Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Fuerntrath, F.
Schmerztherapie und Knie-Total-Endoprothesen: Effektivitätsbeurteilung eines perioperativen multimodalen Therapieschemas.
[ Dissertation ] Graz Medical University; 2010. pp.78.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Sandner-Kiesling Andreas
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- Abstract:
- Background: This study presents a simple perioperative multimodal pain management protocol for TKA. The protocol is based on local infiltration analgesia and standardized perioperative administration of NSAIDs as well as immediate- and sustained-release opioids via the oral route. The aim of this study was to evaluate the efficiency of the pain control with reduced side-effects and its practicability in daily practice. Patients and methods: 50 consecutive patients eligible for TKA were assessed. The patients received boli of iv-piritramide for pain control in the immediate postoperative period. Starting with to first postoperative evening, patients were switched to the oral route and received sustained -release hydromorphone (2x 4mg) as baseline therapy and immediate-release hydromorphone (2,6mg) as rescue medication on request, supported by a perioperative treatment with non-opioid analgesics (celecoxib/ lornoxicam + metamizole). Postoperative pain was measured tid on a numeric rating scale. The administration of both opioid baseline and rescue medication was adjusted dynamically according to the reported pain levels. Opioid consumption and side effects were recorded. The results were compared to the current literature. Results: 43 of 50 patients were eligible for full analysis. Median pain scores remained NRS 3 at all times peaking on day 2, with some individual pain exacerbations. Peak median opioid consumption was reached on day 2 with a slight rebound on day 4. The demand for rescue medication peaked on day 1+4. Compared to the literature on postoperative PCA-treatment, opioid consumption was reduced by 32% by using our pain regimen, but not the side effects. Patients rarely needed rescue medication for breakthrough pain. One patient aborted opioid treatment due to PONV. Discussion: This study showed that a combination of LIA and PMP may replace both PCA and regional catheter techniques for postoperative pain treatment in TKA, with a reduced opioid consumption compared to historic PCA-treatment. However, further improvements in PONV prophylaxis and in pain treatment on day 4 are necessary. Pain assessment and documentation, patient education and information need to be improved to achieve this goal. The featured protocol may benefit from further modifications of PMP and LIA. The efficacy of these adaptations needs to be evaluated in a pre- vs. post-intervention randomized controlled trial with a larger patient sample.