Effect of Rebound Pain on Chronic Postsurgical Pain After Total Knee Arthroplasty

Effect of Rebound Pain on Chronic Postsurgical Pain After Total Knee Arthroplasty: A Prospective Observational Study

This prospective observational study aims to evaluate whether rebound pain after peripheral nerve block is associated with the development of chronic postsurgical pain following elective total knee arthroplasty. Adult patients undergoing unilateral total knee arthroplasty under spinal anesthesia and receiving a peripheral nerve block as part of routine multimodal analgesia will be included. No additional intervention, drug administration, or biological sampling will be performed beyond standard clinical care.

Rebound pain will be assessed during the early postoperative period using pain diaries, numeric rating scale pain scores, and analgesic consumption records. Chronic postsurgical pain and related outcomes will be evaluated at postoperative 3 and 6 months using validated instruments assessing pain severity, neuropathic pain features, psychological status, functional outcomes, and health-related quality of life. The primary outcome is the presence of chronic postsurgical pain at 3 months after surgery. Secondary outcomes include chronic pain at 6 months, pain intensity, neuropathic pain characteristics, opioid consumption, rescue analgesic requirements, sleep disturbance, and quality-of-life measures. The study also aims to explore demographic and clinical factors associated with rebound pain and chronic postsurgical pain.

Study Overview

• Status: Not yet recruiting
• Conditions: Chronic Pain; Arthroplasty, Replacement, Knee; Acute Pain, Postoperative

• Study Type: Observational
• Enrollment (Estimated): 220

Contacts and Locations

• Study Contact: Name: Mahmut Tutar, MD; Phone Number: +905552723704; Email: masatu42@gmail.com

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Adult patients undergoing unilateral elective total knee arthroplasty at Konya City Hospital under spinal anesthesia and receiving a peripheral nerve block as part of routine multimodal analgesia.

Description

Inclusion Criteria:

• Age 18 years or older
• ASA physical status I to III
• Scheduled for unilateral elective total knee arthroplasty
• Planned to undergo spinal anesthesia
• Planned to receive a peripheral nerve block as part of routine multimodal analgesia
• Able to provide informed consent and complete study assessments

Exclusion Criteria:

• Chronic opioid use (60 mg oral morphine equivalent per day or more, or use for 3 months or longer)
• Significant neuropathy or radiculopathy
• Bilateral or two-stage total knee arthroplasty during the same hospitalization
• Contralateral total knee arthroplasty within the previous 6 months
• Severe cognitive impairment or major psychiatric disorder
• Chronic analgesic dependence

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Rebound Pain; Participants with a transition from well-controlled pain (Numeric Rating Scale [NRS] <=3) to severe pain (NRS >=7) within 0 to 48 hours after peripheral nerve block resolution.
No Rebound Pain; Participants without a transition from well-controlled pain (Numeric Rating Scale [NRS] <=3) to severe pain (NRS >=7) within 0 to 48 hours after peripheral nerve block resolution.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of Chronic Postsurgical Pain at 3 Months	Chronic postsurgical pain will be defined as pain developing or persisting after total knee arthroplasty that is not explained by another cause. Participants with pain and at least one Brief Pain Inventory-Short Form interference item score of 3 or higher at postoperative month 3 will be considered positive for chronic postsurgical pain.	3 months after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity in the Early Postoperative Period	Pain intensity at rest and during movement will be assessed using the Numeric Rating Scale during the first 72 hours after surgery.	0 to 72 hours after surgery
Presence of Chronic Postsurgical Pain at 6 Months assessed by Brief Pain Inventory-Short Form (BPI-SF) interference score	Presence of chronic postsurgical pain at postoperative month 6 will be assessed using the same Brief Pain Inventory-Short Form (BPI-SF)-based study definition applied at month 3: pain not explained by another cause, NRS >0, and at least one BPI-SF interference item score of 3 or higher.	6 months after surgery

Collaborators and Investigators

• Sponsor: Konya City Hospital
• Investigators: Principal Investigator: MAHMUT TUTAR, MD, Konya City Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): April 7, 2026
• Primary Completion (Estimated): December 12, 2026
• Study Completion (Estimated): December 12, 2026

Study Registration Dates

• First Submitted: March 30, 2026
• First Submitted That Met QC Criteria: March 30, 2026
• First Posted (Actual): April 6, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 5, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: total knee arthroplasty; chronic postsurgical pain; rebound pain
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Chronic Pain
• Other Study ID Numbers: KONYAEH-RA-TDP-2025-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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