Application of self-assessment of pain in perioperative pain management of total knee arthroplasty_West China Medical Journal

Authors：

QIN Xia , HE Jie , YI Dekun , YUAN Yuxia ,  ZHANG Yumei

Department of Orthopedics, the Second Affiliated Hospital of the Third Military Medical University, Chongqing 400037, P. R. China;

Corresponding?author：

ZHANG Yumei, Email: zhangyumei19693@sina.com

Keywords：

Enhanced recovery after surgery, ERAS; Self-assessment of pain; Total knee arthroplasty; Perioperative period

DOI：

10.7507/1002-0179.201707105

Video：

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Objective To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty (TKA). Methods A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale (SER) and the range of motion (ROM) of knee were observed and recorded. Results There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain (t=–2.736, P=0.007), types and frequencies of temporary rescue medicine (χ²=10.276, P<0.05), the overall postoperative pain score (Z=–2.146, P=0.032), average hospitalization time after surgery (t=–2.468, P=0.015), SER scores 7 days after surgery (F=2.390, P=0.018) and 14 days after surgery (F=3.427, P=0.001), and ROM at the postoperative day 7 (F=2.109, P=0.037); there were no significant differences in postoperative daily pain scores (Z=–1.779, P=0.077), SER scores at the postoperative day 3 (F=1.010, P=0.314), ROM at the postoperative day 1 (F=1.319, P=0.189) and day 14 (F=1.603, P=0.111). Conclusion Self-assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.

Citation： QIN Xia, HE Jie, YI Dekun, YUAN Yuxia, ZHANG Yumei. Application of self-assessment of pain in perioperative pain management of total knee arthroplasty. West China Medical Journal, 2017, 32(9): 1333-1338. doi: 10.7507/1002-0179.201707105 Copy

1.	Li N, Liu M, Wang D, et al. Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage. J Orthop Surg Res, 2015, 10: 3.
2.	Kurtz SM, Ong KL, Lau E, et al. International survey of primary and revision total knee replacement. Int Orthop, 2011, 35(12): 1783-1789.
3.	Anie KA, Grocott H, White L, et al. Patient self-assessment of hospital pain, mood and health-related quality of life in adults with sickle cell disease. BMJ Open, 2012, 2(4): e001274.
4.	Sandhu S, Veinot P, Embuldeniya G, et al. Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot. BMJ Open, 2013, 3(3): e002267.
5.	王海燕, 許燕玲, 胡三蓮, 等. 中文版康復自我效能感量表的信效度評價. 中華現代護理雜志, 2014, 20(3): 268-270.
6.	范建萍, 吳沛霞. 婦科腹腔鏡術后患者主訴疼痛與護理評估結果的比較. 解放軍護理雜志, 2012, 29(10): 29-31.
7.	Lewis GN, Rice DA, Mcnair PJ, et al. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561.
8.	李紅. 電話隨訪式疼痛管理對癌痛患者鎮痛藥物治療依從性的影響. 護理實踐與研究, 2016, 13(8): 135-136.
9.	童鶯歌, 成燕, 劉冬華, 等. 術后疼痛護理評分與患者靜息及活動性疼痛自評結果的比較. 護理學雜志, 2015, 30(6): 15-18.
10.	王云霞, 李亞鋒, 湯靜. 急診疼痛患者與護士疼痛評估的差異分析. 護理學雜志, 2015, 30(9): 51-52.
11.	曾玉, 席淑新, 朱艷梅, 等. 成人低視力患者自我效能感與生活質量的調查分析. 中華護理雜志, 2013, 48(3): 197-199.
12.	van den Akker-Scheek I, Stevens M, Groothoff JW, et al. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty?. Patient Educ Couns, 2007, 66(1): 92-99.
13.	王海燕, 許燕玲, 胡三蓮, 等. 自我效能增強干預對膝關節置換術病人膝關節功能的影響. 護理研究, 2015(20): 2526-2528.
14.	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.
15.	Werner BC, Evans CL, Carothers JT, et al. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty, 2015, 30(5): 849-853.
16.	Yvonne D. Compact clinical guide to acute pain manage ment: an evidence-based approach for nurse. New York: Springer Publishing Company, 2011: 39-45.
17.	代月娥, 文傳兵, 劉慧. 老年人疼痛評估及治療研究進展. 華西醫學, 2009, 24(2): 517-519.

1. Li N, Liu M, Wang D, et al. Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage. J Orthop Surg Res, 2015, 10: 3.
2. Kurtz SM, Ong KL, Lau E, et al. International survey of primary and revision total knee replacement. Int Orthop, 2011, 35(12): 1783-1789.
3. Anie KA, Grocott H, White L, et al. Patient self-assessment of hospital pain, mood and health-related quality of life in adults with sickle cell disease. BMJ Open, 2012, 2(4): e001274.
4. Sandhu S, Veinot P, Embuldeniya G, et al. Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot. BMJ Open, 2013, 3(3): e002267.
5. 王海燕, 許燕玲, 胡三蓮, 等. 中文版康復自我效能感量表的信效度評價. 中華現代護理雜志, 2014, 20(3): 268-270.
6. 范建萍, 吳沛霞. 婦科腹腔鏡術后患者主訴疼痛與護理評估結果的比較. 解放軍護理雜志, 2012, 29(10): 29-31.
7. Lewis GN, Rice DA, Mcnair PJ, et al. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561.
8. 李紅. 電話隨訪式疼痛管理對癌痛患者鎮痛藥物治療依從性的影響. 護理實踐與研究, 2016, 13(8): 135-136.
9. 童鶯歌, 成燕, 劉冬華, 等. 術后疼痛護理評分與患者靜息及活動性疼痛自評結果的比較. 護理學雜志, 2015, 30(6): 15-18.
10. 王云霞, 李亞鋒, 湯靜. 急診疼痛患者與護士疼痛評估的差異分析. 護理學雜志, 2015, 30(9): 51-52.
11. 曾玉, 席淑新, 朱艷梅, 等. 成人低視力患者自我效能感與生活質量的調查分析. 中華護理雜志, 2013, 48(3): 197-199.
12. van den Akker-Scheek I, Stevens M, Groothoff JW, et al. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty?. Patient Educ Couns, 2007, 66(1): 92-99.
13. 王海燕, 許燕玲, 胡三蓮, 等. 自我效能增強干預對膝關節置換術病人膝關節功能的影響. 護理研究, 2015(20): 2526-2528.
14. 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.
15. Werner BC, Evans CL, Carothers JT, et al. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty, 2015, 30(5): 849-853.
16. Yvonne D. Compact clinical guide to acute pain manage ment: an evidence-based approach for nurse. New York: Springer Publishing Company, 2011: 39-45.
17. 代月娥, 文傳兵, 劉慧. 老年人疼痛評估及治療研究進展. 華西醫學, 2009, 24(2): 517-519.

West China Medical Journal

Application of self-assessment of pain in perioperative pain management of total knee arthroplasty

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