Arthroplasty, Replacement, Knee, Pain, Postoperative
Conditions
Keywords
Central Nervous System Sensitization, Neuropeptides
Brief summary
For patients who underwent two-stage replacement of both knee joints (one knee surgery - one week term- the other knee surgery), postoperative pain and analgesic usage with patient-controlled analgesia (PCA) increased at the second stage, which suggests that central sensitization occurs within a short period (one week) in patients who undergo total knee arthroplasty (TKA). Neurosteroids act on NMDA and AMPA receptors, GABAa receptors, and voltage-dependent Ca2+ or K+ channels of sensory neurons to increase invasive or neuropathic pain and, conversely, to exhibit analgesic and anticonvulsant effects. These actions mean that the neurosteroid acts as an endogenous regulator of pain control and central sensitization. The purpose of this study is to confirm that the hypothalamus-pituitary-adrenal (HPA) axis, which is the main body of endocrine neurosteroid, is associated with increased pain sensitivity after TKA. The concentrations of cortisol and dehydroepiandrosterone (DHEA) in the saliva of patients who undergo two-staged bilateral knee replacement surgery (one knee surgery - one week term- the other knee surgery) will be measured at each stage and analyzed for correlation between concentration-related changes of HPA and postoperative knee pain variations.
Interventions
None listed
Sponsors
Seoul National University Bundang Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
No minimum to 70 Years
Healthy volunteers
No
Inclusion criteria
* Two-staged bilateral total knee arthroplasty (one knee - one week - the other knee) * American Society of Anesthesiologists (ASA) class I, II * Postmenopausal women aged under 71
Exclusion criteria
* Patients who have used analgesics before surgery, such as chronic pain patients * ≥ ASA class III, including patients with renal impairment or symptomatic cardiovascular disease * Patients who refuse to participate in the study or from whom receive informed consent cannot be received.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The profiles of cortisol in the saliva | From the evening (9PM) before the operation day to the morning (60 minutes after the wake-up) of the operation day, for each stage of the operation. | The cortisol concentrations in the saliva, at the evening before the operation (21:00-22:00), just after wake-up in the morning of operation day, and 30 and 60 minutes after the wake-up. |
| The profiles of DHEA in the saliva | From the evening (9PM) before the operation day to the morning (60 minutes after the wake-up) of the operation day, for each stage of the operation. | The DHEA concentrations in the saliva, at the evening before the operation (21:00-22:00), just after wake-up in the morning of operation day, and 30 and 60 minutes after the wake-up. |
| Post operative knee pain | At 24h and 48h after the operation, for each stage of the operation. | At rest and at maximum knee flexion, visual analogue scale (VAS) score of knee pain; |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diurnal slope | From the evening (9PM) before the operation day to the morning (60 minutes after the wake-up) of the operation day, for each stage of the operation. | slope for diurnal cortisol decline from the time point immediately upon awakening to nighttime |
| CARi | At the morning of operation day, for each stage of the operation | net increases in cortisol levels within the first 30 min after awakening |
| Analgesic usage (PCA) | At 24h and 48h after the operation, for each stage of the operation. | Fentanyl usage with PCA |
| Daucawk | At the morning of operation day, for each stage of the operation | DHEA secretion area under the curve with respect to ground from the time point immediately after waking to 60 min after waking |
| CARauc | At the morning of operation day, for each stage of the operation | cortisol secretion area under the curve with respect to ground from the time point immediately after waking to 60 min after waking |
| Analgesic usage (rescue) | At 24h and 48h after the operation, for each stage of the operation. | The number of rescue analgesics treatments |
| Antiemetic usage | At 24h and 48h after the operation, for each stage of the operation. | The number of antiemetics treatments |
Countries
South Korea
Outcome results
None listed