Postoperative Management and Radiography

2015 ◽  
Author(s):  
John Goodfellow ◽  
John O'Connor ◽  
Hemant Pandit ◽  
Christopher Dodd ◽  
David Murray
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Pain Control ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Multimodal Approach ◽  
Invasive Approach ◽  
Opiate Use ◽  
Total Knee ◽  
Good Pain Control

In the early postoperative period, good pain control is essential. Regimes of pain management appropriate for total knee arthroplasty may not be suited to the very rapid mobilisation that is possible after UKA through a minimally invasive approach. A multimodal approach is best with minimal opiate use. Different regimes are used successfully in different institutions.

Does Patient Perception of Pain Influence How Patients Rate Their Experience after Total Knee Arthroplasty?

2017 ◽  
Vol 30 (07) ◽  
pp. 622-626 ◽  
Author(s):  
Chukwuweike Gwam ◽  
Jaydev Mistry ◽  
Ronald Delanois ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Hospital Staff ◽  
Patient Perception ◽  
Control Score ◽  
Total Knee ◽  
Survey Responses ◽  
Good Pain Control

Press Ganey (PG) is an increasingly used measure to determine patient satisfaction. It has yet to be determined which factors influence the PG scores most amongst patients with inadequate pain control after total knee arthroplasty (TKA). Therefore, we assessed (1) which PG factors influence overall hospital rating (OHR) in patients who had poor pain control in comparison to those with good pain control and (2) whether pain control influences OHR during hospital admission following TKA. An institutional database search was performed between November 2009 and January 2015 for all TKA patient responders to the PG questionnaire. This yielded 148 patients (mean = 61 years; range, 24–92 years). Pain control was graded on a scale from 1(least satisfied) to 4 (most satisfied). Patients were separated into two cohorts: those who had poor pain control (score ≤ 2) and those who had good pain control (score > 2). Multiple regression analysis assessed the weighted means (β) of all PG categories on OHR. To compare the demographics and survey responses between the two cohorts, χ 2 and t-tests were utilized. For patients with poor pain control, the responsiveness of hospital support staff had the highest influence on OHR (β = 2.103), followed by communication about medications (β = 1.230). For patients with good pain control, communication with nurses had the strongest effect on hospital rating (β = 0.233, p = 0.056), followed by communication about medications (β = 0.200, p = 0.049). The patients with good pain control had significantly higher OHR (6.0 vs. 9.1, p = ≤ 0.001) and scores in each category of PG. Communication about medications and responsiveness of hospital staff had a significant effect on OHR. Well-controlled patients were highly influenced by communication of medication and communication with nurses. Moreover, patients with good pain control had significantly higher scores in all areas of PG survey, signifying that patient perception of pain affects patient satisfaction with the hospital. Orthopaedists should be involved in direct efforts to improve pain control as well as address the aforementioned PG domains.

Pain Management After Total Knee Arthroplasty Using a Multimodal Approach

Orthopedics ◽  
2012 ◽  
Vol 35 (5) ◽  
pp. e660-e664 ◽  
Author(s):  
Morteza Meftah ◽  
Anthony C. Wong ◽  
Danyal H. Nawabi ◽  
Richard J. Yun ◽  
Amar S. Ranawat ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Knee Arthroplasty ◽  
Multimodal Approach ◽  
Total Knee

scholarly journals New Pain Management Procedure after Total Knee Arthroplasty: Gonyautoxins are Safe and Effective after A Single Intra-Articular Infiltration

2018 ◽  
pp. 15-25
Author(s):  
Jaime Hinzpeter ◽  
Cristián Barrientos ◽  
Maximiliano Barahona ◽  
Álvaro Zamorano ◽  
Miguel Palet ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Range Of Motion ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Wound Closure ◽  
Full Extension ◽  
Management Procedure ◽  
Total Knee

Objective To evaluate the effect of a single intraarticular dose of Gonyautoxins for pain control after Total Knee Arthroplasty (TKA). Subjects 30 consecutive patients with osteoarthritis with Kellgren & Lawrence level of two or more, who required TKA, were enrolled. Methods Subjects receive a single intra-articular infiltration of 40 µg dose of Gonyautoxins, immediately after TKA wound closure. The pain was measured with the Visual Analog Scale (VAS). Additionally, the range of motion at 12, 36, and 60 hours and hospital stay length were recorded. Results were compared to the 2014 TKA cohort. Results 25 patients (83.33%) achieved successful pain management. All patients achieved complete flexion ≥90° 60 hours after surgery and 24 patients achieved full extension before hospital discharge. The median VAS pain score for each evaluation period was ≥2. The 25 Gonyautoxins treated patients who achieved successful pain management had a median VAS pain score of 0 after 36 and 60 hours. Conclusions Gonyautoxins are safe and effective in pain management after TKA when used as a single intra-articular dose. This protocol shows adequate pain control in TKA, reducing discharge to 3 days and greater range of motion, improving the post-operated patient experience.

scholarly journals Efficacy and safety of duloxetine for postoperative pain after total knee arthroplasty in centrally sensitized patients: study protocol for a randomized controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shicheng Wang ◽  
Wensheng Wang ◽  
Long Shao ◽  
Jing Ling
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Pain Control ◽  
Controlled Trial ◽  
Control Group ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Total Knee ◽  
Postoperative Residual

Abstract Background Postoperative residual knee pain after total knee arthroplasty (TKA) is a significant factor that contributes to patient dissatisfaction. Patients with preoperative central sensitization (CS) may be more susceptible to unexplained chronic pain after TKA, and duloxetine has been reported to be effective in post-TKA pain control in patients with CS. However, there remains limited evidence to support this off-label use in routine clinical practice. Hence, we designed this randomized, placebo-controlled, triple-blind clinical trial to evaluate the effects of preoperative screening and targeted duloxetine treatment of CS on postoperative residual pain compared with the care-as-usual control group. Methods This randomized controlled trial includes patients with knee osteoarthritis on a waiting list for primary unilateral TKA. Patients with preoperative CS will be randomly allocated to the perioperative duloxetine treatment group (duloxetine group) or the care-as-usual control group (placebo group). Patients in the duloxetine group will receive a half-dose of preemptive duloxetine (30 mg/day) for a week before surgery and a full-dose of duloxetine (60 mg/day) for six weeks after surgery. The primary outcome is the intensity of residual pain at six months after TKA, including the visual analogue scale, 11-point numeric rating scale, the sensory dimension of the brief pain inventory, and the pain subscale of the Knee injury and Osteoarthritis Outcome Score. The secondary outcome measures will include the pain and function related outcomes. All of the patients will be followed up at one, three, and six months after surgery. All adverse events will be recorded and immediately reported to the primary investigator and ethics committee to decide if the patient needs to drop out from the trial. Discussion This clinical trial will convey the latest evidence of the efficacy and safety of the application of duloxetine in postoperative pain control in CS patients who are scheduled for TKA. The study results will be disseminated at national and international conferences and published in peer-reviewed journals. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) registration number: ChiCTR2000031674. Registered 07 April 2020.

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