Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty

Greimel, Felix; Maderbacher, Günther; Baier, Clemens; Keshmiri, Armin; Schwarz, Timo; Zeman, Florian; Meißner, Winfried; Grifka, Joachim; Benditz, Achim

doi:10.1038/s41598-018-22146-7

Cited by 22 publications

(31 citation statements)

References 31 publications

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“…Patients were divided into two groups in question: UKA (n = 2117) and TKA (n = 3798). The following statistical evaluation was performed according to Greimel et al 28 , 29 . To get comparable groups in size and distribution of the confounding variables a 1:1 match was performed.…”

Section: Methodsmentioning

confidence: 99%

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Leiß¹,

Götz²,

Maderbacher³

et al. 2020

Sci Rep

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Unicompartmental knee arthroplasty and total knee arthroplasty are well established treatment options for end-stage osteoarthritis, UKA still remains infrequently used if you take all knee arthroplasties into account. An important factor following knee arthroplasty is pain control in the perioperative experience, as high postoperative pain level is associated with persistent postsurgical pain. There is little literature which describes pain values and the need for pain medication following UKA and/or TKA. So far, no significant difference in pain has been found between UKA and TKA. The aim of the study was to evaluate differences in the postoperative course in unicompartmental knee arthroplasty vs. total knee arthroplasty regarding the need for pain medication and patient-reported outcomes including pain scores and side effects. We hypothesized that unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of postoperative pain values and the need of pain medication. In this project, we evaluated 2117 patients who had unicompartmental knee arthroplasty and 3798 who had total knee arthroplasty performed, from 2015 to 2018. A total of 4144 patients could be compared after performing the matched pair analysis. A professional team was used for data collection and short patient interviews to achieve high data quality on the first postoperative day. Parameters were compared after performing a 1:1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those of the TKA group (p < 0.001 respectively for activity pain, minimum and maximum pain). In the recovery unit, there was less need for pain medication in patients with UKA (p = 0.004 for non-opioids). The opiate consumption was similarly lower for the UKA group, but not statistically significant (p = 0.15). In the ward, the UKA group needed less opioids (p < 0.001). Patient subjective parameters were significantly better for UKA. After implantation of unicompartmental knee arthroplasty, patients showed lower pain scores, a reduced need for pain medication and better patient subjective parameters in the early postoperative course in this study.

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Section: Methodsmentioning

confidence: 99%

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Leiß¹,

Götz²,

Maderbacher³

et al. 2020

Sci Rep

Self Cite

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“…Although each technique has some advantages and drawbacks, it seems that the combination of intraoperative general balanced anaesthesia and postoperative peripheral anaesthesia (nerve blocks) offers best analgesia and adverse effect profile. 23 Neural blocks other than FNB and FICNB are also being used, with similar effects, such as psoas compartment block (PCB) 39 and adductor canal block (ACB). 40 These new variations of the multimodal concept of analgesia offer no additional value, in comparison with the FNB and FICNB.…”

Section: Resultsmentioning

confidence: 99%

“…18 Due to a significant list of comorbidities in patients undergoing TKA 19 on one hand and the complex innervation of the knee joint on the other, 20 postoperative analgesia following the elective knee surgery evolves towards a multimodal approach, combining nerve blocks with the conventional systemic administration of analgesics. 21,22 Among the several nerve blocks used so far, 20,23,24 the "3-in-1" femoral nerve block (FNB) 25 and the fascia iliaca compartment nerve block (FICNB) 26 have been most frequently used.…”

Section: Multimodal Neural Block Analgesia Versus Morphine Analgesia mentioning

confidence: 99%

Multimodal neural block analgesia versus morphine analgesia after elective knee surgery

Lončar-Stojiljković¹

2019

Scripta Medica

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Background: Total knee arthroplasty has become a standard for treatment of endstage knee osteoarthritis. Due to intense and complex knee innervation, there is a need to improve the anaesthetic/analgesic approach to such operations. The aim of this randomised clinical trial was to compare the analgesic efficacy of the classical regimen and two of those based on the nerve blocks. Methods: A total of 60 patients was included and subjected to elective total knee arthroplasty under the general balanced anaesthesia. They were randomised to receive postoperatively (1) only morphine 5-10 mg q6h and paracetamol 1 g q6h (MP), (2) femoral nerve block (FNB) or (3) fascia iliac compartment nerve block (FICNB). Nerve blocks were produced by a single administration of 30-40 ml of bupivacaine 0.5%. Pain intensity, duration of neural block and additional consumption of analgesics were recorded postoperatively. Results: There were no demographic differences among the three groups of patients. Pain intensity was significantly lower in the two nerve block groups than in the MP group. The same two groups also demanded significantly less analgesics postoperatively than the MP group. Cardiovascular control was significantly better in the nerve block groups. There were no significant differences between the FNB and FIC-NB groups of patients regarding any of the studied parameters. Conclusion: In comparison with the classical MP analgesia, use of FNB or FICNB after the elective total knee arthroplasty results in lower pain scores, lower systolic blood pressure and less consumption of analgesics in the immediate postoperative course.

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“…The most common type of anaesthesia in total knee arthroplasty is spinal anaesthesia, general anaesthesia and combined spinal and epidural anaesthesia (Greimel et al 2018). Neuraxial anaesthesia was safe and equally effective compared to general anaesthesia while performing arthroplasty surgery (Johnson et al 2016).…”

Section: Discussionmentioning

confidence: 99%

An evidence-based review of enhanced recovery after surgery in total knee replacement surgery

Ghosh

Chatterji

2018

Journal of Perioperative Practice

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Enhanced recovery after surgery is gaining popularity among orthopaedic surgeons across the globe and hence a strong evidence base had to be reviewed to make an evidence-based sustainable protocol. Methods The following databases, PubMed, OVID, Cochrane database and EMBASE were searched. The search was limited to 15 components of enhanced recovery after surgery programme which is divided into preoperative, intraoperative and postoperative phases. Inclusion criteria were restricted to articles published in English within the last 15 years and articles comprising of unicompartmental arthroplasty, revision knee arthroplasty, bilateral simultaneous knee arthroplasty and only hip arthroplasty excluded. The full texts were analysed and controversies and limitations of various studies were summarised. Discussion Each component of the programme was thoroughly reviewed and strength and weaknesses of the evidence base summarised. The strength of the evidence was assessed by critically appraising the study methodology and justifying the appropriateness of the inclusion in enhanced recovery after surgery protocol. Conclusion Enhanced recovery after surgery has already been used successfully in various surgical specialities. Enhanced recovery after surgery programmes in knee arthroplasty are yet to be established as a universal practice to be adopted globally. This evidence-based review provides an insight into the best evidence linked to each component and their rationale for inclusion in the proposed enhanced recovery after surgery protocol.

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Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty

Cited by 22 publications

References 31 publications

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Multimodal neural block analgesia versus morphine analgesia after elective knee surgery

An evidence-based review of enhanced recovery after surgery in total knee replacement surgery

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