Association between BDNF/CB1R expression and postoperative pain and recovery in patients with preoperative sleep disorders.

PURPOSE: This study evaluated how preoperative sleep quality affects postoperative pain and recovery in total knee arthroplasty (TKA) patients, focusing on serum BDNF and CB1R's roles.

METHODS

This study involved 185 patients scheduled for TKA, categorized by their Pittsburgh Sleep Quality Index (PSQI) into normal (PSQI ≤ 5) and poor sleep groups (PSQI > 5). Postoperative pain was assessed using the Numeric Rating Scale (NRS), and data on hydromorphone use, rescue analgesia needs, and QoR-15 recovery scores were collected 24 h after surgery. Pre-anesthesia plasma samples were analyzed for BDNF and CB1R levels. Spearman correlation and generalized linear regression with restricted cubic spline models were used to explore the relationships between PSQI scores, BDNF, CB1R, QoR-15 scores, and hydromorphone consumption, adjusting for confounders.

RESULTS

Of 185 patients, 96 (52%) reported poor preoperative sleep, leading to higher pain scores and more opioid use at 24 h post-operation. This group also had lower recovery quality scores and a greater need for rescue analgesia. Preoperative sleep quality was linked to higher pain scores, opioid use, and serum BDNF and CB1R levels, and lower recovery scores, with BDNF and CB1R partially mediating the sleep-pain-recovery relationship.

CONCLUSION

Preoperative sleep quality in TKA patients influences postoperative pain and recovery, with BDNF and CB1R levels partially mediating this effect.