Anesteziyoloji ve reanimasyon hekimleri arasında total kalça artroplastisi cerrahisi sonrası ağrı yönetiminde; prosedüre özgü ağrı yönetimi (PROSPECT) farkındalığı anket çalışması

Abstract

Amaç: Prosedüre özgü ağrı yönetimi (PROSPECT) klinisyenlere postoperatif ağrı yönetiminde kanıta dayalı öneriler sunmaktadır. Anesteziyoloji ve Reanimasyon hekimlerinin total kalça artroplastisi (TKA) cerrahisi sonrası analjezi yönetimine yönelik tercihlerinin değerlendirilmesi amaçlandı. Yöntem: Demografik veriler, TKA cerrahisi için uygulanan analjezi yöntemleri ve PROSPECT önerilerinin takip edilip edilmediğini içeren 19 sorudan oluşan anket hazırlandı. Bu anket elektronik posta yoluyla katılımcılara iletildi. Bulgular: Ankete toplam 199 katılımcı yanıt verdi. Katılımcıların %43,8’i PROSPECT önerilerini takip ettiğini bildirdi. Katılımcıların sadece %6,5’i TKA cerrahisi sonrası analjezi için opioidleri tercih etmezken, %14,1’i rutin olarak kullandığını geri kalanlarda diğer tekniklerle birlikte tercih ettiğini bildirdi. Sonuç: TKA cerrahisi büyük oranda komorbid hastalıkların eşlik ettiği yaşlı popülasyonda uygulanması nedeniyle Anesteziyoloji ve Reanimasyon hekimleri arasında ameliyat sonrası analjezi yöntemleri konusunda kesin bir fikir birliği bulunmamaktadır. TKA cerrahisinde postoperatif ağrı yönetimi eğitimlerinin artırılması ve bu eğitimlerde PROSPECT önerilerinin yaygınlaştırılması gerektiğini düşünmekteyiz.

Keywords

• anesteziyoloji ve reanimasyon
• anket çalışması
• PROSPECT
• total kalça artroplastisi
• ağrı yönetimi

Awareness of procedure specific pain management (PROSPECT) in pain management after total hip arthroplasty surgery among anesthesiology and reanimation physicians survey study

Abstract

Aims: Procedure-specific pain management (PROSPECT) provides clinicians with evidence-based recommendations for postoperative pain management. We aimed to evaluate Anesthesiology and Reanimation physicians' preferences for analgesia management after total hip arthroplasty (THA) surgery. Methods: A questionnaire consisting of 19 questions including demographic data, analgesia methods used for THA surgery and whether PROSPECT recommendations were followed was prepared. This questionnaire was sent to the participants via e-mail. Results: A total of 199 participants responded to the survey. 43.8% of the participants reported following PROSPECT recommendations. Only 6.5% of the participants did not prefer opioids for analgesia after THA surgery, while 14.1% reported that they routinely used opioids and the rest preferred them in combination with other techniques. Conclusion: Since THA surgery is mostly performed in the elderly population with comorbid diseases, there is no consensus among anesthesiology and reanimation physicians about postoperative analgesia methods. We think that postoperative pain management trainings in THA surgery should be increased and PROSPECT recommendations should be disseminated in these trainings.

Keywords

• Anesthesiology and reanimation
• survey
• PROSPECT
• total hip arthroplasty
• pain management

References

1. Lee B, Schug SA, Joshi GP, Kehlet H; PROSPECT Working Group. Procedure-specific pain management (PROSPECT)-an update. Best Pract Res Clin Anaesthesiol. 2018;32(2):101-111. doi:10.1016/j.bpa.2018. 06.012
2. Lavand'homme PM, Kehlet H, Rawal N, Joshi GP; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Pain management after total knee arthroplasty: procedure specific postoperative pain management recommendations. Eur J Anaesthesiol. 2022;39(9):743-757. doi:10.1097/EJA.0000000000001691
3. Højer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015;156(1):8-30. doi:10.1016/j.pain.0000000000000003
4. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol. 2019;33(3):259-267. doi:10. 1016/j.bpa.2019.07.016
5. Safa B, Trinh H, Lansdown A, et al. Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty: a randomized controlled trial. Br J Anaesth. 2024; 133(1):146-151. doi:10.1016/j.bja.2024.04.019
6. Geisler A, Dahl JB, Thybo KH, et al. Pain management after total hip arthroplasty at five different Danish hospitals: a prospective, observational cohort study of 501 patients. Acta Anaesthesiol Scand. 2019;63(7):923-930. doi:10.1111/aas.13349
7. Anger M, Valovska T, Beloeil H, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(8):1082-1097. doi:10.1111/anae.15498
8. Moyer R, Ikert K, Long K, Marsh J. The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. JBJS Rev. 2017;5(12):e2. doi:10. 2106/JBJS.RVW.17.00015

9. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269-287. doi:10. 1016/j.bja.2019.05.042
10. Sinatra RS, Jahr JS, Reynolds L, et al. Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis. Pain Pract. 2012;12(5):357-365. doi:10.1111/j.1533-2500.2011.00514.x
11. Takeda Y, Fukunishi S, Nishio S, Yoshiya S, Hashimoto K, Simura Y. Evaluating the effect of intravenous acetaminophen in multimodal analgesia after total hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2019;34(6):1155-1161. doi:10.1016/j.arth.2019.02.033
12. Westrich GH, Birch GA, Muskat AR, et al. Intravenous vs oral acetaminophen as a component of multimodal analgesia after total hip arthroplasty: a randomized, blinded trial. J Arthroplasty. 2019;34(7S): S215-S220. doi:10.1016/j.arth.2019.02.030
13. Thybo KH, Hägi-Pedersen D, Dahl JB, et al. Effect of combination of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty: the PANSAID randomized clinical trial. JAMA. 2019;321(6):562-571. doi:10.1001/jama.2018.22039
14. Camu F, Borgeat A, Heylen RJ, Viel EJ, Boye ME, Cheung RY. Parecoxib, propacetamol, and their combination for analgesia after total hip arthroplasty: a randomized non-inferiority trial. Acta Anaesthesiol Scand. 2017;61(1):99-110. doi:10.1111/aas.12841
15. Gombotz H, Lochner R, Sigl R, Blasl J, Herzer G, Trimmel H. Opiate sparing effect of fixed combination of diclophenac and orphenadrine after unilateral total hip arthroplasty: a double-blind, randomized, placebo-controlled, multi-centre clinical trial. Wien Med Wochenschr. 2010;160(19-20):526-534. doi:10.1007/s10354-010-0829-7
16. McQuay HJ, Moore RA, Berta A, et al. Randomized clinical trial of dexketoprofen/tramadol 25 mg/75 mg in moderate-to-severe pain after total hip arthroplasty. Br J Anaesth. 2016;116(2):269-276. doi:10.1093/bja/aev457
17. Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K. Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain. 2012;16(6):838-848. doi:10.1002/j.1532-2149.2011.00062.x
18. Ittichaikulthol W, Prachanpanich N, Kositchaiwat C, Intapan T. The post-operative analgesic efficacy of celecoxib compared with placebo and parecoxib after total hip or knee arthroplasty. J Med Assoc Thai. 2010;93(8):937-942.
19. Lunn TH, Andersen LØ, Kristensen BB, et al. Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth. 2013;110(1):66-73. doi:10.1093/bja/aes345
20. Backes JR, Bentley JC, Politi JR, Chambers BT. Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial. J Arthroplasty. 2013;28(8 Suppl):11-17. doi:10.1016/j.arth.2013.05.041
21. Albrecht E, Bayon V, Hirotsu C, Ja'bari A, Heinzer R. Intrathecal morphine and sleep apnoea severity in patients undergoing hip arthroplasty: a randomized, controlled, triple-blinded trial. Br J Anaesth. 2020;125(5):811-817. doi:10.1016/j.bja.2020.07.052
22. Kuchálik J, Granath B, Ljunggren A, Magnuson A, Lundin A, Gupta A. Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. Br J Anaesth. 2013;111(5):793-799. doi:10.1093/bja/aet248
23. Spreng UJ, Dahl V, Hjall A, Fagerland MW, Ræder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth. 2010;105(5):675-682. doi:10.1093/bja/aeq232
24. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med. 2021;46(11):971-985. doi:10.1136/rapm-2021-102750
25. Yan H, Cang J, Xue Z, Lu J, Wang H. Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: a systematic review and meta-analysis. Bosn J Basic Med Sci. 2016;16(4):239-246. doi:10.17305/bjbms. 2016.1072
26. Jiménez-Almonte JH, Wyles CC, Wyles SP, et al. Is local infiltration analgesia superior to peripheral nerve blockade for pain management after total hip arthroplasty: a network meta-analysis. Clin Orthop Relat Res. 2016;474(2):495-516. doi:10.1007/s11999-015-4619-9
27. Musclow SL, Bowers T, Vo H, Glube M, Nguyen T. Long-acting morphine following hip or knee replacement: a randomized, double-blind, placebo-controlled trial. Pain Res Manag. 2012;17(2):83-88. doi: 10.1155/2012/704932