Spanish researchers have developed recommendations on how to assess and manage preoperative pain in patients undergoing total knee or total hip replacement (TKR/THR).
Their 21 recommendations, which were presented in a poster at the recent annual meeting of the European League Against Rheumatism in Paris, France, cover the assessment, management and monitoring of preoperative pain, as well as pre-emptive treatment.
“Our aim was to develop recommendations for preoperative pain management in patients undertaking TKR and/or THR due to osteoarthritis [OA] based on the best evidence and experience”, explained Miguel Angel Ruiz Iban (Hospital Universitario Ramón y Cajal, Madrid) and co-authors.
A panel of five orthopaedic specialists and one anaesthesiologist set out draft recommendations, evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence and data from systematic literature reviews. Within this model, the level of evidence (LE) is scored from 1 (the highest, most robust level) to 5 (findings based on expert opinion). The evidence is also given a grade (GR), where A is the highest level.
The draft was then made available to 38 additional orthopaedic specialists and anaesthesiologists to determine their level of agreement. Each participant graded their agreement level on a scale of 1 (total disagreement) to 10 (total agreement). A general agreement (GA) percentage was then obtained.
The consultation process showed that participants’ levels of agreement with the panel’s recommendations were often highest even when the clinical evidence scores were lowest.
The recommendation that once surgery is indicated that a proper treatment to relieve symptoms and signs should be given, for example, was associated with the highest level of agreement among participants (GA=100%) but had the lowest levels of clinical evidence in its support (LE=5; GR=D).
Contrary to available evidence, most participants also agreed with the panel’s recommendation that previous pharmacological treatments should be carefully evaluated in order to determine the treatment until surgery (LE=5; GR=D; GA=95%).
All the experts were also in favour of encouraging patients to lose and maintain their weight at a lower level and undertake physical activity (LE=2a; GR=B; GA=100%).
Another key recommendation was the need to assess preoperative factors associated with postoperative pain as soon as surgery is indicated (LE=2a; GR=B; GA=100%). Primary care physicians should also play an active role in patients’ management during the preoperative period (LE=5; GR=D; GA=95%).
Ruiz Iban et al concluded: “A proper evaluation of the surgery indication, pharmacological pain management, and patient and treatment monitoring, could improve postoperative pain.”
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