Multidimensional pain assessment and opioid use after total knee arthroplasty: continuous vs single-injection regional vs systemic analgesia.

Abstract

Introduction: Effective pain management after total knee arthroplasty (TKA) is essential for recovery. Continuous peripheral nerve blocks (PNBc) are often believed to provide superior pain relief compared with single-injection peripheral nerve blocks (PNBs). However, multidimensional pain-related patient-reported outcomes (PROs) have not been extensively studied.

Objective: Based on registry data, this study compared pain intensities summarized as a pain composite score (PCS) and postoperative opioid use between PNBc and PNBs nerve blocks in patients undergoing TKA, and evaluated additional PROs.

Methods: Data from 4,328 adults undergoing TKA enrolled in the PAIN OUT registry (ClinicalTrials.gov NCT02083835) were analyzed. Patients were categorized into general anesthesia (GA) or spinal anesthesia (SA), with subgroups general anesthesia only (GA-o) or spinal anesthesia only (SA-o), and combinations with single-injection PNB (GA&PNBs and SA&PNBs) or continuous PNB via catheter (GA&PNBc and SA&PNBc). The primary end point was PCS, summarizing pain intensities and time in severe pain during the first 24 hours. Secondary end points included opioid use and additional PROs.

Results: The use of GA&PNBc was associated with a higher PCS (+0.5 [0.0-0.9], P = 0.035) compared with GA&PNBs, while PCS was similar between SA&PNBs and SA&PNBc. Opioid use was more frequent in GA&PNBc (+20.3%) and SA&PNBc (+50.8%) compared with the respective PNBs groups (P < 0.001). Patient-reported outcomes were higher in PNBc groups (median score 3.2 vs 2.7-2.9 in other groups; P < 0.001).

Conclusion: Continuous PNBc showed no clear advantage over PNBs in pain relief, opioid use, or further PROs. Future research should incorporate comprehensive PROs to better evaluate analgesic techniques in TKA.