RESUMEN
Only limited data are available regarding the infiltration of local anaesthetic for total hip arthroplasty (THA), and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated the effect of both standard and reverse infiltration of local anaesthetic in combination with the anterior approach for THA. The primary endpoint was the mean numeric rating score for pain four hours post-operatively. In addition, we recorded the length of hospital stay, the operating time, the destination of the patient at discharge, the use of pain medication, the occurrence of side effects and pain scores at various times post-operatively. Between November 2012 and January 2014, 75 patients were included in the study. They were randomised into three groups: standard infiltration of local anaesthetic, reversed infiltration of local anaesthetic, and placebo. There was no difference in mean numeric rating score for pain four hours post-operatively (p = 0.87). There were significantly more side effects at one and eight hours post-operatively in the placebo group (p = 0.02; p = 0.03), but this did not influence the mobilisation of the patients. There were no differences in all other outcomes between the groups. We found no clinically relevant effect when the infiltration of local anaesthetic with ropivacaine and epinephrine was used in a multimodal pain protocol for THA using the anterior approach.
Asunto(s)
Amidas/farmacocinética , Anestesia Local , Anestésicos Locales/farmacocinética , Artroplastia de Reemplazo de Cadera/métodos , Dolor Postoperatorio/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/rehabilitación , Epinefrina/farmacocinética , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RopivacaínaRESUMEN
After implementation of a 'fast-track' rehabilitation protocol in our hospital, mean length of hospital stay for primary total hip arthroplasty decreased from 4.6 to 2.9 nights for unselected patients. However, despite this reduction there was still a wide range across the patients' hospital duration. The purpose of this study was to identify which specific patient characteristics influence length of stay after successful implementation of a 'fast-track' rehabilitation protocol. A total of 477 patients (317 female and 160 male, mean age 71.0 years; 39.3 to 92.6, mean BMI 27.0 kg/m(2);18.8 to 45.2) who underwent primary total hip arthroplasty between 1 February 2011 and 31 January 2013, were included in this retrospective cohort study. A length of stay greater than the median was considered as an increased duration. Logistic regression analyses were performed to identify potential factors associated with increased durations. Median length of stay was two nights (interquartile range 1), and the mean length of stay 2.9 nights (1 to 75). In all, 266 patients had a length of stay ≤ two nights. Age (odds ratio (OR) 2.46; 95% confidence intervals (CI) 1.72 to 3.51; p < 0.001), living situation (alone vs living together with cohabitants, OR 2.09; 95% CI 1.33 to 3.30; p = 0.002) and approach (anterior approach vs lateral, OR 0.29; 95% CI 0.19 to 0.46; p < 0.001) (posterolateral approach vs lateral, OR 0.24; 95% CI 0.10 to 0.55; p < 0.001) were factors that were significantly associated with increased length of stay in the multivariable logistic regression model.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/rehabilitación , Características Humanas , Tiempo de Internación/tendencias , Osteoartritis de la Cadera/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Cohortes , Femenino , Prótesis de Cadera , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Osteoartritis de la Cadera/diagnóstico , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores Socioeconómicos , Carga de Trabajo/estadística & datos numéricosRESUMEN
One of the reasons for inadequate pain treatment in hospitalized patients is that nurses have insufficient knowledge about pain and pain management. To address this problem, a Pain Monitoring Program (PMP) for nurses was developed, implemented, and evaluated. The PMP consisted of two components: educating nurses about pain, pain assessment, and pain management, and implementing daily pain assessment by means of a numeric rating scale. The effects of the PMP were measured in a one-group pretest-post-test design. The results show that nurses have knowledge deficits and prejudices with regard to pain and pain management. Age and additional pain courses in pain partly predict nurses' pain knowledge. After nurses were educated, the average score on the Pain Knowledge Questionnaire increased from 69.1% (SD = 13.2) at pretest to 75.8% (SD = 11.5) at post-test (P < 0.001). Nurses' attitudes changed with regard to their level of knowledge and skills in relieving pain, willingness to assess pain on a daily basis, and attention to patients' pain complaints. It can be concluded that the PMP is effective in improving nurses' knowledge of pain management and focusing nurses' attention to patients' pain complaints.