The influence of anesthesia and analgesia on the formation of chronic pain syndrome in patients undergoing total knee or hip arthroplasty. Article

Abstract

Introduction. Total knee and hip replacement surgery for stages 3–4 of osteoarthritis often complicated by chronic postoperative pain syndrome (CPOP). Objectives. The aim of the study was to choosing anesthesia that lid to decries the incidence of CPOP. Materials and methods. The study included 104 patients over 65 years old who underwent total knee or hip arthroplasty. Patients were divided into two groups: combined spinal-epidural anesthesia and extended epidural analgesia (CSEA) — 53 patients; general anesthesia and multicomponent postoperative analgesia (GA) — 51 patients. The Western Ontario MacMaster (WOMAC) scale and The Douleur Neuropathique 4 Questions (DN4) scale was used. Indicators were evaluated in 3, 6 and 12 months after surgery. We also assess the area of the hyperalgesia zone in the early postoperative period. Results. The WOMAC score was 85.7 ± 9.99 points in the CSEA group and 99.0 ± 11.68 in the GA group 3 months after surgery (p < 0.01), 81.3 ± 10.19 versus 93, 8 ± 11.31 after 6 months (p < 0.01) and 78.7 ± 10.48 versus 89.9 ± 10.77 after a year (p < 0.01). The formation of CPOP was observed in 16 (15.4 %) patients, 4 (7.5 %) patients in the CSEA group and 12 (23.53 %) patients in the GA group (p < 0.05). The neuropathic component of chronic pain was observed in 10 (62.5 %) patients, somewhat less often in the CSEA group (p > 0.05). In patients with advanced CPOP, it was noted that the area of the secondary hyperalgesia zone in the first two days after surgery was significantly larger. The hyperalgesia zone was significantly smaller in patients with CSEA. Conclusions. Performing knee or hip joint replacement using CSEA compared with GA without a regional component is associated with a lower risk of developing CPOP syndrome and better functional rehabilitation.