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Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later

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Abstract

Purpose

Much remains unknown about the relationship between acute postoperative pain and the development of pathologic chronic postsurgical pain (CPSP). The purpose of this project was to identify the extent to which maximum pain scores on movement over the first two days after total hip arthroplasty predicted the presence of chronic pain 6 months later after controlling for potentially important covariates.

Methods

The sample comprised 82 of 114 patients who participated in a double-blinded randomized controlled trial in which all patients received acetaminophen 1 g p.o., celecoxib 400 mg p.o., and dexamethasone 8 mg i.v., 1–2 h preoperatively. In addition, patients received gabapentin (GBP) 600 mg (G2) or placebo (G1 and G3) 2 h prior to surgery [G1: placebo/placebo (n = 38); G2: GBP/placebo (n = 38); G3: placebo/GBP (n = 38)]. In the PACU, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). Follow-up data from the 82 patients who were contacted by telephone 6 months postsurgery were used for the current study.

Results

Maximal movement-evoked pain intensity over the first two postoperative days (P = 0.38) failed to predict the presence of CPSP 6 months later after controlling for age (P = 0.09), treatment group (P = 0.91), and cumulative morphine consumption (P = 0.8) (multivariate logistic regression likelihood ratio test against the intercept only model P = 0.59).

Conclusion

Neither maximum movement-evoked acute pain, nor any other factor measured, predicted the presence of CPSP at 6 months. Further research is needed to identify risk factors for CPSP after total hip arthroplasty.

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Acknowledgments

This study was made possible through a grant from the Physicians’ Services Incorporated. Many thanks to our study coordinator Beth Goudie RN, and to the Holland Orthopedic and Arthritic Centre’s nursing staff and Pharmacy and Physiotherapy Departments for all of their hard work and support. Many thanks to Eileen Halket RN and the Acute Pain Research team at the Toronto General Hospital for their many hours of hard work. This work was performed in partial fulfillment of Hance Clarke’s doctoral dissertation. Hance Clarke is supported by a Canadian Institute of Health Research Ph.D. Fellowship Award. Joel Katz is supported by a Canada Research Chair in Health Psychology.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Management, Toronto General Hospital, Acute Pain Research Unit, 200 Elizabeth Street, Eaton North 3EB 317, Toronto, ON, M5G 2C4, Canada

    Hance Clarke, Nicholas Mitsakakis & Joel Katz

  2. Holland Orthopedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Hance Clarke, Joseph Kay & Joel Katz

  3. Department of Psychology and School of Kinesiology and Health Science, York University, Toronto, ON, Canada

    Joel Katz

  4. Department of Anesthesia, University of Toronto, Toronto, ON, Canada

    Hance Clarke & Joseph Kay

Authors
  1. Hance Clarke
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  2. Joseph Kay
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  4. Joel Katz
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Correspondence to Hance Clarke.

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Clarke, H., Kay, J., Mitsakakis, N. et al. Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later. J Anesth 24, 537–543 (2010). https://doi.org/10.1007/s00540-010-0960-z

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  • DOI: https://doi.org/10.1007/s00540-010-0960-z

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