Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty
Background Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphen...
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| Veröffentlicht in: | European journal of pain 2018-04, Vol.22 (4), p.691-699 |
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| container_title | European journal of pain |
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| creator | Dincklage, F. Jakuscheit, A. Weth, J. Lichtner, G. Jurth, C. Rehberg‐Klug, B. |
| description | Background
Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphenomenon of insufficient intraoperative analgesia. In this study, we investigated the association between the intraoperative level of analgesia and the persistent postoperative pain 6 months after surgery.
Methods
We investigated 110 patients undergoing primary total hip arthroplasty under total intravenous general anaesthesia in a prospective cohort study. A highly standardized surgical and a standardized anaesthetic procedure were performed to reduce variability and psychosocial influences were investigated to adjust for confounders. Acute postoperative pain was controlled using patient‐controlled analgesia pumps. Postoperative pain intensities and analgesic requirements were monitored for 6 months following surgery.
Results
Of 105 patients included in the analysis, 32% continued using daily pain medication 6 months after surgery and reported a median pain level of 4/10. Multivariate analyses confirmed that the amount of intraoperative analgesia is a significant predictor of regular analgesic use and pain intensity 6 months after surgery.
Conclusions
Higher levels of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption 6 months after total hip arthroplasty. Persistent pain may be attributable to intraoperative nociception, which is likely not adequately assessed and suppressed using current clinical measures.
Significance
Our study suggests that lower doses of intraoperative analgesia are associated with higher levels of persistent postoperative pain. Persistent pain may be caused by intraoperative nociception, which is likely not adequately suppressed using current clinical standard analgesic measures. |
| doi_str_mv | 10.1002/ejp.1145 |
| format | Article |
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Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphenomenon of insufficient intraoperative analgesia. In this study, we investigated the association between the intraoperative level of analgesia and the persistent postoperative pain 6 months after surgery.
Methods
We investigated 110 patients undergoing primary total hip arthroplasty under total intravenous general anaesthesia in a prospective cohort study. A highly standardized surgical and a standardized anaesthetic procedure were performed to reduce variability and psychosocial influences were investigated to adjust for confounders. Acute postoperative pain was controlled using patient‐controlled analgesia pumps. Postoperative pain intensities and analgesic requirements were monitored for 6 months following surgery.
Results
Of 105 patients included in the analysis, 32% continued using daily pain medication 6 months after surgery and reported a median pain level of 4/10. Multivariate analyses confirmed that the amount of intraoperative analgesia is a significant predictor of regular analgesic use and pain intensity 6 months after surgery.
Conclusions
Higher levels of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption 6 months after total hip arthroplasty. Persistent pain may be attributable to intraoperative nociception, which is likely not adequately assessed and suppressed using current clinical measures.
Significance
Our study suggests that lower doses of intraoperative analgesia are associated with higher levels of persistent postoperative pain. Persistent pain may be caused by intraoperative nociception, which is likely not adequately suppressed using current clinical standard analgesic measures.</description><identifier>ISSN: 1090-3801</identifier><identifier>EISSN: 1532-2149</identifier><identifier>DOI: 10.1002/ejp.1145</identifier><identifier>PMID: 29139193</identifier><language>eng</language><publisher>England</publisher><subject>Aged ; Analgesics - therapeutic use ; Arthroplasty, Replacement, Hip - methods ; Female ; Humans ; Intraoperative Care - methods ; Male ; Middle Aged ; Pain Management - methods ; Pain Measurement - methods ; Pain, Postoperative - drug therapy ; Pain, Postoperative - prevention & control ; Prospective Studies ; Time Factors ; Treatment Outcome</subject><ispartof>European journal of pain, 2018-04, Vol.22 (4), p.691-699</ispartof><rights>2017 European Pain Federation ‐ EFIC</rights><rights>2017 European Pain Federation - EFIC®.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3555-9f71e603be485e3a94314fee80b25f6f27aaaca72ef69f81aa0df505b4f7f6573</citedby><cites>FETCH-LOGICAL-c3555-9f71e603be485e3a94314fee80b25f6f27aaaca72ef69f81aa0df505b4f7f6573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejp.1145$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejp.1145$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29139193$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dincklage, F.</creatorcontrib><creatorcontrib>Jakuscheit, A.</creatorcontrib><creatorcontrib>Weth, J.</creatorcontrib><creatorcontrib>Lichtner, G.</creatorcontrib><creatorcontrib>Jurth, C.</creatorcontrib><creatorcontrib>Rehberg‐Klug, B.</creatorcontrib><title>Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty</title><title>European journal of pain</title><addtitle>Eur J Pain</addtitle><description>Background
Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphenomenon of insufficient intraoperative analgesia. In this study, we investigated the association between the intraoperative level of analgesia and the persistent postoperative pain 6 months after surgery.
Methods
We investigated 110 patients undergoing primary total hip arthroplasty under total intravenous general anaesthesia in a prospective cohort study. A highly standardized surgical and a standardized anaesthetic procedure were performed to reduce variability and psychosocial influences were investigated to adjust for confounders. Acute postoperative pain was controlled using patient‐controlled analgesia pumps. Postoperative pain intensities and analgesic requirements were monitored for 6 months following surgery.
Results
Of 105 patients included in the analysis, 32% continued using daily pain medication 6 months after surgery and reported a median pain level of 4/10. Multivariate analyses confirmed that the amount of intraoperative analgesia is a significant predictor of regular analgesic use and pain intensity 6 months after surgery.
Conclusions
Higher levels of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption 6 months after total hip arthroplasty. Persistent pain may be attributable to intraoperative nociception, which is likely not adequately assessed and suppressed using current clinical measures.
Significance
Our study suggests that lower doses of intraoperative analgesia are associated with higher levels of persistent postoperative pain. Persistent pain may be caused by intraoperative nociception, which is likely not adequately suppressed using current clinical standard analgesic measures.</description><subject>Aged</subject><subject>Analgesics - therapeutic use</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Intraoperative Care - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pain Management - methods</subject><subject>Pain Measurement - methods</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Prospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1090-3801</issn><issn>1532-2149</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1P3DAQhq2KCihF6i9APnIJ2HGcrI8IAdsKqT2052g2GRMjJw4eL8v-Hv4o5qNw4jQe-XmfObyM_ZDiRApRnuLtfCJlpb-wfalVWZSyMjv5LYwo1ELIPfaN6FYIUTVC7bK90khlpFH77HHpbgaMvA-ExIPlbkoRwowRkrtHDhP4GyQHHGLeiELnIGHPNy4N3IdNznq8R_8SzjFylHBKfAY35XSff4neNR3vwkTrcU4uTJzcAx_DlIYM2JRNKSTwfHBzvpaGGGYPlLbf2VcLnvDwbR6wf5cXf8-XxfXvq5_nZ9dFp7TWhbGNxFqoFVYLjQpMpWRlERdiVWpb27IBgA6aEm1t7EICiN5qoVeVbWytG3XAjl-9cwx3a6TUjo469B4mDGtqpamr2tTGlB9oFwNRRNvO0Y0Qt60U7XMlba6kfa4ko0dv1vVqxP4d_N9BBopXYOM8bj8VtRe__rwInwB-25oH</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>Dincklage, F.</creator><creator>Jakuscheit, A.</creator><creator>Weth, J.</creator><creator>Lichtner, G.</creator><creator>Jurth, C.</creator><creator>Rehberg‐Klug, B.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201804</creationdate><title>Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty</title><author>Dincklage, F. ; Jakuscheit, A. ; Weth, J. ; Lichtner, G. ; Jurth, C. ; Rehberg‐Klug, B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3555-9f71e603be485e3a94314fee80b25f6f27aaaca72ef69f81aa0df505b4f7f6573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Analgesics - therapeutic use</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Intraoperative Care - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pain Management - methods</topic><topic>Pain Measurement - methods</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Prospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dincklage, F.</creatorcontrib><creatorcontrib>Jakuscheit, A.</creatorcontrib><creatorcontrib>Weth, J.</creatorcontrib><creatorcontrib>Lichtner, G.</creatorcontrib><creatorcontrib>Jurth, C.</creatorcontrib><creatorcontrib>Rehberg‐Klug, B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dincklage, F.</au><au>Jakuscheit, A.</au><au>Weth, J.</au><au>Lichtner, G.</au><au>Jurth, C.</au><au>Rehberg‐Klug, B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty</atitle><jtitle>European journal of pain</jtitle><addtitle>Eur J Pain</addtitle><date>2018-04</date><risdate>2018</risdate><volume>22</volume><issue>4</issue><spage>691</spage><epage>699</epage><pages>691-699</pages><issn>1090-3801</issn><eissn>1532-2149</eissn><abstract>Background
Persistent postoperative pain is a major health problem affecting nearly 30% of all patients undergoing total hip arthroplasty. Previous studies have demonstrated an association between the intensity of acute postoperative pain and persistent pain, but this association might be an epiphenomenon of insufficient intraoperative analgesia. In this study, we investigated the association between the intraoperative level of analgesia and the persistent postoperative pain 6 months after surgery.
Methods
We investigated 110 patients undergoing primary total hip arthroplasty under total intravenous general anaesthesia in a prospective cohort study. A highly standardized surgical and a standardized anaesthetic procedure were performed to reduce variability and psychosocial influences were investigated to adjust for confounders. Acute postoperative pain was controlled using patient‐controlled analgesia pumps. Postoperative pain intensities and analgesic requirements were monitored for 6 months following surgery.
Results
Of 105 patients included in the analysis, 32% continued using daily pain medication 6 months after surgery and reported a median pain level of 4/10. Multivariate analyses confirmed that the amount of intraoperative analgesia is a significant predictor of regular analgesic use and pain intensity 6 months after surgery.
Conclusions
Higher levels of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption 6 months after total hip arthroplasty. Persistent pain may be attributable to intraoperative nociception, which is likely not adequately assessed and suppressed using current clinical measures.
Significance
Our study suggests that lower doses of intraoperative analgesia are associated with higher levels of persistent postoperative pain. Persistent pain may be caused by intraoperative nociception, which is likely not adequately suppressed using current clinical standard analgesic measures.</abstract><cop>England</cop><pmid>29139193</pmid><doi>10.1002/ejp.1145</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of pain, 2018-04, Vol.22 (4), p.691-699 |
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| source | Access via Wiley Online Library; MEDLINE |
| subjects | Aged Analgesics - therapeutic use Arthroplasty, Replacement, Hip - methods Female Humans Intraoperative Care - methods Male Middle Aged Pain Management - methods Pain Measurement - methods Pain, Postoperative - drug therapy Pain, Postoperative - prevention & control Prospective Studies Time Factors Treatment Outcome |
| title | Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty |
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