Improved Pain Management in Knee Osteoarthritis-related Surgeries

Study Overview
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Brief Summary
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In recent years, pain management coordinated with enhanced recovery after surgery (ERAS) has been widely applied and rapidly developed in orthopedics, showing promising prospects. Since 2016, our hospital has used a series of continuously improved pain management schemes for patients with knee OA who underwent total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO). Here, we retrospectively analyze these patients' clinical data to compare the effects of different pain intervention measures during the perioperative period on postoperative pain, functional exercise, hospital stay, and prognosis of the three surgical methods in an attempt to provide a feasible solution for pain management of these patients.

Detailed Description
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We retrospectively analyzed the clinical data of patients with knee osteoarthritis (OA) who received surgical treatment to provide a feasible solution for perioperative pain management of these patients. The medical records of 714 patients with knee OA who had undergone total knee arthroplasty (n=551), unicompartmental knee arthroplasty (n=92) and high tibial osteotomy (n=71) were retrospectively analyzed and the cases were divided into Groups A, B, and C, according to the continuously optimized pain management. Clinical data including anesthesia grade, surgery time, functional exercise, hospital stay, pain, emotion, complications and prognosis were compared.

Official Title
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Evaluating the Effectiveness of Continuously Improved Pain Management in Knee Osteoarthritis-related Surgeries

Conditions
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Knee Osteoarthritis, Total Knee Arthroplasty, Unicompartmental Knee Arthroplasty, High Tibial Osteotomy, Pain Management

Intervention / Treatment
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* Procedure: Preoperative pain managment
* Procedure: Intraoperative pain managment
* Procedure: Postoperative pain managment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: first knee surgery were 50-80 years old had complete clinical and follow-up data Exclusion Criteria: American Society of Anesthesiologists Physical Status grade≥4 comorbidity with three or more systemic diseases long-term anxiety and depression, contraindications of painkillers, long-term alcoholism, or taking painkillers concomitant limb pain caused by spinal degeneration

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Total knee arthroplasty (TKA)<br>Total knee arthroplasty | Procedure: Preoperative pain managment<br>* propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery<br>Procedure: Intraoperative pain managment<br>* Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia;<br>Procedure: Postoperative pain managment<br>* The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡<br>|
| Unicompartmental knee arthroplasty (UKA)<br>Unicompartmental knee arthroplasty | Procedure: Preoperative pain managment<br>* propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery<br>Procedure: Intraoperative pain managment<br>* Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia;<br>Procedure: Postoperative pain managment<br>* The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡<br>|
| High tibial osteotomy (HTO)<br>High tibial osteotomy | Procedure: Preoperative pain managment<br>* propaganda and education on pain; Preemptive analgesia with celecoxib (200 mg bid) 2 days before surgery<br>Procedure: Intraoperative pain managment<br>* Squeeze to expel blood (tourniquet); Before skin suture, 20 mL 0.5% ropivacaine was given subcutaneously for local infiltration anesthesia;<br>Procedure: Postoperative pain managment<br>* The intravenous analgesia pump was placed until 48 h after surgery;On the second day after surgery, celecoxib (200 mg bid) was administered orally, and buprenorphine transdermal patch was applied externally until hospital discharge;FNB catheter was placed under the guidance of ultrasound and connected with an analgesic pump, the anesthesia lasted until 48 h after surgery ‡<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| visual analogue score (VAS) | visual analogue score (VAS) | 24 hours after surgery | 
| visual analogue score (VAS) | visual analogue score (VAS) | 72 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quadriceps muscle strength | Quadriceps muscle strength | 24 hours after surgery | 
| Quadriceps muscle strength | Quadriceps muscle strength | 72 hours after surgery | 
| Scope of activities to knee joint | Scope of activities to knee joint | 24 hours after surgery | 
| Scope of activities to knee joint | Scope of activities to knee joint | 72 hours after surgery |