DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 81
Survey of current pain treatment after total knee
arthroplasty in Denmark
Karen T Bjørnholdt, Lone Nikolajsen, Kjeld Søballe
Regionshospitalet Horsens; Århus Universitetshospital
Background: Treatment of pain after total knee arthroplasty (TKA) has
changed considerably during the past five years. Here we present the
current standard treatment of postoperative pain after TKA in Danish
hospitals.
Purpose: By determining which treatments are in practice and how
widespread they are we hope to discover and pass on local experiences
and disseminate successful practices. We also aim to stimulate further
research into the applied treatments.
Methods: Danish public and private hospitals performing TKA were
identified mainly using the National Board of Health information system.
Using a short questionnaire and telephone interviews, data were
obtained from surgeons and supplemented if necessary by other staff.
Interviews were made between May 21st and August 2nd 2010. Data
were entered in Epidata and processed in Stata.
Findings: Replies were obtained from 45 out of 47 hospitals. Operations
were mostly performed using spinal anaesthesia (n=38). Local infiltration
analgesia (LIA) was used in 42 cases, alone (n=11) or in combination
with femoral and/or sciatic block (n=3), intraarticular bolus and/or
infusion (n=25), or saphenus block (n=1). The drugs, doses and infiltration
techniques varied, as did the bolus injections and infusions. Postoperatively
a tight bandage (n=40), cooling (n=38), and elevation (n=8)
was used. Postoperative drugs included paracetamol (n=45) supplemented
with NSAID (n=20), opioids (n=45), gabapentin (n=8), and klozoxazon
(n=1). Mean length of stay was 3.2 days (SD 1).
Conclusion: Current practice reflects recent research and local experiences.
This survey illustrates how practice changes very quickly as a
result of intensive research in the field, and how local variations exist.
Many details of postoperative pain treatment can still be optimized by
systematic randomized clinical trials.
81