Pain monitoring and management in a rehabilitation setting after total joint replacement

Abstract

Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.

What is the optimal regimen for intravenous dexamethasone administration in primary total hip arthroplasty?

“…[ 13 , 14 ] Nevertheless, the former researches reported that there was a pain peak within 72 hours after the THA. [ 15 , 16 ] In Lei et al's study, the authors observed that the multiple low-dose dexamethasone can in-depth reduce postoperative pain, improve nausea after surgery, offer extra inflammatory control, increase activity, and decreased postoperative hospital stays. [ 11 ] Therefore, we designed the randomized controlled research to look for the optimal intravenous dexamethasone dose for the treatment of early postoperative pain after the THA.…”

Does walking the day of total hip arthroplasty speed up functional independence? A non-randomized controlled study

“…Pain was assessed after got out of bed and set on a chair in autonomy using the Numeric Rating Scale (NRS). It consists of 11-point numeric scale with a score ranging from 0 to 10 (maximum pain) to evaluate pain intensity after THA [25]. Hip function was assessed using Harris Hip Score (HHS), which is a valid tool ranging from 0 to 100 (maximum function) to assess hip functional status especially after surgery [26].…”

Pre-Conditioning and Post-Operative Photobiomodulation Therapy by a Novel Light Patch System for Knee Arthroplasty: A Protocol for a Phase 1 Study

“…NPRS pain assessments will be recorded by participants in a pain diary and carried out daily pre-operatively, postoperatively (thrice daily morning, noon, and evening in hospital until discharge), daily for the first fortnight after surgery, and weekly until the participant exits the study. The NPRS has been used in many studies to monitor pain, for example, in total hip replacement and total knee replacement surgery, 31,32 and compared to the others scales [e.g., visual analogue scale (VAS), verbal rating scale (VRS), and faces pain scale-revised (FPS-R)], has the greatest validity and strength. 31 The NPRS value for patients undergoing total joint replacement is 7.9 -1.7 (mean and standard deviation), and the minimum improvement clinically accepted requires a pain reduction of 20%.…”