1
|
Youngcharoen P, Piyakhachornrot C. Online Learning to Improve Nurses' Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults. Pain Manag Nurs 2024; 25:249-257. [PMID: 38492991 DOI: 10.1016/j.pmn.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/28/2024] [Accepted: 02/11/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Older adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses' knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management. AIM To determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty. DESIGN A quasi-experimental pre-test-post-test design with intervention and control groups. METHOD Six inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses' knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired t-tests, and independent t-tests. RESULTS The knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group. CONCLUSIONS An online learning program improves nurses' understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.
Collapse
MESH Headings
- Humans
- Female
- Male
- Pain, Postoperative/nursing
- Self Efficacy
- Pain Management/methods
- Pain Management/standards
- Health Knowledge, Attitudes, Practice
- Middle Aged
- Aged
- Adult
- Arthroplasty, Replacement, Knee/nursing
- Arthroplasty, Replacement, Knee/adverse effects
- Surveys and Questionnaires
- Education, Distance/methods
- Education, Distance/standards
- Education, Nursing, Continuing/methods
- Nurses/statistics & numerical data
- Nurses/psychology
- Nurses/standards
Collapse
Affiliation(s)
- Phichpraorn Youngcharoen
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Chayada Piyakhachornrot
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Murphy J, Pak S, Shteynman L, Winkeler I, Jin Z, Kaczocha M, Bergese SD. Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review. Int J Mol Sci 2024; 25:4722. [PMID: 38731944 PMCID: PMC11083264 DOI: 10.3390/ijms25094722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA. While the etiology of CPSP is not fully understood, several factors such as chronic inflammation and preoperative central sensitization have been identified. Other potential mechanisms include genetic factors (e.g., catechol-O-methyltransferase (COMT) and potassium inwardly rectifying channel subfamily J member 6 (KCNJ6) genes), lipid markers, and psychological risk factors (anxiety and depression). With regards to therapeutics and prevention, multimodal pharmacological analgesia, emphasizing nonopioid analgesics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has gained prominence over epidural analgesia. Nerve blocks and local infiltrative anesthesia have shown mixed results in preventing CPSP. Ketamine, an N-methyl-D-aspartate (NMDA)-receptor antagonist, exhibits antihyperalgesic properties, but its efficacy in reducing CPSP is inconclusive. Lidocaine, an amide-type local anesthetic, shows tentative positive effects on CPSP. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have mixed results, while gabapentinoids, like gabapentin and pregabalin, present hopeful data but require further research, especially in the context of TKA and THA, to justify their use for CPSP prevention.
Collapse
Affiliation(s)
- Jasper Murphy
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Sery Pak
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Lana Shteynman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Ian Winkeler
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
| | - Martin Kaczocha
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
| | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
| |
Collapse
|
3
|
Sreckovic S, Ladjevic N, Milicic B, Tulic G, Milovanovic D, Djukanovic M, Kadija M. Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks. Front Med (Lausanne) 2024; 10:1335405. [PMID: 38274441 PMCID: PMC10810136 DOI: 10.3389/fmed.2023.1335405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Peripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP). Methods This prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA. Results 166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg). Conclusion Peripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.
Collapse
Affiliation(s)
- Svetlana Sreckovic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nebojsa Ladjevic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, Belgrade, Serbia
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Tulic
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Darko Milovanovic
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Marija Djukanovic
- Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Marko Kadija
- Clinic for Orthopaedics Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
4
|
Barahona M, Bustos F, Navarro T, Chamorro P, Barahona MA, Carvajal S, Brañes J, Hinzpeter J, Barrientos C, Infante C. Similar Patient Satisfaction and Quality of Life Improvement Achieved with TKA and THA According to the Goodman Scale: A Comparative Study. J Clin Med 2023; 12:6096. [PMID: 37763035 PMCID: PMC10532345 DOI: 10.3390/jcm12186096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatments for severe knee and hip osteoarthritis. Historically, TKA has been associated with lower satisfaction than THA, but recent advances in knee surgery have led to lower dissatisfaction rates. This study aimed to compare the satisfaction and self-reported improvement in the quality of life of two cohorts of patients who underwent TKA and THA, respectively. Methods: This observational study compared two previously published cohorts of patients who underwent THA and TKA in a single university center. The Goodman scale was used to assess satisfaction and self-perception of improved quality of life after TKA and THA at a minimum one-year follow-up. Propensity score matching was used to balance age, gender, and follow-up between groups. Significance was set at 0.05. Results: The study included a total of 105 THAs and 131 TKAs. Both groups had high levels of satisfaction with pain relief, ability to do house/yard work, and overall satisfaction, with above 90% satisfaction rates. Regarding improvement in quality of life, both groups had 86% of patients reporting improvement as "much better." After propensity score matching, no significant difference was found between THA and TKA for any of the comparisons made using the Goodman scale. Conclusions: The study showed that both TKA and THA resulted in high levels of satisfaction and improvement in quality of life. There was no significant difference in satisfaction rates between TKA and THA, contrary to the historical trend of lower satisfaction rates for TKA.
Collapse
Affiliation(s)
- Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Felipe Bustos
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Tomás Navarro
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Pablo Chamorro
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Macarena Alejandra Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Sebastián Carvajal
- Department of Orthopaedic Surgery, Hospital del Salvador, Providencia, Santiago 7500922, Chile
| | - Julian Brañes
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Jaime Hinzpeter
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| | - Cristian Barrientos
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
- Department of Orthopaedic Surgery, Hospital del Salvador, Providencia, Santiago 7500922, Chile
| | - Carlos Infante
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independencia, Santiago 8380420, Chile (C.I.)
| |
Collapse
|
5
|
Reinhard J, Pulido LC, Schindler M, Schraag A, Greimel F, Grifka J, Benditz A. No Success without Effort: Follow-Up at Six Years after Implementing a Benchmarking and Feedback Concept for Postoperative Pain after Total Hip Arthroplasty. J Clin Med 2023; 12:4577. [PMID: 37510694 PMCID: PMC10380292 DOI: 10.3390/jcm12144577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is still ranked among the operations with the highest postoperative pain scores. Uncontrolled postsurgical pain leads to prolongated hospital stays, causes more frequent adverse reactions and can induce chronical pain syndromes. In 2014, we implemented a standardized, multidisciplinary pain management concept with continuous benchmarking at our tertiary referral center by using the "Quality Improvement in Postoperative Pain Management" (QUIPS) program with excellent results over a period of two years. The initial study ended in 2016 and we aimed to evaluate if it was possible to obtain the excellent short-term results over a period of six years without any extra effort within the daily clinical routine. MATERIALS AND METHODS In a retrospective study design, we compared postoperative pain, side effects and functional outcome after primary THA for 2015 and 2021, using validated questionnaires from the QUIPS project. In contrast to the implementation of the pain management concept in 2014, the weekly meetings of the multidisciplinary health care team and special education for nurses were stopped in 2021. Data assessment was performed by an independent pain nurse who was not involved in pain management. RESULTS Altogether, 491 patients received primary THA in 2015 and 2021 at our tertiary referral center. Collected data revealed significantly worse maximum and activity-related pain (both p < 0.001) in combination with significantly higher opioid consumption in comparison to implementation in 2015. Though the patients reported to be less involved in pain management (p < 0.001), the worse pain scores were not reflected by patient satisfaction which remained high. While the participation rate in this benchmarking program dropped, we still fell behind in terms of maximum and activity-related pain in comparison to 24 clinics. CONCLUSION Significantly worse pain scores in combination with higher opioid usage and a lower hospital participation rate resemble a reduced awareness in postoperative pain management. The significantly lower patient participation in pain management is in line with the worse pain scores and indirectly highlights the need for special education in pain management. The fact patient satisfaction appeared to remain high and did not differ significantly from 2015, as well as the fact we still achieved an acceptable ranking in comparison to other clinics, highlight the value of the implemented multidisciplinary pain management concept.
Collapse
Affiliation(s)
- Jan Reinhard
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Loreto C Pulido
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Melanie Schindler
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Amadeus Schraag
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| |
Collapse
|