Abstract
BackgroundTotal knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis. However, the management of postoperative acute pain remains inefficient. Transcutaneous electrical acupoint stimulation (TEAS) is a nonpharmacological method to manage postoperative acute pain. Different frequencies of TEAS have been tested using varying parameters, but the optimal analgesic frequency remains controversial. The aim of this study was to explore the optimal analgesic frequency of TEAS for treating acute pain after the primary unilateral TKA.Methods/designThis is a double-blind, randomized controlled trial. A total of 156 patients are randomly assigned to: G1, 5 Hz TEAS; G2, 100 Hz TEAS; G3, mixed TEAS (alternative use of daily 5 Hz and 100 Hz TEAS) and G4, placebo TEAS. In the G1, G2 and G3 groups, TEAS is conducted at acupoints SP9 and GB34 of the leg that was operated on (at a wave of continuous, balanced and asymmetrical biphasic square, with a pulse width of 200 μs, and a strong but comfortable current) for 30 min prior to a 30-min rehabilitation session per day for 2 weeks. In G4 group, TEAS is delivered at a strong but comfortable current for 30 s, then the current is gradually decreased to none over the next 15 s. The primary outcomes are measured before surgery, at baseline (POD 3, before TEAS intervention), week 1 and 2 after TEAS intervention with the Numeric Pain Rating Scale and The American Knee Society Score. The secondary outcomes include: (1) Active range of motion of the knee that was operated on; (2) Surface electromyography of both quadriceps; (3) Modified 30-s sit to stand test; (4) Additional usage of analgesia; and (5) SF-36. The additional outcomes include: (1) Patients’ satisfaction rate; (2) Patient’s expectation rate; and (3) Incidence of analgesia-related side effects. To test the blinding of participants and assessors, they are asked to guess whether the subjects received active or placebo TEAS within 5 min after the latest intervention. The safety and financial cost of TEAS are assessed.DiscussionMixed TEAS has more favorable effect on acute pain control than the placebo or 5 Hz or 100 Hz TEAS.Trial registrationChiCTR1800016347. Date of registration was 26 May 2018. Retrospectively registered.
Highlights
Total knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis
Opioids are essential in the management of postoperative acute pain multiple opioid-sparing approaches have been developed [48]
Nonpharmacological therapies adjunct to the multimodal analgesic regimen are urgently required [49]
Summary
Total knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis. The aim of this study was to explore the optimal analgesic frequency of TEAS for treating acute pain after the primary unilateral TKA. The optimal treatment for middle-toend-stage KOA is total knee arthroplasty (TKA) [1, 2] which can relieve pain, recover function and improve early stage quality of life (QoL) of KOA patients [2, 3]. The therapeutic methods for middle-to-end-stage KOA have been gradually redefined, TKA of which will remain at hand in the few decades [4]. Though half of all TKA patients report postoperative pain relief [7], 44% of them still suffer continued pain at 3–4 years after the operation [6]. It can be said that recently developed interventional and preventive strategies have all failed to effectively control the post-TKA pain [13]
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