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Perioperative regional anaesthesia could be a preferred
over multimodal analgesia without local anaesthesia as it provided superior
relief in pain up till one-month post-TKA.
A total
knee replacement is a surgical manner whereby the diseased knee joint is
displaced with artificial material. The knee is the hinge joint which gives
motion at the point where the thigh meets the lower leg. Perioperative regional
anaesthesia can protect from persistent postsurgical pain (PPSP) and improve
outcome after total knee arthroplasty (TKA). Total knee replacement study was
aimed to determine the impact of regional anaesthesia on PPSP and long-term
functional outcome after TKA.
Undergoing basic unilateral TKA, aged more than 18 years, informed consent,
American Society of Anesthesiologists (ASA) physical status classes 1 to 3, no
earlier knee surgery. Personal data such as age, sex, BMI and ASA class,
preoperative pain evaluated by numerical rating scale (NRS) score, and risk
determinants for PPSP were registered preoperatively. Data were collected on
anaesthetic and analgesic techniques. Postoperative pain (NRS), analgesic
consumption, significant complications and patient satisfaction were recorded
up to the time of discharge. A blinded investigator assessed PPSP during a
phone call after 1, 3 and six months, examining patient satisfaction, quality
of life (QOL) and normal functionality.
Main outcome meaures experience of PPSP according to the type of peri-operative
analgesia.
Five hundred sixty-three patients completed the follow-up. At six months, 21.6% of patients experienced PPSP, whereas autonomy was developed only in 56.3%; QOL was aggravated or unchanged in 30.7% of patients and developed in 69.3%. Patients who received continuous regional anaesthesia with epidural or peripheral nerve block exhibited a lower NRS through the whole peri-operative period up to 1 month when compared with both single shots peripheral nerve block and those who did not receive any regional anaesthesia. Variation was not observed between these latter two groups. Variations in PPSP at 3 or 6 months were not consequently affected by the type of anaesthesia or postoperative analgesia. A higher NRS score at one month, younger age, history of anxiety or depression, higher BMI, pro-inflammatory status, and a lower ASA physical status were related to a higher prevalence of PPSP and worsened QOL at six months.
Continuous
regional anaesthesia provided analgesic benefit for up to 1 month after surgery
but did not influence PPSP at six months. Better pain control at one month
found associated with reduced PPSP. Patients with higher expectations from
surgery enhanced basal inflammation and a pessimistic outlook is more prone to
develop PPSP.
Eur J Anaesthesiol. 2017 Aug 1
Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: A prospective, observational, multicentre study
Bugada D. et al.
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