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全髋关节和膝关节置换术后急性疼痛并不影响术后第一年的慢性疼痛:389 例患者的观察性队列研究。

Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients.

机构信息

Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.

Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Rheumatol Int. 2022 Apr;42(4):689-698. doi: 10.1007/s00296-022-05094-4. Epub 2022 Feb 26.

Abstract

Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012-December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS ≤ 4) or moderate/severe (NRS > 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [-12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [-9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain.

摘要

慢性疼痛在骨关节炎(OA)患者接受全髋关节和膝关节置换术后(THA/TKA)经常报告。我们研究了 OA 患者 THA/TKA 后急性术后疼痛的严重程度是否与术后第一年的疼痛有关。从一项观察性研究中,我们从荷兰的两家医院纳入了计划接受初次 THA/TKA(2012 年 6 月至 2017 年 12 月)的 OA 患者。在术后 72 小时内收集急性术后疼痛评分,并分为无/轻度(NRS≤4)或中度/重度(NRS>4)。使用 HOOS/KOOS 亚量表疼痛,在术前、术后 3、6 和 12 个月评估疼痛。通过多级混合效应分析,我们估计了急性和慢性疼痛之间的关联,直到术后 1 年,调整了混杂因素并包括了交互项(Time*Acute pain)。纳入了 193 例 THA 和 196 例 TKA 患者,29%的 THA 和 51%的 TKA 患者术后急性疼痛中度/重度。在 THA 组中,无/轻度和中度/重度组在术后 3 个月的疼痛差异约为 6 点,无/轻度组有利(95%CI[-12.4 至 0.9]),随着时间的推移,这种差异变小。在 TKA 组中,我们发现了类似的差异,无/轻度和中度/重度组在术后 6 个月时差异约为 4 点(95%CI[-9.6 至 1.3]),12 个月时差异减弱。急性术后疼痛严重程度与术后第一年疼痛之间没有关联。这些发现表明,限制急性术后疼痛的措施可能不会影响慢性疼痛的发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/625a/8940785/7565b6742762/296_2022_5094_Fig1_HTML.jpg

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