Acute pain Factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement

作者：Thomazeau J; Rouquette A; Martinez V; Rabuel C; Prince N; Laplanche J L; Nizard R; Bergmann J F; Perrot S; Lloret Linares C^*

来源：European Journal of Pain, 2016, 20(5): 822-832.

DOI：10.1002/ejp.808

BackgroundDespite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context.
MethodsIn this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement.
ResultsWe included 109 patients. Pre-operative pain at rest (p=0.047), anxiety level (p=0.001) and neuropathic pain symptoms (p=0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p=0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5days was low, but highly variable (78.232.1mg, from 9.9 to 170mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p=0.004), and positively correlated with associated paracetamol treatment (p=0.031). No genetic effect was detected in our sample.
ConclusionsOur findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery.

• 出版日期2016-5