Ulus Travma Acil Cer: Comparison of analgesic consumption in patients with hemophilia and non-hemophilia during knee replacement

Hemophilia is a rare inherited bleeding disorder that develops
due to factor VIII or IX deficiency.
Long-term complications of hemophilia, such as arthropathy, synovitis, and arthritis, can lead to the development of
recurrent chronic pain.
Therefore, pain is a key aspect of
hemophilia.
The gold standard treatment for end-stage hemophilic knee arthropathy is total knee replacement (TKA).

A team of researchers conducted a study that hypothesized that hemophilia patients who took analgesics for a long time might experience higher levels of pain and use more opioids and non-opioids after knee replacement surgery, which causes severe postoperative pain
.

Figure: Research flowchart

This retrospective study included patients with hemophilia and non-hemophilia TKA who underwent surgery under general anaesthesia from 2001 to 2020
.
All surgeries are performed
by the same surgeon.
Patients with missing files or additional surgery for TKA were excluded from
the study.
Data
is obtained using files from the hospital registry, perioperative anesthesia forms, hematology forms, and discharge information.
In this study, data from 82 patients were evaluated and their eligibility for the study investigated
.
Of these, 73 patients were included in the study
.
According to the diagnosis of hemophilia, it was divided into two groups: 36 cases in the hemophilia group and 37 cases
in the non-hemophilia group.

Table: Regression analysis

In this retrospective study, they found that tramadol (p=0.
002) and meperidine (p=0.
003) were significantly higher
in the hemophilia group in terms of consumption as analgesics after TKA.
Pain that does not respond to analgesics is the most common indication for TKA, which is considered the gold standard treatment
for end-stage hemophilic arthropathy in patients with hemophilia.
Increased pain sensitivity in patients correlates
with the severity of joint lesions.

Based on this information, the researchers believe that acute postoperative pain management in hemophilia patients should be planned as individualized, multimodal prophylaxis, and preemptive analgesia
.
Regional anesthesia is also an option
.
Optimizing factor levels, femur, ischial and IPACK blocks under ultrasound guidance can be used for analgesia after total knee replacement in hemophilia patients to avoid increased opioid use and its side effects
.

Original source:

Canbolat N, Dinç T, Koltka K, et al.
Comparison of analgesic consumption of hemophilic and non-hemophilic patients in knee arthroplasty.
Diz artroplastilerinde hemofilik ve non-hemofilik hastaların analjezik tüketimlerinin karşılaştırılması.
Ulus Travma Acil Cerrahi Derg.
2022; 28(11):1616-1621.
doi:10.
14744/tjtes.
2021.
47482