DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20194173

Does ischemic preconditioning preoperatively reduce postoperative pain and analgesic requirement in total knee arthroplasty?

Rajiv Ranjan Dubey, Bhabani Shankar Behera, Manish Prasad

Abstract


Background: Osteoarthritis of knee is one of the most commonly affecting condition affecting the activities of daily living in the middle age group Indian and Asian population. Total knee arthroplasty (TKA) performed for pain relief and improvement in mobility of individuals is associated with significant post-operative pain. Ischemic preconditioning is one of the non-pharmacologic methods of reduction in postoperative pain using variable periods of tourniquet induced ischaemia which has limited data in literature.

Methods: Sample size (n=30) was taken. A standard automatic pneumatic tourniquet was used while performing ischemic preconditioning of the limb prior to TKA and during surgery. Statistical analysis was performed with p values <0.05 considered significant. Standard postoperative analgesia as per hospital protocol was given to patients.

Results: The mean 6 hour postoperative and 48-hr postoperative visual analogue scale (VAS) score at rest is significantly higher compared to mean preoperative VAS score at rest (p<0.01 for both). The distribution of mean preoperative and 24 hour postoperative VAS score at rest did not differ significantly (p>0.05). The mean % change in postoperative period compared to preoperative VAS at rest was 47.06%.

Conclusions: In this study, the effect of preconditioning over postoperative pain relief was not consistent. Although the patient reported pain scores were low at 6th and 24th postoperative hour, the effect at 48th postoperative hour was not satisfactory. Studies with larger sample size required for better understanding of ischemic preconditioning.


Keywords


Scheming preconditioning, Tourniquet, Total knee arthroplasty, Visual analogue score

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References


Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50(5):518-22.

Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, et al. Ranawat Award Paper: Predicting Total Knee Replacement Pain: A Prospective, Observational Study. Clin Orthop Related Res. 2003;416:27-36.

Ejaz A, Laursen AC, Kappel A, Laursen MB, Jakobsen T, Rasmussen S, et al. Faster recovery without the use of a tourniquet in total knee arthroplasty: A randomized study of 70 patients. Acta Orthop. 2014;85(4):422-6.

Abdel-Salam AN, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. Bone Joint J. 1995;77(2):250-3.

Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986;74(5):1124-36.

Clavien PA, Selzner M, RĂ¼diger HA, Graf R, Kadry Z, Rousson V, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg. 2003;238(6):843.

Memtsoudis SG, Stundner O, Yoo D, Della Valle AG, Boettner F, Bombardieri AM, et al. Does limb preconditioning reduce pain after total knee arthroplasty? A randomized, double-blind study. Clin Orthop Related Res. 2014;472(5):1467-74.

Memtsoudis SG, Della Valle AG, Jules-Elysse K, Poultsides L, Reid S, Starcher B, et al. Perioperative inflammatory response in total knee arthroplasty patients: impact of limb preconditioning. Regional Anesthesia Pain Med. 2010;35(5):412-6.