Acute Pain after Knee Replacement in Diabetic Patients: A Prospective Cohort Study

  Objective  To compare the difference of acute pain after joint replacement in patients with knee osteoarthritis (KOA) with or without diabetes.

  Methods  Clinical data of patients with total knee arthroplasty (TKA) who underwent surgery at Beijing Chaoyang Hospital, Capital Medical University from October 2017 to February 2018 were prospectively collected and analyzed. They were divided into the diabetes group and the non-diabetes group according to whether they had diabetes or not. Patients of the two groups were given subarachnoid anesthesia combined with single femoral nerve block anesthesia. After the operation, patient controlled intravenousanalgesia (PCIA) was applied. If the visual analogue scale (VAS) score exceeded 4 in the resting state, the patients would take 5 mg of Oxycodone analgesia orally. VAS scores of resting pain/exercise pain, drug dosage in postoperative analgesia pump, and oral oxycodone dose were compared between the two groups before, 4 h, 1 d, 2 d, 3 d, 4 dand 5 d after the operation. The occurrence of adverse reactionsduring the use of narcotic drugs was recorded.

  Results  A total of 117 KOA patients meeting the inclusion and exclusion criteria were included in this study, including 49 in the diabetic group and 68 in the non-diabetic group. VAS scores of rest pain/exercise pain were not significantly different between the two groups before, 4 h, and 1 d after the operation (all P > 0.05). VAS scores of rest pain/exercise pain were significantly higher in the diabetic group than in the non-diabetic group 2 d, 3 d, 4 d, and 5 d after the operation (all P < 0.05). There was no statistically significant difference between the two groups in term of the dosage of analgesia pump 4 h after the operation and the dosage of oral oxycodone 1 d after the operation (all P > 0.05). The dosage of oral oxycodone 2 d, 3 d, 4 d and 5 d after the operation and the dosage of oral oxycodone 24 h and 48 h after the operation of the diabetes group were higher than that of the non-diabetes group (all P < 0.05). There was no statistical difference in the incidence of nausea, vomiting, and dizziness during applying PCIA between the two groups (all P > 0.05).

  Conclusion  Diabetes can aggravate acute pain in KOA patients after TKA (2-5 d after TKA) and increase the use of opioid analgesics in the early stage.