Perioperative pain management following total joint arthroplasty: A review and update to an institutional pain protocol

Stevenson, Kimberly L.; Neuwirth, Alexander L.; Sheth, Neil P.

doi:10.1016/j.jcot.2017.09.014

Cited by 17 publications

(6 citation statements)

References 55 publications

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“…Although the incidence of emergency treatment events was higher in the platform consultation group, they had a lower re-admission than the telephone consultation group, because their postoperative problems were promptly intervened and processed. In our study, the most frequent cause of postoperative emergency treatment and readmission in the patients who had undergone joint replacement surgery (Table 4) was pain, especially chronic pain, , which is consistent with the results reported in many literatures [11][12][13][14]. However, although pain, allergies, and other problems may lead to increased incidence of emergency treatment after the operation, they will not lead to re-admission; it is more likely that patients with incision-, activity-, and infectionrelated concerns are re-admitted [15][16][17][18][19][20].…”

Section: Discussionsupporting

confidence: 92%

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

Zheng

Geng

et al. 2019

J Orthop Surg Res

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Background: Follow-up after artificial joint replacement greatly helps achieve surgical outcomes. Mobile internet technology and mobile terminal equipment may increase the effectiveness of artificial joint replacement. However, only a few studies have evaluated the effectiveness of this technology. We aimed to analyze the reasons and outcomes of patients who used the instant messaging platform after undergoing artificial joint replacement. Methods: Among the 548 cases of arthroplasty (250 hips, 298 knees) performed between December 2015 and June 2018 in the Department of Joint Surgery of our institution; 358 (164 hip joints, 194 knee joints) participated in instant messaging platform consultation, whereas the remaining 190 (86 hip joints, 104 knee joints) participated in traditional telephone consultation, as a control group. Follow-up time was from December 2015 to August 2018 (follow-up period was 2-32 months). Data on age, sex, type of surgery, date of surgery, date of discharge, and length of hospital stay were collected from electronic medical records. Results: We analyzed the consultation contents of 358 patients who participated in instant messaging platform consultation. Counseling was mainly related to pain (13.6%), appointment review (12.4%), activity problems (10.5%), and incision problems (8.9%). Most problems were resolved through online guidance, with 8.4% of patients requiring only outpatient treatment and 2.5% of patients requiring rehospitalization. A total of 190 patients were followed up through traditional telephone consultation; 6.8% of patients required outpatient department treatment and 7.4% were eventually re-admitted. Conclusion: The instant messaging platform consultation service effectively informs patients of potential postoperative problems and helps resolve them. It allows early detection and management of postoperative adverse events, including problems related to medication, wound, and activity, thereby effectively reducing readmission rate.

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Section: Discussionsupporting

confidence: 92%

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

Zheng

Geng

et al. 2019

J Orthop Surg Res

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“…In addition, severe postoperative pain also contributes to immobility-related complications like deep vein thrombosis and delay hospital discharge [1–5]. Although the analgesic techniques have been greatly improved, the effect is far from optimal [6–8]. Femoral nerve block is commonly used for analgesia after open knee surgery [9].…”

Section: Introductionmentioning

confidence: 99%

Epidural morphine improves postoperative analgesia in patients after total knee arthroplasty: A randomized controlled trial

Meng¹,

Cui²,

Li³

et al. 2019

PLoS ONE

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Background Patients after total knee arthroplasty (TKA) often develop moderate to severe pain. This study compared the analgesic effect of low-dose epidural morphine vs. a comparable saline injection in patients following TKA surgery. Methods This randomized, double-blinded, and placebo-controlled trial was conducted in a tertiary hospital in Beijing between July 1, 2017 and May 30, 2018. One hundred and ten patients following TKA under combined spinal-epidural anesthesia were randomized to receive either epidural morphine (2 mg diluted to 5 ml normal saline, the epidural morphine group) or placebo (5 ml normal saline, the placebo group). For all patients, single-injection femoral nerve block was performed, and a supplementary patient-controlled intravenous analgesia pump was provided. The severity of pain was assessed with the numerical rating scale (NRS, an 11-point scale where 0 = no pain and 10 = the worst pain) at 6, 12, 24, 36, and 48 hours after surgery. The primary endpoint was moderate to severe pain (NRS pain score ≥4) within 48 hours after surgery. Results The percentage with moderate to severe pain within 48 hours was lower in the epidural morphine group than in the placebo group (58.2% [32/55] with epidural morphine vs. 76.4% [42/55] with placebo; OR 0.43, 95% CI 0.19–0.98; p = 0.042). Furthermore, the cumulative morphine consumption within 48 hours was lower (18.4±6.1 mg vs. 22.4±7.3 mg; p = 0.002) whereas the mental component summary score of 30-day quality of life was higher (63.8±2.9 vs. 61.9±4.2; p = 0.008) in the epidural morphine group than in the placebo group. Conclusions For patients following TKA, the addition of epidural morphine to single-injection femoral nerve block improves the quality of analgesia within 48 hours, without increasing adverse events. Trial registration ClinicalTrials.gov NCT03203967 .

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“…In order to best manage postoperative pain, several protocols have been studied and adopted in literature. [ 12 – 17 ] To reduce the occurrence of collateral effects, the analgesia protocol should be multimodal [ 18 – 20 ] which consists of the employment of more than 2 different drugs or modalities with different mechanisms or sites of action for synergistic effects on pain and should block pain at its origin. [ 6 ] Horlocker [ 8 ] demonstrated that, in order to minimize the use of opioid analgesics, employing peripheral nerve blockages (PNB) together with a combination of analgesic agents allows early mobilization and helps patient's rehabilitation, reducing hospitalization times and costs.…”

Section: Introductionmentioning

confidence: 99%

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

Luca

Ciccarello²,

Martorana

et al. 2018

Medicine

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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.

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Perioperative pain management following total joint arthroplasty: A review and update to an institutional pain protocol

Cited by 17 publications

References 55 publications

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

Modern instant messaging platform for postoperative follow-up of patients after total joint arthroplasty may reduce re-admission rate

Epidural morphine improves postoperative analgesia in patients after total knee arthroplasty: A randomized controlled trial

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

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