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

1.	潘京華, 查振剛. 初次膝關節置換術后膝部疼痛原因分析及處理方法. 中華關節外科雜志: 電子版, 2015, 9(2): 252-256.
2.	袁睆, 肖水源. 疼痛評估工具的臨床應用. 中國心理衛生雜志, 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, 蘇佳燦. 膝關節功能評分: 現狀與展望. 中國組織工程研究與臨床康復, 2010, 14(39): 7367-7370.
6.	江志偉, 黎介壽. 加速康復外科的現狀與展望. 浙江醫學, 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, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
9.	甘玉云, 代極靜, 劉星, 等. 醫麻護三位一體疼痛管理模式在膝關節置換術患者圍手術期的效果研究. 護士進修雜志, 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, 趙體玉, 楊純子, 等. 術前教育減輕髖膝關節置換術患者術后疼痛效果的 Meta 分析. 護理學雜志, 2015, 30(12): 105-109.
14.	成燕, 童鶯歌, 劉敏君, 等. 術后活動性疼痛護理評估對疼痛管理質量的影響. 中華護理雜志, 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, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復——圍術期疼痛與睡眠管理專家共識. 中華骨與關節外科雜志, 2016, 9(2): 91-97.
17.	杜玉萍. 疼痛控制對人工全膝關節置換術后患者早期康復效果的影響. 醫學信息, 2015(2): 60.
18.	彭慧明, 唐杞衡, 錢文偉, 等. 膝關節周圍注射鎮痛在全膝關節置換術后多模式鎮痛方案中的作用. 中華骨科雜志, 2016, 36(7): 406-412.

1. 潘京華, 查振剛. 初次膝關節置換術后膝部疼痛原因分析及處理方法. 中華關節外科雜志: 電子版, 2015, 9(2): 252-256.
2. 袁睆, 肖水源. 疼痛評估工具的臨床應用. 中國心理衛生雜志, 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, 蘇佳燦. 膝關節功能評分: 現狀與展望. 中國組織工程研究與臨床康復, 2010, 14(39): 7367-7370.
6. 江志偉, 黎介壽. 加速康復外科的現狀與展望. 浙江醫學, 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, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
9. 甘玉云, 代極靜, 劉星, 等. 醫麻護三位一體疼痛管理模式在膝關節置換術患者圍手術期的效果研究. 護士進修雜志, 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, 趙體玉, 楊純子, 等. 術前教育減輕髖膝關節置換術患者術后疼痛效果的 Meta 分析. 護理學雜志, 2015, 30(12): 105-109.
14. 成燕, 童鶯歌, 劉敏君, 等. 術后活動性疼痛護理評估對疼痛管理質量的影響. 中華護理雜志, 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, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復——圍術期疼痛與睡眠管理專家共識. 中華骨與關節外科雜志, 2016, 9(2): 91-97.
17. 杜玉萍. 疼痛控制對人工全膝關節置換術后患者早期康復效果的影響. 醫學信息, 2015(2): 60.
18. 彭慧明, 唐杞衡, 錢文偉, 等. 膝關節周圍注射鎮痛在全膝關節置換術后多模式鎮痛方案中的作用. 中華骨科雜志, 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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