Article Details

Authors
Paolo Perazzo MD, Giovanni Albano MD, Tiziano Crespi MD, Claudio Roscitano MD, Francesco Verde MD

Article Type
Original Research

DOI
10.7573/dic.2020-6-4

Article Page

Abstract

Patients eligible for knee and/or hip arthroplasty exhibit osteoarthritis pain, loss of functional mobility and pronounced disability. The wait time for arthroplasty appears critical for the patient with relevant implications on both functional status and surgery outcomes. Pre-operative pain has been identified as a predictive factor of short- and long-term outcomes of joint replacement interventions. A recent survey, promoted by Orthopea Association and recruiting specialists who prescribe pain therapy for patients eligible for either arthroplasty or vertebral surgery, evaluated the specialist perception of the clinical relevance of pre-operative pain and investigated its pharmacological management in clinical practice. Adequate control of pre-operative pain would allow not only optimized intra- and post-operative pain management but appears to also facilitate the subsequent rehabilitation. The choice of a treatment able to control both the somatic and neuropathic components of osteoarticular pain and to provide greater tolerability in patients with comorbidities, organ insufficiency, high hemorragic risk and older age, appears desirable in patients eligible for arthroplasty.

Riassunto

I pazienti candidati a interventi di protesizzazione del ginocchio e/o dell’anca presentano dolore osteoarticolare, perdita di mobilità e marcata disabilità. Il periodo di attesa per l’artroprotesi risulta particolarmente critico per il paziente con importanti implicazioni sia sul suo stato funzionale che sugli esiti dell’intervento. Il dolore pre-operatorio è stato identificato quale fattore predittivo degli esiti a breve e lungo termine degli interventi di sostituzione protesica. Una recente survey, promossa dall’associazione Orthopea e rivolta a medici specialisti coinvolti nella prescrizione della terapia analgesica nel paziente candidato ad artroprotesi o ad interventi di chirurgia vertebrale, ha indagato la rilevanza clinica attribuita dallo specialista al dolore pre-operatorio e ne ha esplorato la gestione farmacologica nella pratica clinica. Un controllo adeguato del dolore pre-operatorio non solo consentirebbe un’ottimizzazione del trattamento analgesico intra- e post-operatorio ma sembra anche favorire un migliore svolgimento delle attività riabilitative successive. La scelta di un trattamento in grado di controllare entrambe le componenti, somatica e neuropatica, del dolore osteoarticolare e che possa offrire una maggiore tollerabilità in presenza di co-morbidità, insufficienza d’organo, età avanzata ed elevato rischio emorragico, appare preferibile nei pazienti candidati all’artroprotesi.

Keywords: artroprotesi, dolore neuropatico, dolore preoperatorio, tapentadolo.

Citation: Perazzo P, Albano G, Crespi T, Roscitano C, Verde F. Management of pre-surgical pain in orthopaedics [article in Italian]. Drugs in Context 2020; 9: 2020-6-4. DOI: 10.7573/dic.2020-6-4

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Perazzo P è il Presidente dell’Associazione Orthopea. Albano G, Crespi T, Roscitano C, e Verde F dichiarano di non avere conflitti di interesse. La survey, promossa dall’Associazione Orthopea, è stata finanziata da Grunenthal Italia. Perazzo P is the President of the Associazione Orthopea. Albano G, Crespi T, Roscitano C, and Verde F declare that they have no conflict of interest. The survey, promoted by the Associazione Orthopea, was funded by Grunenthal Italia. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/07/dic.2020-6-4-COI.pdf

Acknowledgements: Gli autori ringraziano Chiara Degirolamo, PhD e Sara di Nunzio, PhD (Polistudium Srl, Milano) per il supporto (stesura della bozza, assistenza editoriale e revisione critica) nella preparazione del manoscritto ed Elma Research per l’analisi dei risultati della survey pilota condotta in occasione dell’International Meeting “Verso la chirurgia ortopedica ambulatoriale” svoltosi a Milano il 7-8 Giugno 2019 e organizzato dall’ Associazione Orthopea. Questo supporto è stato finanziato da Grunenthal Italia.

Funding declaration: The survey, promoted by the Associazione Orthopea, was supported by Grunenthal Italia. Medical writing and editorial support was funded by Grunenthal Italia.

Copyright: Copyright © 2020 Perazzo P, Albano G, Crespi T, Roscitano C, Verde F. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Perazzo P, Albano G, Crespi T, Roscitano C, Verde F. https://doi.org/10.7573/dic.2020-6-4. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/educational_section/management-of-pre-surgical-pain-in-orthopaedics

Correspondence: Tiziano Crespi, IRCCS Istituto Ortopedico Galeazzi, Milano, Italia. dott_crespi@hotmail.it

Provenance: Submitted; internally reviewed.

Submitted: 9 June 2020; Peer review comments to author: 22 June 2020; Revised manuscript received: 20 July 2020; Accepted: 24 July 2020; Publication date: 31 August 2020.

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