Effectiveness of Multimodal Pain Management Protocol in Total Knee Arthroplasty Patients

Lewis, Cynthia; Gunta, Kathleen; Mitchell, Kimberly; Bobay, Kathleen L.

doi:10.1097/nor.0b013e3182558d0b

Cited by 15 publications

(12 citation statements)

References 6 publications

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“…This is the fi rst study to evaluate the PCA knowledge of elderly patients. The highest postoperative pain scores recorded in the early postoperative period were less than 7 for the vast majority of patients, indicating that their perceived pain level was not too severe, contrary to prior reports about pain for joint replacement surgery ( Dalury et al, 2012 ;Lewis et al, 2012 ;Meftah et al, 2012 ). Our observation of low postoperative pain scores may be related to recent changes in total knee replacement analgesic standards, which include the use of regional femoral nerve blocks for the fi rst 24-36 hours postoperatively in total knee replacement surgeries.…”

Section: Discussioncontrasting

confidence: 83%

“…Our observation of low postoperative pain scores may be related to recent changes in total knee replacement analgesic standards, which include the use of regional femoral nerve blocks for the fi rst 24-36 hours postoperatively in total knee replacement surgeries. Prior studies that reported on postoperative pain levels during the fi rst postoperative day in joint replacement patients either had no or few patients with femoral blocks, different from the majority of patients in our study ( Dalury et al, 2012 ;Lewis et al, 2012 ;Meftah et al, 2012 ).…”

Section: Discussioncontrasting

confidence: 52%

“…Studies on the effi cacy of PCA delivery versus traditional nurse administered analgesic therapy found high patient satisfaction with the delivery method and better pain control after surgical procedures ( Bainbridge, Martin, & Cheng, 2006 ;Chang & Cho, 2012 ;Dalury, Lieberman, & MacDonald, 2012 ;Dolin, Cashman, & Bland, 2002 ;Helfand & Freeman, 2009 ;Hudcova, McNicol, Quah, Lau, & Carr, 2006 ;Lewis, Gunta, Mitchell, & Bobay, 2012 ;Meftah et al, 2012 ;Miaskowski, 2005 ;Walder, Schafer, Henzi, & Tramer, 2001 ;Wu et al, 2005 ). Total analgesic doses received were also higher in the PCA delivery, supporting the belief that patients would obtain more pain medication if they did not have to go through others ( Chumbley, Hall, & Salmon, 2002 ).…”

Section: Introductionmentioning

confidence: 95%

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Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

Brown

Boshers

Chapman

et al. 2015

Orthopaedic Nursing

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Elderly patients were very knowledgeable about how to use the PCA device but not about how often they could receive PCA medication. This lack of knowledge may have influenced how often they requested pain medication, because almost 90% of patients received less than 25% of the PCA allowable medication dose. This low usage of PCA medication delivery calls into question the cost-effectiveness of this method of medication delivery for the elderly. Additional studies are needed to verify these findings in other elderly patients.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 95%

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Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

Brown

Boshers

Chapman

et al. 2015

Orthopaedic Nursing

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“…[5][6][7] Improvements in pain management following TKA have been associated with early ambulation, thereby lowering the risk of postoperative complications and reducing length of stay. 8 The advent of fast-track surgery programs in North America and Europe may reduce length of stay by identifying and addressing factors that cause patients to remain in hospital. 9 One of these factors is pain, so discharge after TKA may be accelerated by effective postoperative pain management.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing orthopedic nurses’ pain management: A focused ethnography

Denness

Carr

Seneviratne

et al. 2017

Canadian Journal of Pain

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Aim: The aim of this study was to explore the factors influencing orthopedic surgery nurses' decisions to administer pro re nata (PRN) opioid analgesia for postoperative pain. Background: Fast-track surgery programs reduce length of stay by identifying and addressing factors causing patients to remain in hospital, including pain (H. Kehlet, Lancet. 2013;381:9878 (9878)). The management of acute pain is an important component of quality care for patients after total knee arthroplasty. Methods: The study used a qualitative design of focused ethnography. Ten nurses working on an orthopedic surgery unit at a large urban hospital in western Canada participated in semistructured interviews that used a patient vignette to examine factors that influenced participants' pain management in the context of fast-track surgery. Interviews were transcribed and analyzed using thematic analysis and constant comparison. Findings: Nurses described a complex clinical environment where the interplay of several factors informed decisions to administer PRN opioid analgesia. The unit's culture and physical space influenced nurses' assessments of pain and their decisions whether to treat pain with PRN opioids. Each nurse's self-concept affected pain management decisions because of perceived importance of pain control and perceived duty to provide analgesics. The subjectivity of pain added another layer of complexity as nurses responded to the patient's expression of pain from within the milieu of the unit culture and their unique self-concept. Conclusion: Understanding the complexity of factors that influence nurses' postoperative pain management provides clinical nurses and nursing leaders with directions for future education and research, guided by the goal of continued improvement in pain management in the challenging setting of fast-track surgeries. RÉSUMÉBut: Étudier les facteurs qui influencent la décision des infirmières en chirurgie orthopédique d'administrer des analgésiques opiacés pro re nata pour la douleur postopératoire. Contexte: Les programmes de chirurgie accélérée réduisent la durée du séjour en cernant les facteurs qui font en sorte que les patients restent à l'hôpital, dont la douleur, et en y apportant des réponses (Kehlet, 2013). La gestion de la douleur aigue est une composante importante de la qualité des soins pour les patients après une arthroplastie totale du genou. Méthodes: L'étude a eu recours à un devis qualitatif d'ethnographie focalisée. Dix infirmières travaillant dans l'unité de chirurgie orthopédique d'un grand hôpital urbain de l'Ouest du Canada ont participé à des entrevues semi-structurées qui avaient recours à une vignette de patient pour examiner les facteurs influençant la gestion de la douleur dans le contexte d'une chirurgie accélérée. Les entrevues ont été transcrites et analysées au moyen d'une analyse thématique et de la méthode de comparaison constante. Résultats: Les infirmières ont décrit un environnement clinique complexe où l'interaction de plusieurs facteurs était à l'origine ...

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“…From April 1, 2010, to March 31, 2011, there were 47,113 acute-care hospitalizations for primary TKA in Canada, of which 6,392 were in British Columbia. 1 Immediate consequences after TKA include significant pain, 2 swelling, 3 limited movement, 4 nausea or vomiting, 5 and potential blood loss. 6 The goal of surgery is to reduce pain, improve function, and maximize knee range of motion (ROM).…”

mentioning

confidence: 99%

Device or Ice: The Effect of Consistent Cooling Using a Device Compared with Intermittent Cooling Using an Ice Bag after Total Knee Arthroplasty

Bech

Moorhen

Cho

et al. 2015

Physiotherapy Canada

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Purpose: To determine the comparative effectiveness of consistent cooling using an icing device (DonJoy Iceman, DJO Canada, Mississauga, ON) versus intermittent cooling using an ice bag (usual care) for the first 48 hours after total knee arthroplasty (TKA). Method: A sample of 78 patients (intervention group, n ¼ 37; control group, n ¼ 34) undergoing primary TKA were randomized to intervention (device) or control (ice) groups. The primary outcome was pain intensity, measured by numerical pain rating scale (NPRS). Secondary outcomes were passive range of motion (PROM), nausea or vomiting, opioid use, blood loss, lower limb function, hospital length of stay, and patient-reported compliance and satisfaction. Results: No significant differences in the primary outcome (pain intensity measured via NPRS) were observed between control and intervention groups. Patients in the intervention group were significantly more satisfied (8.4 vs. 6.0, p ¼ 0.002); used the device more consistently, day and night (85.7% vs. 29.6% and 87.6% vs. 30.8%, respectively, p < 0.001); and were more likely to recommend this method of cooling (96.8% vs. 68.0%, p ¼ 0.004). Conclusion: The study found no additional benefit of consistent cryotherapy using the icing device over intermittent ice bags on postoperative pain, PROM, nausea or vomiting, opioid use, blood loss, lower limb function, or length of stay, despite significant differences in patient-reported compliance and satisfaction.Key Words: arthroplasty; cryotherapy; knee. RÉ SUMÉObjet: Dé terminer l'efficacité comparative du refroidissement constant au moyen d'un dispositif de refroidissement (DonJoy Iceman, DJO Canada, Mississauga, Ontario) en comparaison du refroidissement intermittent dé coulant de l'utilisation d'un sac à glace (soins habituels) dans les 48 premiè res heures suivant l'arthroplastie totale du genou. Mé thode: Un é chantillon de 78 patients (groupe d'intervention n ¼ 37; groupe té moin n ¼ 34) ayant subi une premiè re arthroplastie totale du genou ont é té randomisé s dans des groupes d'intervention (dispositif) ou té moin (glace). Le ré sultat principal é tait l'intensité de la douleur, mesuré e selon une é chelle d'é valuation numé rique de la douleur. Les ré sultats secondaires é taient l'amplitude passive du mouvement, les nausé es/vomissements, l'utilisation d'opioïde, la perte de sang, la fonction des membres infé rieurs, la duré e du sé jour à l'hô pital, et la conformité et la satisfaction dé claré es par les patients. Ré sultats: On n'a observé aucune diffé rence significative dans le ré sultat principal (intensité de la douleur mesuré e selon une é chelle d'é valuation numé rique de la douleur) entre les groupes té moin et d'intervention. Les patients du groupe d'intervention é taient consid-é rablement plus satisfaits (8,4 contre 6, 0, p ¼ 0,002); utilisaient le dispositif de fac¸on plus uniforme, le jour et la nuit (85.7% contre 29.6% et 87.6% contre 30.8%, respectivement, p < 0,001); et é taient plus susceptibles de recommander cette mé thode de r...

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Effectiveness of Multimodal Pain Management Protocol in Total Knee Arthroplasty Patients

Abstract: The multimodal pain approach improved patient outcomes in TKA patients.

Cited by 15 publications

References 6 publications

Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

Do Elderly Patients Use Patient-Controlled Analgesia Medication Delivery Systems Correctly?

Factors influencing orthopedic nurses’ pain management: A focused ethnography

Device or Ice: The Effect of Consistent Cooling Using a Device Compared with Intermittent Cooling Using an Ice Bag after Total Knee Arthroplasty

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