The association between sleep quality, preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty

Background: Chronic postoperative pain following total joint replacement (TJA) is a substantial clinical problem, and poor sleep may affect predictive factors for postoperative pain, such as pain catastrophizing. However, the magnitude of these associations is currently unknown. This exploratory study investigated (1) the relationship between preoperative sleep quality, clinical pain intensity, pain catastrophizing, anxiety, and depression and (2) their associations with chronic postoperative pain following TJA. Methods: This secondary analysis from a larger randomized controlled trial included rest pain intensity (preoperative and 12 months postoperative; visual analogue scale, VAS), preoperative Pittsburgh Sleep Quality Index (PSQI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) data from 74 knee and 89 hip osteoarthritis (OA) patients scheduled for TJA. Poor sleepers were identified based on preoperative PSQI scores higher than 5. Results: Poor sleepers demonstrated higher preoperative VAS, pain catastrophizing, anxiety, and depression compared with good sleepers (all p < 0.003). Preoperative PSQI (β = 0.23, p = 0.006), PCS (β = 0.44, p < 0.005), and anxiety (β = 0.18, p = 0.036) were independent factors for preoperative VAS. Preoperative VAS (β = 0.32, p < 0.005), but not preoperative sleep quality (β = −0.06, p = 0.5), was an independent factor for postoperative VAS. Conclusion: The OA patients reporting poor preoperative sleep quality show higher preoperative pain, pain catastrophizing, anxiety, and depression. High preoperative pain intensity, but not poor sleep quality, was associated with higher chronic postoperative pain intensity. Future studies are encouraged to explore associations between sleep and chronic postoperative pain.

OPTIMIZATION OF THE CHOICE OF LAPAROSCOPIC AND OPEN ALLOPLASTICS IN CASE OF INCISIONAL VENTRAL HERNIAS

The aim of the work – to increase the effectiveness of surgical treatment of incisionalventral hernias (IVH) by optimizing the choice of laparoscopic and open allohernioplasty.Material and methods. The analysis of surgical treatment of 508 patients with IVH from2009 to 2020 was conducted. According to the Europenian Herniology Association(EGA) classification (Ghent, Belgium, 2008) IVH was distributed as follows: MW1-2R0 was diagnosed in 217 (42,7%), MW3R0 – in 291 (57,3%) patients. Diastasis of therectus abdominis muscles up to 5 cm was present in 217 (42,7%) patients, diastasis5-10 cm – in 127 (25%), diastasis greater than 10 cm – in 164 (32.3%) patients.Depending on the size of the hernia and the width of diastasis of the rectus abdominis,patients were divided into 3 groups.In group I, laparoscopic allohernioplasty was performed in 109 (21,5%) patients withsmall and medium-sized IVH with diastasis of up to 5 cm, in particular the developedlaparoscopic preperitoneal in 63 patiens and laparoscopuc retromuscular alloplastiesin 46 patients. The comparison group IIa consisted of 108 (15,1%) patients whounderwent open retromuscular allohernioplasty.In group II, 64 (12,6%) patients with large IVH and diastasis of the rectus abdominis5-10 cm underwent open allohernioplasty by «sublay» technique. The comparison groupIIa consisted of 63 (12,4%) patients who were performed the open method «onlay».In group III, in 82 (16,1%) patients with giant IVH and diastasis more than 10 cm ananterior component separation technique of the abdominal wall in combination withalloplasty with intra-abdominal placement of a mesh implant with anti-adhesive coatingwas performed according to the developed method. Comparison group IIIa consistedof 82 (16,1%) patients who underwent anterior component separation technique of theabdominal wall in combination with alloplasty «onlay».Results. For small and medium-sized IVH and diastasis of the rectus abdominis musclesup to 5 cm, laparoscopic allohernioplasty with preperitoneal and retromuscularplacement of a mesh implant and elimination of diastasis is optimal in comparisonwith open retromuscular allohernioplasty, contributes to a significant decrease in theincidence of seroma from 35,2% to 3,7 %, postoperative wound suppuration – from6,5% to 0%, inflammatory infiltrate – from 4,6% to 0%, chronic postoperative pain –from 6,4% to 2,6%, hernia recurrence – from 6,4% up to 0%.The optimal method of allohernioplasty for large IVH and diastasis of the rectusabdominis muscles from 5 to 10 cm is the open «sublay» technique in comparison withthe open «onlay» technique, reduces the incidence of seroma from 23,8% to 6,3%,postoperative wound suppuration – from 4,8% to 1,6%, chronic postoperative pain –from 4,8% to 1,6%, hernia recurrence – from 7,9% to 3,1%.In case of gigantic IVH, contracture of the rectus abdominis muscles and diastasisof more than 10 cm the anterior component separation technique of the anatomicalcomponents of the abdominal wall in combination with intra-abdominal alloplasty isoptimal in comparison with the use of an anterior component separation techniqueof an abdominal wall combined with «onlay» significant improvement in treatmentoutcomes, namely, reduction of seroma frequency from 25,6% to 7,3%, postoperativewound suppuration – from 4,9% to 2,4%, postoperative wound infiltrate – from 13,4%to 2,4 %, chronic postoperative pain – from 8,1% to 1,6%, recurrence of IVH – from6,5% to 1,6%.Conclusion. Optimization of the choice of laparoscopic and open allohernioplastyenables to increase significantly ventral hernias and to decrease the quantity of thepost-operative complications.

Circulating long non-coding RNA signature in knee osteoarthritis patients with postoperative pain one-year after total knee replacement

Objectives The incidence of chronic postoperative pain after total knee replacement (TKR) is approx. 20%, and hence preoperative risk factors are important to identify. Recent studies have indicated that preoperative inflammatory markers might hold prognostic information for the development of chronic postoperative pain. Long non-coding RNA (lncRNA) regulates the expression of genes related to e.g. inflammatory processes. The current study aimed to investigate the preoperative lncRNA signature as possible preoperative predictive markers for chronic postoperative pain following TKR. Methods Serum samples, collected preoperatively from 20 knee osteoarthritis (KOA) patients, were analyzed for 84 validated circulatory lncRNA. Pain intensity was assessed using a visual analog scale (VAS) before and one-year after TKR. Differences for the lncRNA expression were analyzed between patients with chronic postoperative pain (VAS≥3) and those with a normal postoperative recovery (VAS<3). Results LncRNA Myeloid Zinc Finger 1 Antisense RNA 1 (MZF1-AS1) (fold change −3.99; p-value: 0.038) (shown to be involved neuropathic pain) Metastasis associated lung adenocarcinoma transcript 1 (MALAT1) (fold change −3.39; p-value: 0.044) (shown to be involved neuropathic pain); Patched 1 pseudogene (LOC100287846) (fold change −6.99; p-value: 0.029) (unknown in pain) were down-regulated preoperatively in the group with chronic postoperative pain compared to the group normal postoperative pain recovery. Conclusions These findings suggest, that TKR patients with chronic postoperative pain present preoperative downregulations of three specific lncRNA detectable at the systemic level. The presented study might give new insights into the complexity of chronic postoperative pain development and show how non-coding RNA plays a role in the underlying molecular mechanisms of pain.

Method of fixing titanium pectus bar in surgical correction of funnel chest and its mathematical modeling

The most common surgery for the correction of congenital funnel chest in the 21st century is the Nuss procedure. This intervention is accompanied by complications related to the actual fixing bar and its size and placement and methods of fixing. The most common of these are bar displacement and chronic postoperative pain. Only one size of corrective bar (thickness, width) is used for this type of operation in all age groups. Purpose – to develop and implement the original modification of the Nuss procedure with individual calculation of the minimum dimensions of the corrective bar; to eliminate the probability of bar displacement; reduce the duration and intensity of postoperative pain. Materials and methods. The original method of the correcting titanium bar fixing as a monolithic metal arched structure with rigidly fixed ends was used in the study, the subperiostal fastening of the bar stabilizers to two ribs on each side was used. This method was used to operate on 34 patients with funnel chest aged from 6 to 17 years. Results. Mathematical modeling of the functioning of the correcting bar as a monolithic metal arched structure with rigidly fixed ends and determination of its strength and rigidity were performed. As an example, when calculating the stiffness of a plate with a width of 12 mm and a thickness of 2.2 mm under the use of a load of 25 kg (250 N) and an arch width of 20 cm, we determine the deflection of the bar 3.57 mm, strength factor 1.8. The loads of 250 N are much higher than those that actually exist. The cases of depression of the thorax (deflection of the bar) and cases of eruption of the bar were non indicated. The analyzis the level of postoperative pain syndrome on the NRSP scale for 4–5 days after surgery in patients with II degree of funnel chest determined an average score of 3.74; with III degree – 4.18; after one month of the operation – 1.0 and 1.63, respectively. Chronic postoperative pain was not noted. Conclusions. Rigid subptriostal fixation of the bat stabilizers to two ribs on each side prevents the plate from shifting. The proposed method of mathematical modeling of plate dimensions allows to individually calculate the dimensions of the correcting bar, providing in the vast majority of cases the correction of deformation bars 10, 11, 12 mm. The intensity and duration of the pain syndrome is much less than in standard technique due to the redistribution of pressure on the fulcrums of the bar and the absence of injury to the intercostal nerves, reducing the size of the plate. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Zhytomyr Regional Pediatric Clinical Hospital of the Zhytomyr Regional Council, Ukraine. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Nuss procedure, funnel chest, fixing bardimensions, method of fixation.

Efficacy and safety of opioid therapy guided by pharmacogenetics (PGx): a systematic review

Aim: To perform a systematic review to determine the efficacy/safety of PGx-guided opioid therapy for chronic/postoperative pain. Materials & methods: We searched PubMed and other specialized databases. Articles were considered if they compared the efficacy/safety of PGx-guided opioid therapy versus usual care. The risk of bias assessment was performed using Cochrane tools. Results: A total of 3794 records were retrieved. Only five were included for data extraction. A lower requirement of analgesics during postoperative in the PGx-guided intervention arm was reported in two studies. Also, two studies reported significant pain improvement in favor of the PGx-guided therapy when analyzing the subgroup of patients with a high-risk CYP2D6 phenotype. Conclusion: Despite the findings described, information on the efficacy/safety of this intervention is scarce.