Improved Pain Management in Knee Osteoarthritis-related Surgeries

Evaluating the Effectiveness of Continuously Improved Pain Management in Knee Osteoarthritis-related Surgeries

In recent years, pain management coordinated with enhanced recovery after surgery (ERAS) has been widely applied and rapidly developed in orthopedics, showing promising prospects. Since 2016, our hospital has used a series of continuously improved pain management schemes for patients with knee OA who underwent total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO). Here, we retrospectively analyze these patients' clinical data to compare the effects of different pain intervention measures during the perioperative period on postoperative pain, functional exercise, hospital stay, and prognosis of the three surgical methods in an attempt to provide a feasible solution for pain management of these patients.

Study Overview

• Status: Completed
• Conditions: Knee Osteoarthritis; Pain Management; Total Knee Arthroplasty; Unicompartmental Knee Arthroplasty; High Tibial Osteotomy
• Intervention / Treatment: Procedure: Preoperative pain managment; Procedure: Intraoperative pain managment; Procedure: Postoperative pain managment

Detailed Description

We retrospectively analyzed the clinical data of patients with knee osteoarthritis (OA) who received surgical treatment to provide a feasible solution for perioperative pain management of these patients. The medical records of 714 patients with knee OA who had undergone total knee arthroplasty (n=551), unicompartmental knee arthroplasty (n=92) and high tibial osteotomy (n=71) were retrospectively analyzed and the cases were divided into Groups A, B, and C, according to the continuously optimized pain management. Clinical data including anesthesia grade, surgery time, functional exercise, hospital stay, pain, emotion, complications and prognosis were compared.

• Study Type: Observational
• Enrollment (Actual): 714

Contacts and Locations

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China, 610072
      • Sichuan Provincial People's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The medical records of 714 patients (142 men, 40 women; mean age: 38.5 years; age range: 18-64 years) with moderate or severe knee OA who had undergone TKA (n=551), UKA (n=92), or HTO (n=71) in a group of joint surgery at Sichuan Provincial People's Hospital between March 2016 and February 2022 were retrospectively analyzed. Clinical data, including age, weight, height, anesthesia grade, surgery, and time, as well as continuously improved perioperative pain management measures, were recorded.

Description

Inclusion Criteria:

• first knee surgery were 50-80 years old had complete clinical and follow-up data

Exclusion Criteria:

• American Society of Anesthesiologists Physical Status grade≥4 comorbidity with three or more systemic diseases long-term anxiety and depression, contraindications of painkillers, long-term alcoholism, or taking painkillers concomitant limb pain caused by spinal degeneration

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Total knee arthroplasty (TKA); Total knee arthroplasty	Procedure: Preoperative pain managment; propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery; Procedure: Intraoperative pain managment; Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia; Procedure: Postoperative pain managment; The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡
Unicompartmental knee arthroplasty (UKA); Unicompartmental knee arthroplasty	Procedure: Preoperative pain managment; propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery; Procedure: Intraoperative pain managment; Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia; Procedure: Postoperative pain managment; The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡
High tibial osteotomy (HTO); High tibial osteotomy	Procedure: Preoperative pain managment; propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery; Procedure: Intraoperative pain managment; Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia; Procedure: Postoperative pain managment; The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
visual analogue score (VAS)	visual analogue score (VAS)	24 hours after surgery
visual analogue score (VAS)	visual analogue score (VAS)	72 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps muscle strength	Quadriceps muscle strength	24 hours after surgery
Quadriceps muscle strength	Quadriceps muscle strength	72 hours after surgery
Scope of activities to knee joint	Scope of activities to knee joint	24 hours after surgery
Scope of activities to knee joint	Scope of activities to knee joint	72 hours after surgery

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-Rating Anxiety Scale (SAS)	Self-Rating Anxiety Scale (SAS)	24 hours after surgery
Self-Rating Anxiety Scale (SAS)	Self-Rating Anxiety Scale (SAS)	72 hours after surgery
Self-Rating Depression Scale (SDS)	Self-Rating Depression Scale (SDS)	24 hours after surgery
Self-Rating Depression Scale (SDS)	Self-Rating Depression Scale (SDS)	72 hours after surgery

Collaborators and Investigators

• Sponsor: Peng Liu

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2016
• Primary Completion (Actual): March 2, 2022
• Study Completion (Actual): March 2, 2023

Study Registration Dates

• First Submitted: November 4, 2023
• First Submitted That Met QC Criteria: November 8, 2023
• First Posted (Actual): November 9, 2023

Study Record Updates

• Last Update Posted (Actual): November 9, 2023
• Last Update Submitted That Met QC Criteria: November 8, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: 2023-414

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No