The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study

2021 ◽  
Author(s):  
Vanessa M Meyer ◽  
Hind A Beydoun ◽  
Leonora Gyenai ◽  
Nicole M Goble ◽  
Michelle M Hunter ◽  
...  
Keyword(s):  
Heart Rate ◽  
Rate Of Change ◽  
Opioid Use ◽  
Preoperative Education ◽  
Opioid Medication ◽  
Pain Anxiety ◽  
Randomized Controlled ◽  
Global Rate ◽  
Total Knee ◽  
And Function

ABSTRACT Objective To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. Methods A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). Results The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. Conclusion A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.

The Effect of Tourniquet Application on the Morphology and Function of Quadriceps in Patients Undergoing Total Knee Arthroplasty: A Study Protocol for a Single Blind Randomized Controlled Trial

2021 ◽  
Author(s):  
Ziyang Dong ◽  
Yang Li ◽  
Liyuan Tao ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Intraoperative Blood Loss ◽  
High Quality ◽  
Randomized Controlled ◽  
Total Knee ◽  
And Function ◽  
Single Blind

Abstract Background:Tourniquet is currently widely used in total knee arthroplasty to reduce intraoperative blood loss. Academic view of tourniquet application in TKA is now in dispute. Some scholars argue that tourniquet may cause quadriceps injury and bring extra side effects so they oppose the application of tourniquet. Others find that tourniquet application has no significant adverse impact on TKA patients. Regarding its advantages in reducing intraoperative blood loss, they advocate regular application of tourniquet in TKA. Quadriceps injury is considered the main cause of tourniquet side effects. There are now many high-quality trials about tourniquet application in TKA but few of them concentrate on quadriceps morphology and function.Methods:A prospective, single blind, randomized controlled trail will be adopted. The target sample is 130. Patients who meet the eligibility criteria will be randomly allocated to tourniquet group and non-tourniquet group. Primary outcomes are thickness, stiffness and function of quadriceps, which will be evaluated by ultrasound and rehabilitation tests. Secondary outcomes consist of circumference of thigh, VAS score, opioid consumption, knee function score, postoperative satisfaction score, operation time, intraoperative blood loss, perioperative blood loss, blood transfusion rate, D-Dimer, C-reactive protein, and complications. Discussion:This proposed study will contribute to improve evidence of tourniquet application in total knee arthroplasty. This will be a high-quality single blind randomized controlled trial with sufficient sample size and strict study design. It will investigate the effects of tourniquet application especially on the morphology and function of quadriceps in patients undergoing total knee arthroplasty and offer advice for tourniquet application in clinical practice.Trial registration:Chinese clinical trial registry, ChiCTR2000035097. Registered 31 July 2020, http://www.chictr.org.cn/showproj.aspx?proj=57093

Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study

2017 ◽  
Vol 27 (4) ◽  
pp. 450-466 ◽  
Author(s):  
Mei-Ling Yeh ◽  
Yu-Chu Chung ◽  
Lun-Chia Hsu ◽  
Shuo-Hui Hung
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Electrical Stimulation ◽  
Postoperative Pain ◽  
Anxiety Reduction ◽  
Controlled Study ◽  
Control Group ◽  
Significant Group ◽  
Pain Anxiety ◽  
Randomized Controlled

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group ( n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group ( n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.

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