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Total kalça artroplastisi uygulanan hastalarda postoperatif şiddetli ağrı ile ilişkili faktörler

Year 2014, , 615 - 622, 16.01.2015
https://doi.org/10.3944/AOTT.2014.14.0177

Abstract

Amaç: Bu çalışmada, total kalça artroplastisi sonrası, özellikle psikolojik sıkıntı ve kişilik özellikleri ile bağlantılı gelişebilecek postoperatif ağrıya dair risk faktörlerinin belirlenmesi amaçlandı.

Çalışma planı: Çimentolu total kalça replasmanı sonrası postoperatif ağrı şikayeti ile başvuran 90 hasta, sayısal değerleme ölçeği (SDÖ) ile ölçülen ağrının şiddetine göre iki gruba ayrıldı. SDÖ puanı 5 veya daha yüksek olan hastalar çalışma grubuna, 5 puanın altında kalan hastalar ise kontrol grubuna dahil edildi. Psikolojik değerlendirmede, anksiyete ve depresyon için Hamilton ölçekleri, Tip D kişiliğin saptanması için ise DS14 testinden yararlanıldı.

Bulgular: Çalışma grubundaki bireylerin çoğunluğu kadındı ve anksiyete, depresyon semptomları ve Tip D kişilik özellikleri saptanan olguların kontrol grubuna kıyasla daha yüksek sayıda olduğu belirlendi (sırasıyla, 13’e karşı 3, 11’e karşı 2 ve 18’e karşı 9 olgu). Cerrahi öncesi ortalama SDÖ puanı çalışma grubunda kontrol grubunda ise olarak bulundu (p<0.001). Postoperatif ağrı gelişimiyle ilişkilendirilen faktörler kadın cinsiyet (OO=4.91, %95 GA=2.01-12.01, p<0.001), Tip D kişilik (OO=2.81, GA=1.17-7.32, p=0.030), şiddetli anksiyete (OO=6.01, GA=1.58-22.90, p=0.009), depresif semptomlar (OO=7.33, GA=1.52-35.34, p=0.013) ve cerrahi öncesi dikkat çekici derecede ağrısı bulunan olgular (OO=2.64, GA=1.17-5.44, p<0.001) oldu.

Çıkarımlar: Şiddetli anksiyete, depresyon ve Tip D kişilik özelliklerine sahip olgularda şiddetli postoperatif ağrı görülme riski bulunmaktadır. Bunlar dışında, kadın cinsiyet ve cerrahiden hemen sonraki ağrı şiddetinin de önemli risk faktörleri olduğu belirlenmiştir.

References

  • Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postopera- tive pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40. CrossRef
  • Sinatra R. Causes and consequences of inadequate man- agement of acute pain. Pain Med 2010;11:1859-71. CrossRef
  • Dahmani S, Dupont H, Mantz J, Desmonts JM, Keita H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth 2001;87:385-9. CrossRef
  • Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwa- moto CW, Adamatti LC, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 2002;46:1265-71. CrossRef
  • Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postopera- tive pain. Pain 2003;105:415-23. CrossRef
  • Nikolajsen L, Minella CE. Acute postoperative pain as a risk factor for chronic pain after surgery. Eur J Pain Suppl 2009;3:29-32. CrossRef
  • Foss NB, Kristensen MT, Palm H, Kehlet H. Postopera- tive pain after hip fracture is procedure specific. Br J An- aesth 2009;102:111-6. CrossRef
  • Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post- operative pain and of satisfaction with management. Pain 1998;75:177-85. CrossRef
  • Pinto PR, McIntyre T, Ferrero R, Almeida A, Araşjo- Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain 2013;14:502-15. CrossRef
  • McCleane G. Pain perception in the elderly patient. Clin Geriatr Med 2008;24:203-11. CrossRef
  • Pirrotta R, Jeanmonod D, McAleese S, Aufenberg C, Op- wis K, Jenewein J, et al. Cognitive functioning, emotional processing, mood, and personality variables before and after stereotactic surgery: a study of 8 cases with chronic neuropathic pain. Neurosurgery 2013;73:121-8. CrossRef
  • Denollet J. DS14: standard assessment of negative affec- tivity, social inhibition, and Type D personality. Psycho- som Med 2005;67:89-97. CrossRef
  • Castro M, Kraychete D, Daltro C, Lopes J, Menezes R, Oliveira I. Comorbid anxiety and depression disor- ders in patients with chronic pain. Arq Neuropsiquiatr 2009;67:982-5. CrossRef
  • Sagheer MA, Khan MF, Sharif S. Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre. J Pak Med Assoc 2013;63:688-90.
  • Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-41. CrossRef
  • Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medi- cine. Crit Care Med 2008;36:953-63. CrossRef
  • Aubrun F, Langeron O, Quesnel C, Coriat P, Riou B. Re- lationships between measurement of pain using visual analog score and morphine requirements during postop- erative intravenous morphine titration. Anesthesiology 2003;98:1415-21. CrossRef
  • DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intra- subject variability and correlation with a numeric scale. Anesth Analg 1998;86:102-6. CrossRef
  • Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-5. CrossRef
  • Hamilton M. A rating scale for depression. J Neurol Neu- rosurg Psychiatry 1960;23:56-62. CrossRef
  • Sathappan SS, Strauss EJ, Ginat D, Upasani V, Di Cesare PE. Surgical challenges in complex primary total hip ar- throplasty. Am J Orthop (Belle Mead NJ) 2007;36:534- 41.
  • Pflüger G, Junk-Jantsch S, Schöll V. Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop 2007;31 Suppl 1:7-11. CrossRef
  • Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Charac- teristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001;90:261-9. CrossRef
  • Holtzman J, Saleh K, Kane R. Gender differences in func- tional status and pain in a Medicare population undergo- ing elective total hip arthroplasty. Med Care 2002;40:461- 70. CrossRef
  • Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Pre- dictors of postoperative pain and analgesic consump- tion: a qualitative systematic review. Anesthesiology 2009;111:657-77. CrossRef
  • Ristić B, Ristić DI, Milicić B, Obradović Z. Factors which influence postoperative mortality after hip fracture. [Ar- ticle in Serbian] Vojnosanit Pregl 2006;63:49-53. CrossRef
  • Badura-Brzoza K, Zajac P, Brzoza Z, Kasperska-Zajac A, Matysiakiewicz J, Piegza M, et al. Psychological and psy- chiatric factors related to health-related quality of life after total hip replacement - preliminary report. Eur Psychiatry 2009;24:119-24. CrossRef
  • Schaller F, Sidelnikov E, Theiler R, Egli A, Staehelin HB, Dick W, et al. Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admis- sion in the first year after hip fracture. Bone 2012;51:347- 52. CrossRef
  • Zywiel MG, Prabhu A, Perruccio AV, Gandhi R. The in- fluence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res 2014;472:1453-66. CrossRef
  • Mols F, Denollet J. Type D personality in the general pop- ulation: a systematic review of health status, mechanisms of disease, and work-related problems. Health Qual Life Outcomes 2010;8:9. CrossRef
  • Kuijpers PM, Denollet J, Wellens HJ, Crijns HM, Ho- nig A. Noncardiac chest pain in the emergency depart- ment: the role of cardiac history, anxiety or depression and Type D personality. Eur J Cardiovasc Prev Rehabil 2007;14:273-9. CrossRef
  • Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute peri- operative pain for total knee arthroplasty. Pain Res Manag 2007;12:185-94.
  • Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain inten- sity: a prospective study. Clin J Pain 2005;21:439-45. CrossRef
  • Carr EC, Nicky Thomas V, Wilson-Barnet J. Patient expe- riences of anxiety, depression and acute pain after surgery: a longitudinal perspective. Int J Nurs Stud 2005;42:521- 30. CrossRef
  • Aguirre J, Baulig B, Dora C, Ekatodramis G, Votta-Velis G, Ruland P, et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty: a prospective, randomized, double-blinded, placebo-con- trolled study comparing continuous wound infusion with morphine patient-controlled analgesia. Anesth Analg 2012;114:456-61. CrossRef
  • Murphy TP, Byrne DP, Curtin P, Baker JF, Mulhall KJ. Can a periarticular levobupivacaine injection reduce post- operative opiate consumption during primary hip arthro- plasty? Clin Orthop Relat Res 2012;470:1151-7. CrossRef
  • Reader T, Flin R, Lauche K, Cuthbertson BH. Non- technical skills in the intensive care unit. Br J Anaesth 2006;96:551-9. CrossRef
  • Shaw WS, Campbell P, Nelson CC, Main CJ, Linton SJ. Effects of workplace, family and cultural influences on low back pain: what opportunities exist to address social fac- tors in general consultations? Best Pract Res Clin Rheu- matol 2013;27:637-48. CrossRef
  • Osinaike BB, Dairo MD, Oyebamiji EO, Odesanya JO, Tanimowo A. Attitude of general public to risks associated with anaesthesia. East Afr J Public Health 2007;4:40-2.
  • Ni Mhaolain AM, Butler JS, Magill PF, Wood AE, Shee- han J. The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression. Ir J Med Sci 2008;177:211-5. CrossRef
  • Chun MB, Young KG, Honda AF, Belcher GF, Maskar- inec GG. The development of a cultural standardized pa- tient examination for a general surgery residency program. J Surg Educ 2012;69:650-8. CrossRef

Factors associated with severe postoperative pain in patients with total hip arthroplasty

Year 2014, , 615 - 622, 16.01.2015
https://doi.org/10.3944/AOTT.2014.14.0177

Abstract

Objective: The aim of this study was to determine the risk factors for the development of postoperative pain following total hip arthroplasty, particularly those connected with psychological distress and personality traits.

Methods: The study included 90 patients with complaints of postoperative pain following cemented total hip replacement divided into two groups based on the intensity of postoperative pain as measured using the numerical rating scale (NRS). Patients with NRS scores of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. The Hamilton scales for anxiety and depression and the DS14 test for the identification of Type D personality were used for psychological evaluation.

Results: In the study group, more patients were female (29 vs. 13) and had more anxiety (13 vs. 3), depression symptoms (11 vs. 2), and Type D personality (18 vs. 9) than the control group. Mean preoperative NRS was 7.2±1.7 in the study and 6.0±1.2 in the control group (p<0.001). Factors associated with development of strong postoperative pain was female gender (OR=4.91, 95% CI=2.01 to 12.01, p<0.001), Type D personality (OR=2.81, CI=1.17 to 7.32, p=0.030), severe anxiety (OR=6.01, CI=1.58 to 22.90, p=0.009), depressive symptoms (OR=7.33, CI=1.52 to 35.34, p=0.013) and subjects with marked preoperative painful condition (OR=2.64, CI=1.17 to 5.44, p<0.001).

Conclusion: Patients with severe anxiety, depression and Type D personality appear to be at risk of developing severe postoperative pain. In addition, female gender and the intensity of pain immediately after procedure were found to be important risk factors.

References

  • Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postopera- tive pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40. CrossRef
  • Sinatra R. Causes and consequences of inadequate man- agement of acute pain. Pain Med 2010;11:1859-71. CrossRef
  • Dahmani S, Dupont H, Mantz J, Desmonts JM, Keita H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth 2001;87:385-9. CrossRef
  • Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwa- moto CW, Adamatti LC, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 2002;46:1265-71. CrossRef
  • Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postopera- tive pain. Pain 2003;105:415-23. CrossRef
  • Nikolajsen L, Minella CE. Acute postoperative pain as a risk factor for chronic pain after surgery. Eur J Pain Suppl 2009;3:29-32. CrossRef
  • Foss NB, Kristensen MT, Palm H, Kehlet H. Postopera- tive pain after hip fracture is procedure specific. Br J An- aesth 2009;102:111-6. CrossRef
  • Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post- operative pain and of satisfaction with management. Pain 1998;75:177-85. CrossRef
  • Pinto PR, McIntyre T, Ferrero R, Almeida A, Araşjo- Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain 2013;14:502-15. CrossRef
  • McCleane G. Pain perception in the elderly patient. Clin Geriatr Med 2008;24:203-11. CrossRef
  • Pirrotta R, Jeanmonod D, McAleese S, Aufenberg C, Op- wis K, Jenewein J, et al. Cognitive functioning, emotional processing, mood, and personality variables before and after stereotactic surgery: a study of 8 cases with chronic neuropathic pain. Neurosurgery 2013;73:121-8. CrossRef
  • Denollet J. DS14: standard assessment of negative affec- tivity, social inhibition, and Type D personality. Psycho- som Med 2005;67:89-97. CrossRef
  • Castro M, Kraychete D, Daltro C, Lopes J, Menezes R, Oliveira I. Comorbid anxiety and depression disor- ders in patients with chronic pain. Arq Neuropsiquiatr 2009;67:982-5. CrossRef
  • Sagheer MA, Khan MF, Sharif S. Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre. J Pak Med Assoc 2013;63:688-90.
  • Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-41. CrossRef
  • Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medi- cine. Crit Care Med 2008;36:953-63. CrossRef
  • Aubrun F, Langeron O, Quesnel C, Coriat P, Riou B. Re- lationships between measurement of pain using visual analog score and morphine requirements during postop- erative intravenous morphine titration. Anesthesiology 2003;98:1415-21. CrossRef
  • DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intra- subject variability and correlation with a numeric scale. Anesth Analg 1998;86:102-6. CrossRef
  • Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-5. CrossRef
  • Hamilton M. A rating scale for depression. J Neurol Neu- rosurg Psychiatry 1960;23:56-62. CrossRef
  • Sathappan SS, Strauss EJ, Ginat D, Upasani V, Di Cesare PE. Surgical challenges in complex primary total hip ar- throplasty. Am J Orthop (Belle Mead NJ) 2007;36:534- 41.
  • Pflüger G, Junk-Jantsch S, Schöll V. Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop 2007;31 Suppl 1:7-11. CrossRef
  • Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Charac- teristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001;90:261-9. CrossRef
  • Holtzman J, Saleh K, Kane R. Gender differences in func- tional status and pain in a Medicare population undergo- ing elective total hip arthroplasty. Med Care 2002;40:461- 70. CrossRef
  • Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Pre- dictors of postoperative pain and analgesic consump- tion: a qualitative systematic review. Anesthesiology 2009;111:657-77. CrossRef
  • Ristić B, Ristić DI, Milicić B, Obradović Z. Factors which influence postoperative mortality after hip fracture. [Ar- ticle in Serbian] Vojnosanit Pregl 2006;63:49-53. CrossRef
  • Badura-Brzoza K, Zajac P, Brzoza Z, Kasperska-Zajac A, Matysiakiewicz J, Piegza M, et al. Psychological and psy- chiatric factors related to health-related quality of life after total hip replacement - preliminary report. Eur Psychiatry 2009;24:119-24. CrossRef
  • Schaller F, Sidelnikov E, Theiler R, Egli A, Staehelin HB, Dick W, et al. Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admis- sion in the first year after hip fracture. Bone 2012;51:347- 52. CrossRef
  • Zywiel MG, Prabhu A, Perruccio AV, Gandhi R. The in- fluence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res 2014;472:1453-66. CrossRef
  • Mols F, Denollet J. Type D personality in the general pop- ulation: a systematic review of health status, mechanisms of disease, and work-related problems. Health Qual Life Outcomes 2010;8:9. CrossRef
  • Kuijpers PM, Denollet J, Wellens HJ, Crijns HM, Ho- nig A. Noncardiac chest pain in the emergency depart- ment: the role of cardiac history, anxiety or depression and Type D personality. Eur J Cardiovasc Prev Rehabil 2007;14:273-9. CrossRef
  • Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute peri- operative pain for total knee arthroplasty. Pain Res Manag 2007;12:185-94.
  • Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain inten- sity: a prospective study. Clin J Pain 2005;21:439-45. CrossRef
  • Carr EC, Nicky Thomas V, Wilson-Barnet J. Patient expe- riences of anxiety, depression and acute pain after surgery: a longitudinal perspective. Int J Nurs Stud 2005;42:521- 30. CrossRef
  • Aguirre J, Baulig B, Dora C, Ekatodramis G, Votta-Velis G, Ruland P, et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty: a prospective, randomized, double-blinded, placebo-con- trolled study comparing continuous wound infusion with morphine patient-controlled analgesia. Anesth Analg 2012;114:456-61. CrossRef
  • Murphy TP, Byrne DP, Curtin P, Baker JF, Mulhall KJ. Can a periarticular levobupivacaine injection reduce post- operative opiate consumption during primary hip arthro- plasty? Clin Orthop Relat Res 2012;470:1151-7. CrossRef
  • Reader T, Flin R, Lauche K, Cuthbertson BH. Non- technical skills in the intensive care unit. Br J Anaesth 2006;96:551-9. CrossRef
  • Shaw WS, Campbell P, Nelson CC, Main CJ, Linton SJ. Effects of workplace, family and cultural influences on low back pain: what opportunities exist to address social fac- tors in general consultations? Best Pract Res Clin Rheu- matol 2013;27:637-48. CrossRef
  • Osinaike BB, Dairo MD, Oyebamiji EO, Odesanya JO, Tanimowo A. Attitude of general public to risks associated with anaesthesia. East Afr J Public Health 2007;4:40-2.
  • Ni Mhaolain AM, Butler JS, Magill PF, Wood AE, Shee- han J. The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression. Ir J Med Sci 2008;177:211-5. CrossRef
  • Chun MB, Young KG, Honda AF, Belcher GF, Maskar- inec GG. The development of a cultural standardized pa- tient examination for a general surgery residency program. J Surg Educ 2012;69:650-8. CrossRef
There are 41 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Nadezda M. Petrovic This is me

Dragan R. Milovanovic This is me

Dragana İgnjatovic Ristic This is me

Nikola Riznic This is me

Branko Ristic This is me

Zeljko Stepanovic This is me

Publication Date January 16, 2015
Published in Issue Year 2014

Cite

APA Petrovic, N. M., Milovanovic, D. R., Ristic, D. İ., Riznic, N., et al. (2015). Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica Et Traumatologica Turcica, 48(6), 615-622. https://doi.org/10.3944/AOTT.2014.14.0177
AMA Petrovic NM, Milovanovic DR, Ristic Dİ, Riznic N, Ristic B, Stepanovic Z. Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica et Traumatologica Turcica. January 2015;48(6):615-622. doi:10.3944/AOTT.2014.14.0177
Chicago Petrovic, Nadezda M., Dragan R. Milovanovic, Dragana İgnjatovic Ristic, Nikola Riznic, Branko Ristic, and Zeljko Stepanovic. “Factors Associated With Severe Postoperative Pain in Patients With Total Hip Arthroplasty”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 6 (January 2015): 615-22. https://doi.org/10.3944/AOTT.2014.14.0177.
EndNote Petrovic NM, Milovanovic DR, Ristic Dİ, Riznic N, Ristic B, Stepanovic Z (January 1, 2015) Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica et Traumatologica Turcica 48 6 615–622.
IEEE N. M. Petrovic, D. R. Milovanovic, D. İ. Ristic, N. Riznic, B. Ristic, and Z. Stepanovic, “Factors associated with severe postoperative pain in patients with total hip arthroplasty”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 6, pp. 615–622, 2015, doi: 10.3944/AOTT.2014.14.0177.
ISNAD Petrovic, Nadezda M. et al. “Factors Associated With Severe Postoperative Pain in Patients With Total Hip Arthroplasty”. Acta Orthopaedica et Traumatologica Turcica 48/6 (January 2015), 615-622. https://doi.org/10.3944/AOTT.2014.14.0177.
JAMA Petrovic NM, Milovanovic DR, Ristic Dİ, Riznic N, Ristic B, Stepanovic Z. Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica et Traumatologica Turcica. 2015;48:615–622.
MLA Petrovic, Nadezda M. et al. “Factors Associated With Severe Postoperative Pain in Patients With Total Hip Arthroplasty”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 6, 2015, pp. 615-22, doi:10.3944/AOTT.2014.14.0177.
Vancouver Petrovic NM, Milovanovic DR, Ristic Dİ, Riznic N, Ristic B, Stepanovic Z. Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica et Traumatologica Turcica. 2015;48(6):615-22.