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Acute and Chronic Pain After Shoulder Surgery: Treatment and Epidemiology

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Acute and Chronic Pain After Shoulder Surgery: Treatment and Epidemiology Acute and Chronic Pain after Shoulder Surgery: Treatment and Epidemiology PhD dissertation Karen Toftdahl Bjørnholdt Health Aarhus University 2015 Correspondence Karen Toftdahl Bjørnholdt, M.D. Department of Orthopedic Surgery Horsens Regional Hospital Sundvej 30, DK-8700 Horsens, Denmark E-mail: [email protected], [email protected], or [email protected]. 1 Acute and Chronic Pain after Shoulder Surgery: Treatment and Epidemiology PhD dissertation Karen Toftdahl Bjørnholdt Health Aarhus University Department of Clinical Medicine 2 Preface This PhD dissertation is based on research performed during my employment at the Department of Orthopedic Surgery, Horsens Regional Hospital, and my enrolment at the Department of Clinical Medicine, Aarhus University from 2011 to 2015. Part of study I was carried out at the Department of Orthopedic Surgery, Aarhus University Hospital. Academic supervisors: Kjeld Søballe, Professor, Consultant, DMSc (principal supervisor), Department of Orthopedic Surgery, Aarhus University Hospital, Denmark. Lone Nikolajsen, Associate Professor, Consultant, DMSc (co-supervisor), Danish Pain Research Center and Department of Anesthesiology, Aarhus University Hospital, Denmark. Assessment committee: Andrew Carr, Professor, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom. Ole Mathiesen, Consultant, PhD, Head of Research, Department of Anesthesiology, Copenhagen University Hospital, Køge Hospital, Denmark. Steen Rasmussen, Consultant, Associate Professor, Orthopedic Surgery Research Unit, Science and Innovation Center, Aalborg University Hospital, Denmark. Public defense: June 10 th 2015. 3 Acknowledgements I extend my deepest thanks to my supervisors Kjeld Søballe and Lone Nikolajsen for their guidance and conveyed knowledge. I am very grateful for the possibility of research training that they have provided me, and for the good cooperation that we have. Also a big thank you to my other co- authors, Birgitte Brandsborg, Peter Nørgaard Mønsted, Jan Mick Jensen, and Thomas Fichtner Bendtsen, for their ideas and critical comments. Thank you to my Head of Department, Gerhardt Teichert, for professional sparring. Also a deep-felt thank you to the other people I have been informally trained by along the way: Lise Viskum Hansen for data management, Niels Trolle and Morten Frydenberg for statistical analysis, and secretaries Helle Obenhausen Andersen and Line Jensen for proofreading manuscripts. I wish to thank the financial contributors for making the studies possible: The Health Research Fund of Central Denmark Region (DKK 1.780.000), Augustinusfonden (DKK 100.000), The Family Hede Nielsen Foundation (DKK 74.500), The Danish Rheumatism Association (DKK 50.000), and Horsens Regional Hospital (DKK 40.000 and the necessary, but unused, deficit guarantee for my salary). Office facilities and supplies were provided by Horsens Regional Hospital and Aarhus University Hospital, and finances were administrated by Horsens Regional Hospital. Warm thanks go to my colleagues at the Research Unit of Horsens Regional Hospital and the Clinical Orthopedic Research Group of Aarhus University Hospital for professional and friendly support over the years. Thanks to my hired help: the project nurses Gitte Ellemose Vinther, Johanna Strohbach, and Mette Blichfeldt Kofod for inclusion and data collection during my maternity leave, research assistant Ronja Tügel Carstensen for digitalizing the large majority of the many hundred questionnaires, and project nurse Rie Espensen for insights into the inclusion process. Heartfelt thanks to my entire family for love, support and inspiration in every way. Especially, I extend my thanks to the patients for their willingness to contribute personally to our work to attain new knowledge, and to the involved staff at Horsens Regional Hospital and Aarhus University Hospital for their insistent efforts to do, and to improve, “the best we know how”. Horsens, February 2015 4 List of papers I. Bjørnholdt KT, Jensen JM, Bendtsen TF, Søballe K, Nikolajsen L. Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: A randomized clinical trial. Submitted. II. Bjørnholdt KT, Mønsted PN, Søballe K, Nikolajsen L. Dexamethasone for pain after outpatient shoulder surgery: a randomised, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 2014 Jul; 58(6): 751-758. III. Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L. Persistent pain is common 1–2 years after shoulder replacement. A nationwide registry-based questionnaire study of 538 patients. Acta Orthop. 2015 Feb; 86(1): 71-77. 5 Table of contents Preface........................................................................................................................................... 2 Acknowledgements........................................................................................................................ 3 List of papers................................................................................................................................. 4 Table of contents ........................................................................................................................... 5 List of abbreviations and definitions............................................................................................ 6 Overview of studies ....................................................................................................................... 7 Introduction .................................................................................................................................. 8 Background ................................................................................................................................... 9 Acute postoperative pain.................................................................................................................... 9 Description of the surgical procedures............................................................................................. 10 Pain treatment after shoulder surgery .............................................................................................. 12 Local infiltration analgesia............................................................................................................... 14 Dexamethasone ................................................................................................................................ 16 Chronic postoperative pain .............................................................................................................. 17 Objectives and hypotheses.......................................................................................................... 19 Methods....................................................................................................................................... 20 Assessment of postoperative pain.................................................................................................... 20 Ethics................................................................................................................................................ 20 Study I.............................................................................................................................................. 21 Study II............................................................................................................................................. 25 Study III ........................................................................................................................................... 28 Results ......................................................................................................................................... 31 Study I.............................................................................................................................................. 31 Study II............................................................................................................................................. 33 Study III ........................................................................................................................................... 34 Discussion .................................................................................................................................... 36 Interpretation and comparison with the literature ............................................................................ 36 Methodological considerations and limitations ............................................................................... 39 Conclusion and implications....................................................................................................... 42 References ................................................................................................................................... 43 English summary ........................................................................................................................ 52 Danish summary – Dansk resumé .............................................................................................. 53 Appendices: ................................................................................................................................. 54 Paper I .............................................................................................................................................
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