Subacute pain and function after fast-track hip and knee arthroplasty.
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.
Department of Anaesthesiology, Hvidovre University Hospital, Denmark. lasse.oestergaard.andersen@hvh.regionh.dk
L Ø
LØ
Andersen
L
L
Gaarn-Larsen
B B
BB
Kristensen
H
H
Husted
K S
KS
Otte
H
H
Kehlet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000534:rehabilitation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011184:Postoperative Period; D020127:Recovery of Function; D016138:Walking; D055815:Young Adult
D000700:Analgesics; D000701:Analgesics, Opioid