Analgesic drug consumption increases after knee arthroplasty: A pharmacoepidemiological study investigating postoperative pain

Abstract

Knee arthroplasty remains the gold standard in the treatment of severe osteoarthritis. Chronic postoperative pain has been reported with a prevalence ranging from 15% to 47%. The aim of this study was to compare analgesic drug consumption before and after surgery as an indicator of pain after knee surgery. A pharmacoepidemiological method comparing analgesics and antineuropathic issues 1 year before and 1 year after surgery was used. All patients who underwent knee arthroplasty in the Midi-Pyrenees region (2.5 million inhabitants) were identified through the Health Insurance System Database. Increase of drug issues (all analgesics, antineuropathic drugs, strong opioids) was calculated and compared between several periods surrounding the surgery (12 months, 2 months, and 10 months before and after the knee arthroplasty). A multivariate logistic regression model was used to identify factors associated with chronic postoperative pain. The study included 1939 patients. An increase in analgesic, antineuropathic, and opioid drug consumption was observed the year after the surgery in 47.3%, 8.6%, and 5.6% of patients, respectively. Multivariate analysis found a significant association between type of surgery (total knee vs unicompartmental arthroplasty) and analgesic consumption 1 year after surgery, and between preoperative pain and psychiatric vulnerability and increase in neuropathic drug dispensing. Conversely, older age was considered as a protective factor. This study revealed that an increase in the issue of different analgesic drugs is present in half of patients 1 year after knee arthroplasty. Several associated factors of drug consumption (preoperative pain, type of surgery, and psychiatric disorder) were identified.

One half of patients reports persistent pain three months after orthopaedic surgery

“…Even though acetaminophen remained the most frequently used (Table 3), as it is in the postoperative period in France [27], a combination of different medications, including NSAIDs, tramadol, and opioids, was noted in 38% of cases. These results are in accordance with a recent study, using the French Health Insurance System Database, which concluded that 47.3% of 1939 patients had an increase in the provision of pain-reliever drugs, one year after TKA [28]. In the same study, drugs with anti-neuropathic effects were consumed by 16% of patients only.…”

Analgesic Drug Prescription After Carpal Tunnel Surgery

“…7 Data were extracted from the French national health insurance database (SNIIRAM [Système National d'Information Inter-Régime de l'Assurance Maladie] 8 ) for the Midi-Pyrénées area (southwest France, with 2.8 million inhabitants). This database covers salaried workers, agricultural workers and farmers, self-employed individuals, retired persons, low-income persons, and unemployed persons, including therefore 97% of the area's general population.…”

“…8 The PMSI database was described and used in several previous studies. 7,[11][12][13] In this database, all hospitalizations (in all public and private hospitals wherever in France) are included in standardized hospital discharge summaries for case-mix analysis. The PMSI is commonly used in France to provide epidemiological data and is particularly helpful in determining the magnitude of newly identified problems.…”

“…The goal of the present study was to assess the evolution of analgesic drug prescription patterns before and after CTS surgery, through analysis of prescribed and reimbursed drugs as recorded in the French Health Insurance System Database. [7][8][9] The main objective of the present study was to assess the variations in analgesic drug prescriptions, with a special focus on constant or increased prescription patterns, during the 12 months after CTS surgery compared with the year before surgery. The secondary objectives included description of the type of drugs (particularly antineuropathic but also opioid drugs) and investigation of factors associated with variation in postoperative drug dispensing.…”

Esminės charakteristikos pacientų, atvykstančių į pirminę kelio sąnario endoprotezavimo operaciją

“…Šie rezultatai yra panašūs į kito tyrimo, atlikto 2013 m. Jungtinėse Amerikos Valstijose, rezultatus, kur teigiama, kad kartais arba dažnai vaistus nuo skausmo vartoja 35,57 procento žmonių, kenčiančių nuo kelio sąna-rio osteoartrozės [15]. Tačiau šiuos rezultatus galima vertinti kritiškai, nes yra tyrimų, kurių rezultatai teigia, kad po kelio sąnario endoprotezavimo vaistų nuo skausmo vartojimas nesumažėja, o atvirkščiai -pusė pacientų pradeda vartoti daugiau nuskausminamųjų vaistų [16]. Taigi apie operacijos poreikį turi nuspręsti gydytojas, įvertinęs individualią žmogaus situaciją.…”