1 / 41

Practical Approach in Postoperative pain management after TKA

Practical Approach in Postoperative pain management after TKA. BeomKoo Lee Gil Hospital, Gachon university. “Successful TKA”: Changing Concept. Without Compromising Long-term Goals Emphasis on Short-term Goals Shorter Hospital Stay Quicker Return to Function Less Pain

zola
Download Presentation

Practical Approach in Postoperative pain management after TKA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Practical Approach in Postoperative pain managementafter TKA BeomKoo Lee Gil Hospital, Gachon university

  2. “Successful TKA”: Changing Concept • Without Compromising Long-term Goals • Emphasis on Short-term Goals • Shorter Hospital Stay • Quicker Return to Function • Less Pain • Shorter Use of Assistive Devices (Vail, 2004, CORR)

  3. Pain After TKA • TKA: One of the most painful procedure • Very severe in 1W after TKA • Can last for 3M • Affect Outcome • Impede early rehabilitation • ROM, walking ability • Longer hospital stay • Interfere healing process • Poor sleep

  4. Predictors of poor pain outcomes: • age below 60 (17%) compared with above 60 (7%, P< .05). • The first knee was most likely to be in the poor outcome group (13%) compared with the second knee (6%). • In contrast, patients who underwent simultaneous bilateral arthroplasty faired better (2%, P< .01). David W. Elson and Ivan J arthroplasty 200653

  5. Goal of Pain Management • Maximize patient satisfaction (QoL) • Rapid recovery • Rapid return to normal ADL • Bettersleep • Increase postop. outcome • Reduce medical cost • Reducing dose of risky pain agents: Opioid

  6. Opioid-Related Side Effect • Sedation • Respiratory distress • Pruritus • Ileus • Urinary Retention (10’ KSSTA, Simult. Bilat TKA) • Should be minimizing use of opioid in risk groups • Frail elderly (many of TKA pts) • Obstructive sleep apnea

  7. Multimodal Targets

  8. Modalities for TKA • Pre- / Intraoperative • Patient education • Pre-emptive analgesia • Peripheral n. block • Epidural analgesia • Periarticular injection • Postoperative • Continuous IV PCA • Single IV / IM analgesics • Oral / Patch analgesics

  9. The Effect of Preoperative Information on Anxiety of Patient Undergoing Total Knee Arthroplasty Surgery Han Jung Il Gil hospital, Gachon university

  10. 연구결과 3 Repeated measured ANOVA for Cortisol Level EG:Experiment Group CG  Control Group Han Jung Il Gil hospital, gachon university

  11. 연구결과 4 Repeated measured ANOVA for Pain EG:Experiment Group CG  Control Group Han Jung Il Gil hospital, gachon university

  12. Preemptive Analgesia • ↓ Establishment of ppr & central sensitization

  13. Oral Preemptive Analgesia

  14. Preemptive AnalgesicsCurrently Recommended Drugs • Oxycodone (Oxicontin) • Cox-2 inhibitor (Celebrex) • Acetaminophen (Tylenol) • Pregabalin (Lyrica)

  15. Questions • How much variations in use of pain mx. methods among high volume surgeons? • Do such variations have significant influence on peri-op pain levels in TKA patients? • Do such variations have significant influence on peri-op QoL and overall satisfaction?

  16. Study Design • Multicenter study: 16 Hospitals • 2 sessions of consensus meetings • 5 sessions of major investigator meetings • Using self-administered questionnaire • Supervised by trained investigator

  17. Questionnaire #1: 의사 기록지

  18. Questionnaire #2: 통증 기록지 • Day & Night • 예상통증 • OP #0 • OP #1 • OP #2 • OP #3 • OP #7 • OP #14

  19. Questionnaire #3: QoL 기록지 • EQ-5D • Preop • PO 14D

  20. Questionnaire #4: 만족도 조사 • PO 14D

  21. Results

  22. Use of Pain Mx. Methods (Education) > IV PCA > Epidural ….

  23. Use of Pain Mx in Each Hospital

  24. Average Pain Levels (밤 ≥낮) * * * *

  25. Overall Pain Levels Among Methods rebound Systemic only vs. PMDI + Regional/Epi: p = 0.005

  26. Health Score at PO 2W P < 0.001 Epidural & PMDI + Regional/Epi > Systemic ± Preemptive

  27. 예상보다 통증조절이 잘되었다

  28. 마약성 진통제 부작용으로 고생했다

  29. 수면에 문제가 있다

  30. 전반적으로 치료에 만족하고 있다

  31. Summary • There are wide variations in the use of pain management among the high volume knee surgeons in tertiary Hosp. • Pain levelsof the TKA patients in each hospital also showed wide variations, particularly in early PO period.

  32. Summary • Different pain mx. methods have significant influence on the level of PO pain within 48 hours after TKA. • PMDI + regional or epidural block showed outstanding control of op night pain. However, it had rebound phenomenon. • Adding preemptive analgesics seems to provide better pain control at op date.

  33. Summary • Different pain mx. methods also have significant influence on the level of QoLat 2W TKA. • PMDI + regional or epidural block group and Epidural group show significantly better QoL than other group.

  34. Painmanagement after TKA in Gil Hospital

  35. Preemptive Analgesics • 수술장에서 call 오면 투여 • -cerebrex 400mg (2C) 복용시킴 (물 소량과 함께)

  36. 본원Periarticulardrug injection • 1. Ropivacaine 300mg ( 0.75% 20ml *2A) • 2. Morphine sulfate 10mg (5mg *2A) • 3. Ketorolac 30mg (1A) • 4. Cefuroxime 750mg (Alporin 1V) • Add. saline to make 100cc

  37. post-op • Cerebrex 200mg • Oxycontin 10mg • Lyrica75mg • Acetaminophen 650mg

  38. Thank you for kind attention.

More Related