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Abstract
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Background and Aims Total knee arthroplasty (TKA) is associated with severe postoperative pain. A combination of motor-sparing blocks (femoral triangle block) with multimodal analgesia is the analgesic strategy in our center. We aimed to assess the efficacy of analgesia in patients receiving TKA.
Methods Data was collected from patients undergoing TKA from November to December 2023. Patients received our institutional standard analgesia protocol, which includes a femoral triangle block, and subcutaneous morphine every 4 hours as per patient request. The acute pain service team assessed the maximum pain score using a Numeric Rating Scale (NRS) and the cumulative dose of subcutaneous morphine the first 24 hours following surgery.
Results The postoperative pain of 75 patients who underwent TKA was examined for the first 24 hours. The median postoperative pain score, measured using the NRS, was 5, with an interquartile range of 2 to 7. Severe pain (NRS ≥ 8) was experienced by 20% of patients (n=15). Forty percent (n=30) required postoperative subcutaneous morphine, with a mean cumulative dose of 9.6 mg (standard deviation 8.0 mg). Figure 1 presents a histogram of the postoperative NRS pain scores, annotated with the cumulative morphine doses.
Histogram showing the number of patients with the maximum pain score (NRS) and total morphine dose
Conclusions This study revealed that TKA is a painful procedure and that 40% of the patients received postoperative opioids. Systematic assessment and audit of the efficacy of postoperative analgesia protocols are essential and can provide information for optimizing pain management strategies. In fact, based on these findings we decided to start a project at our center that could improve morphine administration following TKA.