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      Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: clinical evidence of enhanced pain sensitivity after surgical injury.

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          Abstract

          Staged bilateral total knee arthroplasty (TKA) may provide an ideal clinical model for the study of central sensitization. In staged TKA, hyperalgesia may be induced as a result of repeated surgical injury possibly via central sensitization, which can decrease functional outcomes. Therefore, we hypothesized that in staged bilateral TKA, patients would have greater pain in the second operated knee than in the first. Thirty patients undergoing staged bilateral TKA at a 1-week interval were enrolled. Postoperative pain, which was reported on the basis of a visual analog scale (VAS; primary outcome) at rest and at maximum knee flexion, and the amount of patient-controlled analgesic (i.v. fentanyl) and rescue analgesic (i.v. ketoprofen; secondary outcomes) administered during the 48 h after the operation, were compared between the first and second TKA. VAS scores at rest and at maximum knee flexion were greater on the second operated knee (P<.001 and P<.01, respectively). The cumulative amounts of patient-controlled analgesic and the rescue analgesic were greater in the second than in the first TKA (P<.001 and P<.05, respectively). Patients undergoing staged bilateral TKA experience greater postoperative pain in the second operated knee than the first. This suggests extension of hyperalgesia beyond the initially injured site to remote regions after surgical injury, in which central sensitization may be involved. Therapeutic approaches to reduce such hyperalgesia induced in the course of staged operations are required.

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          Author and article information

          Journal
          Pain
          Pain
          1872-6623
          0304-3959
          Jan 2014
          : 155
          : 1
          Affiliations
          [1 ] Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Seongnam-si, Gyeonggi-do, South Korea.
          [2 ] Joint Reconstruction Center, Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 166, Gumi-ro, Seongnam-si, Gyeonggi-do, South Korea.
          [3 ] Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Seongnam-si, Gyeonggi-do, South Korea. Electronic address: shdo@snu.ac.kr.
          Article
          S0304-3959(13)00490-9
          10.1016/j.pain.2013.08.027
          23994101
          3bbf224c-4953-477e-867a-9ba6234732af
          Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
          History

          Arthroplasty, replacement, knee,Central nervous system sensitization,Hyperalgesia,Pain, postoperative

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