Factors Associated with Postoperative Pain Trajectory, Nausea and Vomiting After Total Knee Arthroplasty: A Retrospective Study

Ti-Hsuan Chen; Chih-Cheng Wu; Jun-Peng Chen

doi:10.1097/AJP.0000000000001270

Factors Associated with Postoperative Pain Trajectory, Nausea and Vomiting After Total Knee Arthroplasty: A Retrospective Study

Clin J Pain. 2025 Jan 9. doi: 10.1097/AJP.0000000000001270. Online ahead of print.

Authors

Ti-Hsuan Chen¹, Chih-Cheng Wu^{1

2

3

4}, Jun-Peng Chen⁵

Affiliations

¹ Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Financial Engineering, Providence University, Taichung City, Taiwan.
³ Department of Data Science and Big Data Analytics, Providence University, Taichung City, Taiwan.
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan.
⁵ Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.

PMID: 39782064
DOI: 10.1097/AJP.0000000000001270

Abstract

Objectives: Postoperative pain, nausea and vomiting adversely affect postoperative rehabilitation after total knee arthroplasty (TKA). We aimed to identify factors associated with postoperative pain trajectory and postoperative nausea and vomiting (PONV) and evaluated the effects of different analgesic modalities.

Methods: We retrospectively reviewed patients undergoing unilateral primary TKA from 2017 to 2022. Patients received either general or spinal anesthesia. Patient -controlled analgesia (PCA) included patient-controlled epidural analgesia (PCEA) and intravenous analgesia (PCIA). Outcome variables included maximal pain intensity at certain times (before surgery, and 24h and 48h after surgery); and incidence of PONV. A Generalized estimating equation was used to determine the correlation between PCA usage and longitudinal pain score at 48 hours follow-up after surgery. Multivariable logistic regression analyses were used to evaluate PONV after adjusting for potential confounders.

Results: In total, 2,510 patients were identified. Patients without PCA intervention and with higher BMI reported greater acute postoperative pain. Furthermore, women and lower BMI were associated with higher rates of PONV. After adjusting for confounding factors, the PCEA group had a lower pain score than both the no PCA group (β estimate =-0.443, 95% CI= (-0.561 to -0.324), P<0.001) and the PCIA group (mean difference=-0.227, 95% CI = (-0.328 to -0.126), P <0.001).

Conclusion: General anesthesia and PCA had no effect on the PONV incidence following TKA. Greater BMI correlated with higher pain scores but a lower likelihood of PONV. Epidural PCA provided superior acute postoperative analgesia without increasing the incidence of PONV.