CI 0.11至0.26]，P<0.001），而疼痛程度相当（OR 1.23[95%CI 0.94至1.61]，P = 0.1）。倾向匹配敏感性分析的结果相似。
在全膝关节置换术中，区域麻醉与疼痛减轻和阿片类药物消耗量降低相关。在全髋关节置换术中，区域麻醉与阿片类药物消耗量降低相关，但与疼痛程度减轻无关。
