Abstract
PurposeFactors associated with post-surgical pain are not fully explored. The aim of this study was to identify determinants of postoperative pain after arthroscopic surgery of the knee. Synovial tissue metabolism was analysed by microdialysis and the association with individual and peri-surgical factors to identify determinants important for pain management and thus patient satisfaction.MethodsCross-sectional study of 57 patients (22 women) with median age of 39 years. All patients were operated on with arthroscopic surgery of the knee and monitored postoperatively with synovial microdialysis. The cross-sectional cohort was investigated to determine local tissue levels of inflammatory and metabolic compounds along with postoperative pain experience. Measurements: pain was determined by visual analogue scale (VAS). Postoperative synovial tissue levels of prostaglandin E2 (PGE2), glucose, and glycerol were measured by microdialysis in the knee synovium. Patients reporting VAS ≥ 4 received rescue pain medication with systemic opioids.ResultsInitial results indicated that patients with pain (interpreted as having VAS ≥ 4), i.e. those receiving rescue medication with systemic opioids, were of a younger age (p = 0.04), lower body weight (p = 0.02), had a lower BMI (p = 0.04) and/or were smokers (p = 0.02). A closer analysis using multinomial logistic regression showed a significantly higher amount of pain in smokers (p = 0.01) and patients of a younger age (p = 0.02). A significant correlation was also found between VAS and duration of surgery (p = 0.007). No significant correlation could be found between VAS and synovial levels of PGE2, glycerol and glucose, but a statistically significant decline with time of PGE2 in both groups.ConclusionsThe results from this study show a significantly higher frequency of pain, post-surgery among younger patients (p = 0.02) and smokers (p = 0.01), as well as an association between pain and length of surgery (p = 0.007). These findings point out individual factors useful for the prediction of postoperative pain after arthroscopic surgery and are clinically important for personalized pain management.Level of evidenceII.
Highlights
In modern healthcare, the number of surgeries done at outpatient clinics has significantly increased [1]
We found no statistical differences for ACL, tourniquet, cryo cuff and osteoarthritis between Rescue medication with opioids (RM) versus No rescue medication with opioids (NRM) patients (Table 1)
There were no significant correlations between PGE2, glucose or glycerol and visual analogue scale (VAS) (Fig. 3)
Summary
The number of surgeries done at outpatient clinics has significantly increased [1]. Extended author information available on the last page of the article made in freestanding ambulatory surgery centres, with an overall increase of 49% between 1996 and 2006 [1]. With this comes a need for both patients and surgeons to optimize pain management to promote early discharge and optimal mobilization. The mechanisms for postoperative pain are complex, multifactorial, and subjected to the individual patients’ perioperative experience [2]. Social factors and status are known to affect frequency and level of pain [3,4,5,6,7], but attempts to correlate postoperative
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