Anesthesia Method, Tourniquet Use, and Persistent Postsurgical Pain after Total Knee Arthroplasty: A Prespecified Secondary Analysis of a Randomized Trial. (October 2021)

• Record Type: Journal Article
• Authors: Palanne, Riku A.; Rantasalo, Mikko T.; Vakkuri, Anne P.; Madanat, Rami; Olkkola, Klaus T.; Reponen, Elina M.; Linko, Rita; Vahlberg, Tero J.; Skants, Noora K. A.
• Is Part Of: Anesthesiology. Volume 135:Number 4(2021)
• Publication Date: 2021-10
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000003897
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : Background: Persistent postsurgical pain after total knee arthroplasty is a common problem and a major reason for patient dissatisfaction. This secondary analysis aimed to investigate the effects of anesthesia (spinal vs. general) and tourniquet use on persistent pain after total knee arthroplasty. Methods: In this secondary analysis of a previously presented parallel, single-center, randomized trial, 404 patients scheduled for total knee arthroplasty were randomized to spinal versus general anesthesia and no-tourniquet versus tourniquet groups. Patients assessed pain using the Brief Pain Inventory–short form preoperatively and 3 and 12 months postoperatively. The prespecified main outcome was the change in "average pain" measured with numerical 0 to 10 rating scale 1 yr postoperatively. The threshold for clinical importance between groups was set to 1.0. Results: The change in average pain scores 1 yr postoperatively did not differ between the spinal and general anesthesia groups (–2.6 [SD 2.5] vs . –2.3 [SD 2.5], respectively; mean difference, –0.4; 95% CI, –0.9 to 0.1; P = 0.150). The no-tourniquet group reported a smaller decrease in the average pain scores than the tourniquet group (–2.1 [SD 2.7] vs . –2.8 [SD 2.3]; mean difference, 0.6; 95% CI, 0.1 to 1.1; P = 0.012). After 1 yr, the scores concerning the mean of four pain severity variables (numerical rating scale) decreased more in the spinal than in the general anesthesia group (–2.3 [SD 2.2] vs . –1.8 [SD 2.1]; mean difference, –0.5; 95% CI, –0.9 to –0.05; P = 0.029) and less in the no-tourniquet than in the tourniquet group (–1.7 [SD 2.3] vs . –2.3 [SD 2.0]; mean difference, 0.6; 95% CI, 0.2 to 1.0; P = 0.005). None of the differences in pain scores reached the threshold for clinical importance. Conclusions: The type of anesthesia (spinal vs. general) or tourniquet use has no clinically important effect on persistent postsurgical pain after total knee arthroplasty. Abstract : In a secondary analysis of a study involving 404 patients, no clinically important differences in pain scores 1 yr after arthroplasty were found between the spinal and general anesthesia groups. In the same study, no clinically meaningful differences in 1-yr pain scores were found between the no-tourniquet and tourniquet use groups.Supplemental Digital Content is available in the text.