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The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA: a Randomized Double-Blinded Placebo Controlled Trial in Patients with High-Pain Knee Osteoarthritis and Sensitization

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@article{bd1fafe9e0004a37b304f24ba223f9ff,
title = "The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA: a Randomized Double-Blinded Placebo Controlled Trial in Patients with High-Pain Knee Osteoarthritis and Sensitization",
abstract = "In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥ 5 NRS during walk) and sensitization (pressure pain threshold < 250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patient with moderate/severe pain during a 5 meter walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind up from temporal summation) and inflammatory changes (systemic CRP, intra-articular IL-6). No difference in proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67{\%} and 74{\%}, χ(2)=0.2, p=0.63, odds ratio 0.7, 95{\%} CI 0.2 to 2.8) or at 48 hours (57{\%} and 68{\%}, χ(2)=0.5, p=0.46, odds ratio 0.6 95{\%} CI 0.2 to 2.3), and no difference between groups in postoperative sensitization was found (p > 0.4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group vs. placebo (median change in IL6: -70 pg/mL [IQR -466 to 0] vs. +32 pg/ml [IQR -26 to 75], p= 0.029). Alternative central or peripheral analgesic interventions in this high-risk group are required.",
keywords = "Journal Article",
author = "Luna, {Iben E} and Henrik Kehlet and Jensen, {Claus M} and Christiansen, {Thorbj{\o}rn G} and Thomas Lind and Stephensen, {Snorre L} and Aasvang, {Eske K}",
note = "Copyright {\circledC} 2017. Published by Elsevier Inc.",
year = "2017",
doi = "10.1016/j.jpain.2017.07.010",
language = "English",
volume = "18",
pages = "1476--1487",
journal = "Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",
number = "12",

}

RIS

TY - JOUR

T1 - The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA

T2 - a Randomized Double-Blinded Placebo Controlled Trial in Patients with High-Pain Knee Osteoarthritis and Sensitization

AU - Luna, Iben E

AU - Kehlet, Henrik

AU - Jensen, Claus M

AU - Christiansen, Thorbjørn G

AU - Lind, Thomas

AU - Stephensen, Snorre L

AU - Aasvang, Eske K

N1 - Copyright © 2017. Published by Elsevier Inc.

PY - 2017

Y1 - 2017

N2 - In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥ 5 NRS during walk) and sensitization (pressure pain threshold < 250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patient with moderate/severe pain during a 5 meter walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind up from temporal summation) and inflammatory changes (systemic CRP, intra-articular IL-6). No difference in proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ(2)=0.2, p=0.63, odds ratio 0.7, 95% CI 0.2 to 2.8) or at 48 hours (57% and 68%, χ(2)=0.5, p=0.46, odds ratio 0.6 95% CI 0.2 to 2.3), and no difference between groups in postoperative sensitization was found (p > 0.4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group vs. placebo (median change in IL6: -70 pg/mL [IQR -466 to 0] vs. +32 pg/ml [IQR -26 to 75], p= 0.029). Alternative central or peripheral analgesic interventions in this high-risk group are required.

AB - In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥ 5 NRS during walk) and sensitization (pressure pain threshold < 250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patient with moderate/severe pain during a 5 meter walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind up from temporal summation) and inflammatory changes (systemic CRP, intra-articular IL-6). No difference in proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ(2)=0.2, p=0.63, odds ratio 0.7, 95% CI 0.2 to 2.8) or at 48 hours (57% and 68%, χ(2)=0.5, p=0.46, odds ratio 0.6 95% CI 0.2 to 2.3), and no difference between groups in postoperative sensitization was found (p > 0.4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group vs. placebo (median change in IL6: -70 pg/mL [IQR -466 to 0] vs. +32 pg/ml [IQR -26 to 75], p= 0.029). Alternative central or peripheral analgesic interventions in this high-risk group are required.

KW - Journal Article

U2 - 10.1016/j.jpain.2017.07.010

DO - 10.1016/j.jpain.2017.07.010

M3 - Journal article

VL - 18

SP - 1476

EP - 1487

JO - Journal of Pain

JF - Journal of Pain

SN - 1526-5900

IS - 12

ER -

ID: 51603428