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

PURPOSE: Frailty is reportedly associated with postoperative adverse outcomes and may increase the risk of post-surgical pain. Our study aimed to explore whether frailty was an independent risk factor for pain after total knee arthroplasty (TKA) in older patients. METHODS: Included in this prospective observational study were patients aged 65 or older who underwent primary TKA. Frailty of the patients was assessed before surgery using the comprehensive geriatric assessment-frailty index and pain was evaluated before and after surgery using the Numerical Rating Scale. RESULTS: Of the 164 patients including 125 females with a mean age of 71.4 ± 4.6 years, 51 patients were identified as being frail. Patients with chronic post-surgical pain had a significantly higher frailty index than those without chronic post-surgical pain, which was the same in patients with acute post-surgical pain. After adjusting for other confounding factors, frailty was shown to be an independent risk factor for both acute (OR: 13.23, 95% CI 3.73-46.93, P < 0.001) and chronic post-surgical pain (OR: 4.24, 95% CI 1.29-14.00, P = 0.02). The area under the receiver operating characteristic curve for frailty predicting chronic post-surgical pain was 0.73 (P < 0.001, 95% CI 0.65-0.81). CONCLUSIONS: Our findings demonstrated that preoperative frailty in older patients was a predictor of acute and chronic post-surgical pain after TKA, suggesting that frailty assessment should become a necessary procedure before operations, especially in older patients.

Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery.

BACKGROUND: Thoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively. METHODS: This randomized controlled trial enrolled 100 patients, who were allocated into three groups: Group M (5 µg/kg morphine intrathecal injection), Group B (5 µg/kg morphine combined with bupivacaine 3 mg intrathecal injection) and Group C (intrathecal sham injection). The primary outcome was the assessment of pain relief using the Numeric Rating Scale (NRS). Additionally, intraoperative remifentanil consumption was quantified at the end of the surgery, and postoperative opioid use was determined by the number of patient-controlled analgesia (PCIA) compressions at 48 h post-surgery. Both the efficacy of the treatments and any complications were meticulously recorded. RESULTS: Postoperative NRS scores for both rest and exercise at 6, 12, 24, and 48 h were significantly lower in groups M and B than in group C (P<0.05). The intraoperative remifentanil dosage was significantly greater in groups M and C than in group B (P<0.05), while there was no significant difference between groups M and C (P>0.05). There was no significant difference in intraoperative propofol dosage across all three groups (P>0.05). Postoperative dosages of both sufentanil and Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly less in groups M and B compared to group C (P<0.05). The time of first analgesic request was later in both groups M and B than in group C (P<0.05). Specific and total scores were elevated at 2 days postoperative when compared to scores at 1 day for all groups (P<0.05). Furthermore, at 1 day and 2 days postoperatively, both specific scores and total scores were higher in groups M and B compared to group C (P<0.05). CONCLUSION: Intrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov: ChiCTR2200058544, registered 10/04/2022.

Predictors of Chronic Pain in Elderly Patients Undergoing Total Knee and Hip Arthroplasty: A Prospective Observational Study.

BACKGROUND: Chronic postsurgical pain (CPSP) after total knee arthroplasty and total hip arthroplasty (TKA and THA) is an important clinical problem in which many factors play a role. The risk factors for CPSP in elderly individuals are currently unknown. Therefore, our aim was to predict the risk factors for CPSP after TKA and THA and to provide help regarding early screening and interventions for elderly individuals at risk. METHODS: In this prospective observational study, we collected and analyzed 177 TKA patients and 80 THA patients. Based on pain results at the 3-month follow-up, they were divided into the no chronic postsurgical pain and CPSP groups, respectively. The preoperative baseline conditions, including pain intensity (Numerical Rating Scale) and sleep quality (Pittsburgh Sleep Quality Index), as well as intraoperative and postoperative factors, were compared. Factors with P < .05 were included in binary regression analyses to establish prediction models for CPSP after TKA and THA. RESULTS: The prevalence of CPSP was 20.9% after TKA and 7.5% after THA. The preoperative sleep disorders were an independent risk factor of CPSP after TKA, but no risk factors of CPSP after THA were identified. CONCLUSION: This study indicated that the prevalence of CPSP after TKA was significantly higher than after THA, and that preoperative sleep disorders were an independent risk factor for CPSP after TKA, which may aid clinicians in screening people at risk for CPSP for primary prevention.

A Single Preoperative Dose of S-Ketamine Has No Beneficial Effect on Chronic Postsurgical Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgical Lung Lesion Resection: A Prospective Randomized Controlled Study.

OBJECTIVES: To evaluate the efficacy of a single preoperative dose of S-ketamine for chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgical lung lesion resection (VATS). DESIGN: A prospective randomized, double-blind controlled study. SETTING: Patients were enrolled from March 17, 2021, to November 18, 2021, at a single tertiary academic hospital. PARTICIPANTS: Patients were 18-to-65 years of age and undergoing VATS. INTERVENTIONS: The experiment was divided into an S-ketamine group (0.5 mg/kg intravenous injection before anesthesia induction) or a placebo group (the same volume of normal saline). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the incidence of CPSP and its neuropathic component. The secondary endpoints included acute postoperative pain, the use of postoperative analgesics, anxiety and sleep quality scores, and the occurrence of adverse effects. There were no significant differences between the 2 groups in the incidences of CPSP, neuropathic pain, acute postoperative pain, and postoperative use of analgesics. The sleep quality scores on the first postoperative day differed significantly between the groups (47.45 ± 27.58 v . 52.97 ± 27.57, p = 0.049), but not the anxiety scores. In addition, adverse effects were similar between the 2 groups. CONCLUSIONS: A single preoperative dose of S-ketamine in patients who underwent VATS had no significant effect on acute and chronic postoperative pain or the consumption of analgesics after surgery. A single preoperative dose of S-ketamine could improve sleep on the first day after surgery, whereas it had no significant effect on anxiety levels.

Association between single nucleotide variants and severe chronic pain in older adult patients after lower extremity arthroplasty.

BACKGROUND: Hip or knee osteoarthritis (OA) is one of the main causes of disability worldwide and occurs mostly in the older adults. Total hip or knee arthroplasty is the most effective method to treat OA. However, severe postsurgical pain leading to a poor prognosis. So, investigating the population genetics and genes related to severe chronic pain in older adult patients after lower extremity arthroplasty is helpful to improve the quality of treatment. METHODS: We collected blood samples from elderly patients who underwent lower extremity arthroplasty from September 2020 to February 2021 at the Drum Tower Hospital Affiliated to Nanjing University Medical School. The enrolled patients provided measures of pain intensity using the numerical rating scale on the 90th day after surgery. Patients were divided into the case group (Group A) and the control group (Group B) including 10 patients respectively by the numerical rating scale. DNA was isolated from the blood samples of the two groups for whole-exome sequencing. RESULTS: In total, 661 variants were identified in the 507 gene regions that were significantly different between both groups (P < 0.05), including CASP5, RASGEF1A, CYP4B1, etc. These genes are mainly involved in biological processes, including cell-cell adhesion, ECM-receptor interaction, metabolism, secretion of bioactive substances, ion binding and transport, regulation of DNA methylation, and chromatin assembly. CONCLUSIONS: The current study shows some variants within genes are significantly associated with severe postsurgical chronic pain in older adult patients after lower extremity arthroplasty, indicating a genetic predisposition for chronic postsurgical pain. The study was registered according to ICMJE guidelines. The trial registration number is ChiCTR2000031655 and registration date is April 6th, 2020.

Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: a retrospective study.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. METHODS: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP. RESULTS: 2348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1033 of 2348). Within those suffering CPSP, 14.71% (n = 152 of 1033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. Age < 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), and history of postoperative wound infection (OR 5.949, 95% CI 3.153-11.223, P < 0.001) were independent risk factors for CPSP development. CONCLUSIONS: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24.