Study On The Influencing Factors Of Acute Pain After Total Knee Arthroplasty

Research purposes:To explore and analyze the protective factors and risk factors affecting acute post-surgical pain(APSP)in patients with total knee arthroplasty(TKA)under the existing multimodal analgesic regimen,and provide the basis for the prevention and management of APSP in TKA patients.Research Methods:This study was cross-sectional.From January 2018 to January 2019,a convenience sampling method was used to select the patients who were scheduled to undergo TKA due to knee osteoarthritis in the Department of Joint Surgery of a tertiary care general hospital in Lanzhou City,Gansu Province.360 patients who met the inclusion and exclusion criteria were selected as the study subjects.The demographic data such as gender and age of the study subjects were collected face to face using a general information questionnaire 1 d before surgery;the psychological data such as surgical fear,anxiety,and depression were assessed face to face using the relevant quantity 1 d before surgery;the clinical relevant data such as disease course and surgical site were collected through face-to-face assessment and consulting medical records 1 d before surgery and 3 d after surgery.Pain severity during activity was measured 3 days after surgery using a simple pain assessment scale,and the average of the above three numbers was taken as the outcome variable,with APSP indicated by a score of ?4.The relationship between different characteristics of the study subjects and the presence or absence of APSP was analyzed using univariate analysis,and the factors with statistically significant differences were used as independent variables and the occurrence or absence of APSP was used as the dependent variable and included in binary logistic regression for analysis to further clarify the protective and risk factors affecting APSP in TKA patients.Research Results:Of the 354 TKA patients in this study,198 patients developed APSP,and the incidence of APSP was 55.93%.The comparison of different characteristics of subjects with and without APSP showed that there were significant differences in 19factors: gender,age,religious belief,educational level,pain site,preoperative TCM characteristic therapy,TCM characteristic therapy type,preoperative articular cartilage injury,preemptive analgesia,postoperative PCIA,postoperative analgesic drug,average pain degree during preoperative activity,preoperative activity state pain duration,analgesic use duration,preoperative KSS score,surgical fear,anxiety,depression,preoperative pain catastrophizing(P<0.05).Logistic regression analysis showed that religiosity(OR=0.73),duration of illness(OR=0.80),traditional Chinese medicine(TCM)therapy(OR=0.41),preoperative knee function score(OR=0.98),postoperative patient-controlled intravenous analgesia(OR=0.37),and postoperative addition of analgesic drugs(OR=0.15)were independent protective factors for APSP in TKA patients;education level(OR=1.23),preoperative articular cartilage injury degree(OR=1.78),operation duration(OR=1.02),operation fear(OR=1.36),depression(OR=2.48),and pain catastrophizing(OR=1.13)were independent risk factors for APSP in TKA patients.Research Conclusions:In this study,we analyzed 41 relevant factors affecting APSP in TKA patients from the perspective of the comprehensive effect of social-physiological-psychological factors on APSP in TKA patients,and identified 12 independent influencing factors as the basis for the prevention and management of APSP.Among them,religious belief,disease course for medical treatment,TCM characteristic therapy,preoperative KSS score,postoperative PCIA,and postoperative addition of analgesic drugs are protective factors for APSP in TKA patients and are recommended to be actively applied by clinical staff;education level,preoperative articular cartilage injury degree,surgical duration,surgical fear,depression,and pain catastrophizing are risk factors for APSP in TKA patients,and preventive intervention is recommended through risk factor stratification.