Dr Lydia Liew
Associate Consultant, National University Hospital Singapore, Singapore
Liew QEL, National University Hospital, Singapore
Chow YM Singapore General Hospital, Singapore
Introduction: Total knee replacements are common surgeries and optimal pain treatment is essential for early rehabilitation.
Aims: The objective of this study is to see how peri-operative pain management practices for total knee replacements have evolved over a period of 5 years in a single tertiary institution.
Methods: A retrospective cohort study was performed amongst all patients undergoing total knee replacements between the years of June 2011- 2012 (Group 1), and 2017-2018 (Group 2) in a single tertiary institution.
Results: The results showed that there is increasing use of multimodal analgesia. The modalities studied included paracetamol, Non-steroidal anti-inflammatory drugs(NSAIDs) and regional anaesthesia. Compared with Group 1, the odds of using one or more modalities of analgesia intra-operatively is consistently higher with one modality(OR 1.35), two modalities(OR 26.0) and three modalities of analgesia(OR30.5, p=0.00) respectively. Use of non-opioid analgesia such as Paracetamol and NSAIDs intraoperatively has significantly increased over the five-year period. 73.5% of patients received Paracetamol in group 2 compared with 1.83% in group 1, OR 169(p=0.00). The use of NSAIDs has also significantly increased from 4.18%(Group 1) to 26.7%(Group 2), OR 8.4(p=0.00). The use of regional anaesthesia for intra-operative analgesia decreased from 64.0% in Group 1 to 51.1% in Group 2.The use of NSAIDs post-operatively has increased over the years with odds ratio of 1.93(p=0.001). The use of multimodal analgesia postoperatively has increased slightly with odds ratio of 1.51(p=0.007) for one modality and 1.77(p=0.007) for two modalities of analgesia.
Conclusion: It is reassuring to note an increasing trend of multimodal analgesia used both intra and post-operatively. Despite significant increase in intra-operative NSAID use, the uptake is still overall low. Regional anaesthesia use did not show a significant rise as compared to other modalities. This may be attributed to the need for skills, training and equipment.