The efficacy of pregabalin on the duration of the spinal anesthesia and the early postoperative pain after total knee arthroplasty

Update This article was updated on February 6, 2019, because of a previous error. On page 105, in the subsection titled “Outcomes and Design” the sentence that had read “Furthermore, in a retrospective review, Houdek et al. 48 , at a mean follow-up of 8 years, demonstrated improved survivorship of 9,999 metal-backed compared with 1,645 all-polyethylene tibial components, over all age groups and most BMI categories” now reads “Furthermore, in a retrospective review, Houdek et al. 48 , at a mean follow-up of 8 years, demonstrated inferior survivorship of 9,999 metal-backed compared with 1,645 all-polyethylene tibial components, over all age groups and most BMI categories.” An erratum has been published: J Bone Joint Surg Am. 2019 Mar 20;101(6):e26.

The pregabalin is approved for the management of persistent pain. The aim of this study is to assess the advantages and disadvantages of the use of pregabalin in eye pain management. The PubMed, Cochrane Library, Embase, and Web of Science databases were searched until January 2022 for randomized controlled trials. Randomized, double-blinded trials comparing pregabalin with placebo in eye pain management were included. The primary outcome was visual analog scale or numerical rating scale at acute (24 hours) and chronic (≥7 days after surgery) timepoints. The secondary outcomes were analgesic medication requirements and pregabalin-related complications (nausea, vomiting, dizziness, and headache). We also compared the effect of pregabalin on dry-eye syndrome. Six relevant articles were identified that studied the use of pregabalin as pain relief for photorefractive keratectomy (n = 2), laser epithelial keratomileusis (n = 1), laser-assisted in situ keratomileusis (n = 1), eyelid surgery (n = 1), and dacryocystorhinostomy (n = 1). Pregabalin was associated with a significant reduction in pain scores (95% confidence interval = -0.41 [-0.76--0.06]) 24 hours after surgical procedures. The data were insufficient to draw conclusions regarding dry eye symptoms. Because of the high heterogeneity of outcomes regarding adverse effects, there is no conclusion regarding the safety of pregabalin in eye pain. Pregabalin reduced acute eye pain but had no significant effect on long-term analgesia after ophthalmological surgery in adults. It had no effect on dry-eye symptoms after ocular surgery. Further studies on the safety of pregabalin in eye pain management are required to draw solid conclusions.

Background: Acute postoperative pain control after Total Knee Arthroplasty (TKA) is important given that poorly controlled, persistent pain can delay rehabilitation. The purpose of this study was to compare pain intensity during the early postoperative period (following the first and second surgeries) in patients who underwent bilateral, scheduled, staged TKAs. Materials and Methods: We enrolled 32 patients (64 knees) in this study and evaluated the number of requests for analgesic agents during the first 3 days after TKA, time to walking, and the Wong–Baker FACES pain assessment score (WBS). Results: Comparing the postoperative period following the first and second TKA, there were no significant differences in WBS 24, 48, and 72 h postoperatively. The frequency of requests, and the total number of requests for analgesics did not differ when comparing the first and second TKA, at any time point. The total number of analgesic requests exhibited a moderately strong, positive correlation between the first and second TKA (p < 0.001, r = 0.623). Patients’ WBS scores and requests for analgesics showed a moderately strong, positive correlation, but only at 24 h following the second TKA (p = 0.002, r = 0.567). After both TKAs, patients required a median of 1 day to resume walking. Conclusion: Patients undergoing staged bilateral TKA experienced equivalent early postoperative pain when comparing their experience following their first and second TKAs. Therefore, regarding pain control following the second TKA, we recommend considering the analgesic administration schedule and requirements of the first TKA.

Background Researching modifiable preoperative risk factors is essential for improving outcomes following total joint replacement (TJR). This study explores whether preoperative sleep performance influences pain and recovery in the early postoperative period. Methods This prospective observational study was conducted at an academic elective orthopedic hospital, recruiting patients undergoing total hip replacement (THR) and total knee replacement (TKR). Preoperative sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measured outcomes included pain, oral morphine use, day of crutch mobility, independent bed transfer, and hospital length of stay. Results No statistically significant associations were found between preoperative PSQI scores and primary outcomes, although sex differences existed in THR patients regarding early postoperative pain. The correlation between PSQI and hospital stay was weakly positive for THR (r = 0.223, p = 0.082) and negligible for TKR (r = 0.041, p = 0.807). PSQI showed no significant correlation with early mobility (THR: r = 0.111, p = 0.391; TKR: r = 0.115, p = 0.491) or postoperative morphine use (THR: r = 0.108, p = 0.403; TKR: r = 0.170, p = 0.309). Female THR patients had higher pain scores on days 0 and 1 and poorer PSQI scores. Conclusions Preoperative sleep hygiene was not associated with hospital stay, mobility, or pain in the immediate postoperative period after TJR. However, sleep may impact long-term recovery, highlighting the need for further research on modifiable preoperative factors and sex differences in post-TJR rehabilitation.

Analgesic Efficacy and Side Effects of Low-Dose Pregabalin As a Modern Multimodal Agent for Postoperative Pain Control After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial.

IntroductionThe prevalence of osteoarthritis and postoperative neuropathic pain after arthroplasty highlights the necessity for improved pain management. Many patients develop chronic neuropathic pain, necessitating targeted interventions. Research on pregabalin’s effectiveness in pain relief has yielded conflicting findings, necessitating further exploration to determine its therapeutic value. This study sought to assess pregabalin’s efficacy and safety in postoperative pain management, reconcile inconsistent literature, and enhance understanding of its clinical use.MethodsThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted across four major databases to select clinical trials. Statistical analysis was performed using Review Manager 5.4.1, applying fixed- or random-effects models depending on heterogeneity (I2). Subgroup analyses were conducted based on the type, timing, and dosage of pregabalin administered.ResultsPregabalin was associated with significantly reduced pain during movement at 24 h (MD -0.62, 95%CI -1.02 to -0.23), 48 h (MD -0.53, 95%CI -0.90 to -0.15), and 72 h (MD -0.59, 95%CI -1.05 to -0.12) post-surgery. Opioid consumption was also significantly lower at 24 h (SMD − 0.50, 95%CI -0.80 to -0.20), 48 h (SMD − 0.76, 95%CI -1.34 to -0.19), and 72 h (SMD − 1.33, 95%CI -2.16 to -0.49). While there were no significant improvements in the range of motion at 24 and 48 h, pregabalin was associated with significantly enhanced range of motion at 72 h (SMD 1.11, 95%CI 0.12, 2.09). Treatment with pregabalin was associated with a significant decrease in the odds of nausea (OR 0.30, 95%CI 0.09 to 0.99) and vomiting after total knee arthroplasty (TKA) (OR 0.17, 95%CI 0.04 to 0.65). Additionally, pregabalin exposure was associated with increased sedation after TKA (OR 2.27, 95%CI, 1.13 to 4.56) and total hip arthroplasty (THA) (OR 2.54, 95%CI 1.11 to 5.79), as well as blurred vision at 24 h in TKA/THA patients (OR 4.68, 95%CI 1.37 to 15.99; n = 95; I2 = 34). There was no significant association with other adverse events. The administration of pregabalin for more than 24 h before surgery was associated with maximal reductions in pain and opioid use at 72 h post-surgery.ConclusionPregabalin was associated with significantly reduced postoperative pain and opioid use following total joint arthroplasty while enhancing mobility on the third day, with acceptable tolerability and safety.

What's New in Adult Reconstructive Knee Surgery.

Objective To evaluate the effect of ischemic preconditioning(IPC) on early postoperative pain in patients undergoing total knee arthroplasty. Methods A prospective randomized controlled trial of 40 patients undergoing elective total knee arthroplasty was performed in the First Affiliated Hospital of Anhui Medical University from October 2015 to April 2016.Patients (18-65 years old) with ASA grade Ⅰ-Ⅲ(American Society of Anesthesiologists), were randomly divided into control group and ischemic preconditioning(IPC) group, 20 patients in each group. In the IPC group, ischemic preconditioning was performed before the operation of completely blood block to the lower limbs of the operation side, the tourniquet was inflated for 5 min and deflated for 5 min, for a total of 2 cycles. In the control group, only the tourniquet was attached without inflation or deflation before the surgery completely blocked the lower limb blood supply. The basic information of the general clinical data, tourniquet block time and operation time of the two groups were recorded and compared. The mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) were measured before surgery, 30 minutes after the upper tourniquet, and at the end of the operation. Resting pain scores (VAS) were recorded at recovery time, 6 h after surgery, and 24 h after surgery. The number of pain remedies within 24 hours after surgery was recorded. Venous blood was collected 24 hours after surgery to detect the levels of creatine kinase(CK) and interleukin-6 (IL-6) in the blood. Results There were no significant differences in the general clinical data, tourniquet blockade time, and operation time between the two groups (P>0.05). There were no significant differences in MAP, HR and SpO2 between two groups at each time point (P>0.05). The VAS score (3.10±1.02) point in the IPC group was significantly lower than that in the control group (5.45±0.99) point (t=7.394, P 0.05). The number of pain remedies in the IPC group, was significantly lower than that in the control group at 24 hours after surgery (χ2=4.803, P 0.05). The serum IL-6 level was significantly lower in the IPC group(50.11±20.39) pg/mL than in the control group (70.80±34.82) pg/mL (t=6.628, P<0.05). Conclusions Ischemic preconditioning attenuates early postoperative pain and reduces the number of pain relief patients in total knee arthroplasty. The mechanism may be related to the reduction of inflammatory response by ischemic preconditioning. Key words: Reperfusion injury; Ischemic preconditioning; Interleukin-6; Arthroplasty, replacement, knee; Pain

Short-Term (6 Months or Less) Pain in Cemented versus Cementless Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Objectives. The aim of this study was to estimate the effect of fondaparinux and enoxaparin combined with mechanical prophylaxis (MP) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also investigated the occurrence of pulmonary embolism (PE) and its associated risk factors.Methods. Data were retrospectively collected on patients who underwent THA or TKA between 2008 and 2010 from the Japanese Diagnosis Procedure Combination database (n = 49,678). We extracted information on sex, age, main diagnosis, types of anesthesia, duration of anesthesia, comorbidities, hospital volume, the use of MP, and the use of anticoagulant drugs.Results. The overall occurrence of PE was 0.41%. Multivariate logistic regression analysis showed that the occurrence of PE was significantly higher in females (odds ratio, 2.17; p < 0.001, compared with males), TKA (1.47; p = 0.039, compared with THA), and longer-duration anesthesia (2.63; p = 0.008 in the ≥ 240-min. group compared with the ≤ 119-min. group). Compared with the MP-alone group, the occurrence of PE was significantly reduced in the fondaparinux group (0.58; p = 0.025) and the enoxaparin group (0.59; p = 0.046).Conclusions. Fondaparinux or enoxaparin combined with MP decreased the occurrence of PE. The risk factors for PE were female patients, TKA, and longer-duration anesthesia (≥ 240 min.).

General, Spinal, and Regional Nerve Blocks: Do Different Anesthesia Practices Affect Same-Day Discharge in Primary Total Hip and Knee Arthroplasty?

Total knee arthroplasty is the main method for the treatment of advanced haemophilic knee arthritis. Due to the particularity of hemophilia, the blood management plan is the focus of the perioperative period for haemophilia patients. This study aimed to investigate the clinical effect and safety of intra-articular injection of tranexamic acid in patients with haemophilia. This is a retrospective study. According to whether tranexamic acid is used or not, patients are divided into tranexamic acid group (n=30) and non-tranexamic acid group (n=29). Total blood loss, intraoperative blood loss, complete blood count, total amount of coagulation factor VIII (FVIII) usage, coagulation biomarkers, inflammatory biomarkers, knee range of motion, knee joint function, pain status, complication rate, and patient satisfaction were assessed and compared at a mean follow-up of 16 months. Injecting tranexamic acid into the knee joint cavity can effectively reduce the hidden blood loss and total blood loss (P<0.001), and reduce the patient's early postoperative inflammation biomarkers, pain status, and limb swelling. Therefore, the patient can obtain a better range of motion following total knee arthroplasty. In the long run, in terms of joint function and surgical satisfaction, there are no statistically significant differences. In addition, there are no statistically significant differences between the two groups of patients in terms of the total amount of FVIII usage, length of stay, and hospitalization expenses. In patients with haemophilia, intra-articular injection of tranexamic acid during total knee arthroplasty can effectively reduce postoperative blood loss, early postoperative inflammation levels, pain and limb swelling, and enable patients to receive higher-quality rehabilitation exercises to get better joint function. Previous studies on TKA in haemophilic patients have already demonstrated the efficacy of intra-articular injections of TXA in reducing postoperative blood loss. Our study confirms this efficacy.

TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have recently gained attention due to their potential advantages. This study aims to evaluate the effects of remimazolam and RA-TKA on acute postoperative pain compared with conventional TKA (C-TKA) and standard anesthetic protocols. Materials and Methods: In this retrospective observational study, 460 patients undergoing elective unilateral TKA were divided in to four groups based on surgical technique and anesthetic agents; RA-TKA with remimazolam (Group RR, n = 115), C-TKA with remimazolam (Group CR, n = 134), RA-TKA with conventional anesthesia (Group RC, n = 79), and C-TKA with conventional anesthesia (Group CC, n = 152). Remimazolam was administered at 6 mg/kg/h for induction and 1 mg/kg/h for maintenance, whereas conventional anesthesia was induced with propofol (1.5 mg/kg) and maintained with sevoflurane (1.5~2.0 vol%). The primary endpoint was acute postoperative pain, assessed via patient-controlled analgesia (PCA) consumption and supplemental analgesic use on the day of surgery. Secondary endpoints included total PCA consumption and additional analgesic use during the first 72 h, recovery room stay, discharge scores, and the incidence of postoperative nausea and vomiting (PONV). Results: Group RR required significantly fewer additional analgesics on the day of surgery than the other groups. Although group RR and group CR exhibited prolonged recovery room stay and lower discharge scores, these outcomes were not correlated with PCA consumption or supplementary analgesic use. RA-TKA was associated with approximately a 31% reduction in additional analgesic use compared with C-TKA, indicating a major contribution of the surgical technique to early postoperative pain control. Remimazolam alone did not demonstrate an independent effect on acute pain management. Conclusions: RA-TKA combined with remimazolam significantly reduced the need for additional analgesics on the day of surgery, highlighting a synergistic effect of the anesthetic and surgical approach. These findings support RA-TKA with remimazolam as an effective strategy for managing early postoperative pain following TKA.

Robotic-Assisted Primary Total Knee Arthroplasty Requires Fewer Soft-Tissue Releases and Is Associated With a Larger Reduction in Early Postoperative Pain.