The application of enhanced recovery after surgery in pain management after total knee arthroplasty_West China Medical Journal

Authors：

SU Manman ¹ ,  ZHOU Yang ^1,2 , ZENG Biyun ² , YU Jie ²

1. Xiangya Nursing School of Central South University, Changsha, Hunan 410013, P. R. China;
2. Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P. R. China;

Corresponding author：

ZHOU Yang, Email: 124091564@qq.com

Keywords：

Enhanced recovery after surgery; Total knee arthroplasty; Pain; Knee joint function

DOI：

10.7507/1002-0179.201707099

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Objective To explore the application of enhanced recovery after surgery (ERAS) in pain management after knee arthroplasty (TKA). Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group (before intervention) and 60 TKA patients admitted from August to October 2016 were assigned into the trial group (after intervention). The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; multimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery (HSS) knee score, average length of stay (ALOS) and average hospitalization cost (excluding materials) were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different (P>0.05), and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group (P<0.05). The HSS scores between the two groups at the admission were not statistically different (P>0.05), and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group (P<0.05). And ALOS and average hospitalization cost (excluding materials) in the trial group were significantly lower than those in the control group (P<0.05). Conclusion The application of ERAS in pain management after TKA can effectively alleviate the postoperative pain, improve the patients’ knee function, shorten the ALOS, and decrease the average hospitalization cost.

Citation： SU Manman, ZHOU Yang, ZENG Biyun, YU Jie. The application of enhanced recovery after surgery in pain management after total knee arthroplasty. West China Medical Journal, 2017, 32(9): 1328-1332. doi: 10.7507/1002-0179.201707099 Copy

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4.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am, 1976, 58(6): 754-765.
5.	辛雷, 苏佳灿. 膝关节功能评分: 现状与展望. 中国组织工程研究与临床康复, 2010, 14(39): 7367-7370.
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9.	甘玉云, 代极静, 刘星, 等. 医麻护三位一体疼痛管理模式在膝关节置换术患者围手术期的效果研究. 护士进修杂志, 2016, 31(9): 807-810.
10.	Ochroch EA, Mardini IA, Gottschalk A. What is the role of NSAIDs in pre-emptive analgesia?. Drugs, 2003, 63(24): 2709-2723.
11.	Zhao X, Qin J, Tan Y, et al. Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis. J Orthop Surg Res, 2015, 10: 75.
12.	Jordan RW, Smith NA, Chahal GS, et al. Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review. Physiotherapy, 2014, 100(4): 305-312.
13.	郭月, 赵体玉, 杨纯子, 等. 术前教育减轻髋膝关节置换术患者术后疼痛效果的 Meta 分析. 护理学杂志, 2015, 30(12): 105-109.
14.	成燕, 童莺歌, 刘敏君, 等. 术后活动性疼痛护理评估对疼痛管理质量的影响. 中华护理杂志, 2015, 50(8): 924-928.
15.	Puolakka PA, Rorarius MG, Roviola MA, et al. Persistent pain following knee arthroplasty. Eur J Anaesthesiol, 2010, 27(5): 455-460.
16.	沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中华骨与关节外科杂志, 2016, 9(2): 91-97.
17.	杜玉萍. 疼痛控制对人工全膝关节置换术后患者早期康复效果的影响. 医学信息, 2015(2): 60.
18.	彭慧明, 唐杞衡, 钱文伟, 等. 膝关节周围注射镇痛在全膝关节置换术后多模式镇痛方案中的作用. 中华骨科杂志, 2016, 36(7): 406-412.

1. 潘京华, 查振刚. 初次膝关节置换术后膝部疼痛原因分析及处理方法. 中华关节外科杂志: 电子版, 2015, 9(2): 252-256.
2. 袁睆, 肖水源. 疼痛评估工具的临床应用. 中国心理卫生杂志, 2013, 27(5): 331-334.
3. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
4. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am, 1976, 58(6): 754-765.
5. 辛雷, 苏佳灿. 膝关节功能评分: 现状与展望. 中国组织工程研究与临床康复, 2010, 14(39): 7367-7370.
6. 江志伟, 黎介寿. 加速康复外科的现状与展望. 浙江医学, 2016, 38(1): 9-10, 25.
7. Kehlet H. Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg, 2011, 396(5): 585-590.
8. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
9. 甘玉云, 代极静, 刘星, 等. 医麻护三位一体疼痛管理模式在膝关节置换术患者围手术期的效果研究. 护士进修杂志, 2016, 31(9): 807-810.
10. Ochroch EA, Mardini IA, Gottschalk A. What is the role of NSAIDs in pre-emptive analgesia?. Drugs, 2003, 63(24): 2709-2723.
11. Zhao X, Qin J, Tan Y, et al. Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis. J Orthop Surg Res, 2015, 10: 75.
12. Jordan RW, Smith NA, Chahal GS, et al. Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review. Physiotherapy, 2014, 100(4): 305-312.
13. 郭月, 赵体玉, 杨纯子, 等. 术前教育减轻髋膝关节置换术患者术后疼痛效果的 Meta 分析. 护理学杂志, 2015, 30(12): 105-109.
14. 成燕, 童莺歌, 刘敏君, 等. 术后活动性疼痛护理评估对疼痛管理质量的影响. 中华护理杂志, 2015, 50(8): 924-928.
15. Puolakka PA, Rorarius MG, Roviola MA, et al. Persistent pain following knee arthroplasty. Eur J Anaesthesiol, 2010, 27(5): 455-460.
16. 沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中华骨与关节外科杂志, 2016, 9(2): 91-97.
17. 杜玉萍. 疼痛控制对人工全膝关节置换术后患者早期康复效果的影响. 医学信息, 2015(2): 60.
18. 彭慧明, 唐杞衡, 钱文伟, 等. 膝关节周围注射镇痛在全膝关节置换术后多模式镇痛方案中的作用. 中华骨科杂志, 2016, 36(7): 406-412.

West China Medical Journal

The application of enhanced recovery after surgery in pain management after total knee arthroplasty

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