Moderate-to-Severe Pain after Knee Arthroplasty: A Retrospective Study of Incidence and Risk Factors

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Arissara Iamaroon


Background: Knee arthroplasty is one of the most painful orthopedic surgeries. In daily clinical practice, different analgesic techniques are used for postoperative pain control. Objective: To investigate the incidence and risk factors for moderate-to-severe pain in patients undergoing knee arthroplasty. Materials and Methods: The medical records of 400 patients who underwent knee arthroplasty were retrospectively reviewed. The intensity of postoperative pain was assessed by numeric rating scale (NRS) at every 12-hour interval for 72 hours after surgery. Based on maximum NRS score during the first postoperative day, patients were divided into group moderate-to-severe pain (NRS score≥4) and group no or mild pain (NRS score<4). Risk factors associated with moderate-to-severe pain were analyzed. Results: Approximately half of patients experienced moderate-to-severe pain on the first postoperative day. The independent risk factors for moderate-to-severe pain were preoperative pain (adjusted odds ratio [AOR] 2.10, 95% confidence interval [CI] 1.31-3.35, p=0.002) and type of anesthesia (AOR, 2.79 for spinal anesthesia plus periarticular infiltration and peripheral nerve block group; 95% CI, 1.39-5.60; p=0.004, and AOR, 3.42 for general anesthesia plus periarticular infiltration with or without peripheral nerve block group; 95% CI, 1.27-9.20; p=0.015; when using group spinal anesthesia plus intrathecal morphine, periarticular infiltration and peripheral nerve block as a reference). Conclusions: An approximately 50% of patients had moderate-to-severe pain on the first postoperative day. Preoperative pain and type of anesthesia were identified as independent risk factors for moderate-to-severe pain. 

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