Abstract
Multimodal analgesia protocols for pain control following total joint arthroplasty can reduce post-operative pain, allow early mobilisation and early discharge from hospital.
This study analyses the achievement of functional milestones, patient satisfaction, length of stay and adverse outcomes using a multimodal analgesia protocol in total joint arthroplasty.
All patients planned for elective hip and knee arthroplasty in a NSW teaching hospital under one surgeon between July 2007 and January 2009 were included in this prospective study. Patients undergoing revision surgery, bilateral arthroplasty or total hip arthroplasty for fractures were excluded. Unless contraindicated, all patients followed the multimodal analgesia protocol based on the local infiltration analgesia technique described by Kerr and Kohan.
Outcomes measurements included
Patient demographics, post operation milestones, visual analogue pain scores (VAS), narcotic consumption, length of stay, discharge destination, patient satisfaction scores and adverse outcomes. Nineteen patients (13 female and 6 male) with an average age 67 years and BMI 33 had total hip arthroplasty surgery. 84% (16/19) ambulated within six hours post operation. 47% (9/19) of patients were discharged home by day 3 post operation (1/19 on day 1, 5/19 on day 2, 3/19 on day 3). Average day post operation for discharge home was 4.5 days.
Thirty-one patients (17 female and 14 male) with an average age 68 years and BMI 33 had total knee arthroplasty surgery. 90% (28/31) ambulated within six hours after surgery. 71% (22/31) of patients were discharged home by day three post operation (6/31 on day 1, 8/31 on day 2 and 8/31 on day 3). Average day post operation for discharge home was four days. Ten patients required morphine in addition to protocol analgesia. VAS scores (1 to 10) averaged 3.2 day one post op and 2.6 prior to discharge. Three patients developed nausea and vomiting and one patient developed urinary retention. No infections, DVTs or other adverse effects occurred in either hip or knee arthroplasty groups. Majority of patients were very satisfied according to 24 hour post op pain management survey and six week post op patient satisfaction survey.
Local infiltration analgesia in knee and hip arthroplasty surgery is a safe, well-tolerated and effective form of pain control allowing early mobilisation and early discharge from hospital (1,2). This protocol has been successfully implemented in a public hospital.
