Subacute pain and function after fast-track hip and knee arthroplasty

TY - JOUR

T1 - Subacute pain and function after fast-track hip and knee arthroplasty

AU - Andersen, Lasse Østergaard

AU - Gaarn-Larsen, L

AU - Kristensen, B B

AU - Husted, H

AU - Otte, K S

AU - Kehlet, H

N1 - Keywords: Adult; Aged; Aged, 80 and over; Analgesics; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Period; Recovery of Function; Walking; Young Adult

PY - 2009

Y1 - 2009

N2 - In a well-defined fast-track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra-operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observational study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1-10 and 30 days postoperatively. Fast-track total hip and knee arthroplasty with early discharge (< 3 days) resulted in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95% of patients after discharge before day 10 after total hip arthroplasty. However, after total knee arthroplasty 52% patients reported moderate pain (VAS 30-59 mm), and 16% severe pain (VAS > or = 60 mm) when walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation.

AB - In a well-defined fast-track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra-operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observational study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1-10 and 30 days postoperatively. Fast-track total hip and knee arthroplasty with early discharge (< 3 days) resulted in acceptable levels of pain and postoperative nausea and vomiting with concomitant low use of opioids in > 95% of patients after discharge before day 10 after total hip arthroplasty. However, after total knee arthroplasty 52% patients reported moderate pain (VAS 30-59 mm), and 16% severe pain (VAS > or = 60 mm) when walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation.

U2 - 10.1111/j.1365-2044.2008.05831.x

DO - 10.1111/j.1365-2044.2008.05831.x

M3 - Journal article

C2 - 19413820

SN - 0003-2409

VL - 64

SP - 508

EP - 513

JO - Anaesthesia

JF - Anaesthesia

IS - 5

ER -