Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Abstract

Objectives: Despite substantial research showing the bidrectional relationship between sleep and pain, there remains a dearth of research examining the role of perioperative pain management interventions in mitigating postoperative sleep disturbances. This secondary analysis of a prospective observational multisite study examined the association between peripheral nerve block (PNB) use during total knee or total hip arthroplasty (TKA/THA) procedures and postoperative pain and sleep outcomes.Materials and Methods: Adult patients undergoing TKA or THA procedures were recruited from 2 tertiary care facilities. Average pain and sleep disturbance scores were collected preoperatively and at 1-and 2-week postoperatively. Participants were not randomized to receive PNB. Postoperative outcomes were compared based on receipt of PNB during surgery. Structural equation modeling path analysis was utilized to model multiple co-occurring relationships, including mediation pathways between perioperative pain management approaches, pain, and postoperative sleep outcomes.Results: Of the 197 participants, 53% received PNB. Mediation analyses indicated that PNB was indirectly associated with 1-week sleep disturbance via its effects on 1-week pain intensity (β = −0.02, 95% confidence interval [CI] −0.04, −0.001, P = 0.04). In addition, PNB was indirectly associated with 2-week sleep disturbance, via its effects on 1-week pain intensity and 1-week sleep disturbance (β = −0.04, 95% CI −0.07, −0.02, P = 0.04). Lastly, PNB was indirectly associated with 2-week pain intensity via its effects on 1-week pain intensity (β = −0.10, 95% CI −0.19, −0.02, P = 0.02).Conclusions: Receipt of PNB during TKA or THA was found to be associated with improved 1-week postoperative pain intensity, which in turn was found to be associated with lower sleep disturbances at both 1-and 2-week postoperative time points. Multimodal opioid sparing pain management interventions, capable of improving postoperative sleep, are vital to improving recovery and rehabilitation following arthroplasty.

Preoperative frailty predicts postoperative pain after total knee arthroplasty in elderly patients: a prospective observational study

“…Some previous studies have identi ed APSP as a risk factor for CPSP following TKA even after adjusting for confounding variables [8,15]. In our study, patients with severe pain in three days after operation were more likely to develop CPSP after TKA.…”

Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial

“…In addition, on the first day after surgery, patients in the GA group were awake more often at night than those in the PNB group, suggesting that the sleep quality of patients was better in the PNB group than in the GA group, and the effective postoperative analgesic effect of nerve block anesthesia had a positive effect on patients’ sleep. Nicholas A. Giordano 36 studied the correlation between peripheral nerve block, postoperative pain, and sleep disorders in the first and second weeks after surgery in patients who underwent lower limb joint replacement. At the three postoperative time points, the intensity of pain at each time point was positively correlated with sleep disorders at the same time point.…”

“…In short, receiving a peripheral nerve block during lower limb joint replacement was associated with an improvement in pain intensity one week after surgery and reduced the incidence of sleep disturbances the first and second weeks after surgery. 36 During hospitalization, we used the EQ-5D-5 L scores to evaluate the recovery of patients on the first, second and third days after surgery. The median EQ-5D-5 L score in the two groups was approximately forty points, and most patients showed a negative attitude toward their own quality of life evaluation.…”