Application of self-assessment of pain in perioperative pain management of total knee arthroplasty_West China Medical Journal

Authors：

QIN Xia , HE Jie , YI Dekun , YUAN Yuxia ,  ZHANG Yumei

Department of Orthopedics, the Second Affiliated Hospital of the Third Military Medical University, Chongqing 400037, P. R. China;

Corresponding author：

ZHANG Yumei, Email: zhangyumei19693@sina.com

Keywords：

Enhanced recovery after surgery, ERAS; Self-assessment of pain; Total knee arthroplasty; Perioperative period

DOI：

10.7507/1002-0179.201707105

Video：

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Objective To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty (TKA). Methods A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale (SER) and the range of motion (ROM) of knee were observed and recorded. Results There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain (t=–2.736, P=0.007), types and frequencies of temporary rescue medicine (χ²=10.276, P<0.05), the overall postoperative pain score (Z=–2.146, P=0.032), average hospitalization time after surgery (t=–2.468, P=0.015), SER scores 7 days after surgery (F=2.390, P=0.018) and 14 days after surgery (F=3.427, P=0.001), and ROM at the postoperative day 7 (F=2.109, P=0.037); there were no significant differences in postoperative daily pain scores (Z=–1.779, P=0.077), SER scores at the postoperative day 3 (F=1.010, P=0.314), ROM at the postoperative day 1 (F=1.319, P=0.189) and day 14 (F=1.603, P=0.111). Conclusion Self-assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.

Citation： QIN Xia, HE Jie, YI Dekun, YUAN Yuxia, ZHANG Yumei. Application of self-assessment of pain in perioperative pain management of total knee arthroplasty. West China Medical Journal, 2017, 32(9): 1333-1338. doi: 10.7507/1002-0179.201707105 Copy

1.	Li N, Liu M, Wang D, et al. Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage. J Orthop Surg Res, 2015, 10: 3.
2.	Kurtz SM, Ong KL, Lau E, et al. International survey of primary and revision total knee replacement. Int Orthop, 2011, 35(12): 1783-1789.
3.	Anie KA, Grocott H, White L, et al. Patient self-assessment of hospital pain, mood and health-related quality of life in adults with sickle cell disease. BMJ Open, 2012, 2(4): e001274.
4.	Sandhu S, Veinot P, Embuldeniya G, et al. Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot. BMJ Open, 2013, 3(3): e002267.
5.	王海燕, 许燕玲, 胡三莲, 等. 中文版康复自我效能感量表的信效度评价. 中华现代护理杂志, 2014, 20(3): 268-270.
6.	范建萍, 吴沛霞. 妇科腹腔镜术后患者主诉疼痛与护理评估结果的比较. 解放军护理杂志, 2012, 29(10): 29-31.
7.	Lewis GN, Rice DA, Mcnair PJ, et al. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561.
8.	李红. 电话随访式疼痛管理对癌痛患者镇痛药物治疗依从性的影响. 护理实践与研究, 2016, 13(8): 135-136.
9.	童莺歌, 成燕, 刘冬华, 等. 术后疼痛护理评分与患者静息及活动性疼痛自评结果的比较. 护理学杂志, 2015, 30(6): 15-18.
10.	王云霞, 李亚锋, 汤静. 急诊疼痛患者与护士疼痛评估的差异分析. 护理学杂志, 2015, 30(9): 51-52.
11.	曾玉, 席淑新, 朱艳梅, 等. 成人低视力患者自我效能感与生活质量的调查分析. 中华护理杂志, 2013, 48(3): 197-199.
12.	van den Akker-Scheek I, Stevens M, Groothoff JW, et al. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty?. Patient Educ Couns, 2007, 66(1): 92-99.
13.	王海燕, 许燕玲, 胡三莲, 等. 自我效能增强干预对膝关节置换术病人膝关节功能的影响. 护理研究, 2015(20): 2526-2528.
14.	沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中华骨与关节外科杂志, 2016, 9(2): 91-97.
15.	Werner BC, Evans CL, Carothers JT, et al. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty, 2015, 30(5): 849-853.
16.	Yvonne D. Compact clinical guide to acute pain manage ment: an evidence-based approach for nurse. New York: Springer Publishing Company, 2011: 39-45.
17.	代月娥, 文传兵, 刘慧. 老年人疼痛评估及治疗研究进展. 华西医学, 2009, 24(2): 517-519.

1. Li N, Liu M, Wang D, et al. Comparison of complications in one-stage bilateral total knee arthroplasty with and without drainage. J Orthop Surg Res, 2015, 10: 3.
2. Kurtz SM, Ong KL, Lau E, et al. International survey of primary and revision total knee replacement. Int Orthop, 2011, 35(12): 1783-1789.
3. Anie KA, Grocott H, White L, et al. Patient self-assessment of hospital pain, mood and health-related quality of life in adults with sickle cell disease. BMJ Open, 2012, 2(4): e001274.
4. Sandhu S, Veinot P, Embuldeniya G, et al. Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot. BMJ Open, 2013, 3(3): e002267.
5. 王海燕, 许燕玲, 胡三莲, 等. 中文版康复自我效能感量表的信效度评价. 中华现代护理杂志, 2014, 20(3): 268-270.
6. 范建萍, 吴沛霞. 妇科腹腔镜术后患者主诉疼痛与护理评估结果的比较. 解放军护理杂志, 2012, 29(10): 29-31.
7. Lewis GN, Rice DA, Mcnair PJ, et al. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561.
8. 李红. 电话随访式疼痛管理对癌痛患者镇痛药物治疗依从性的影响. 护理实践与研究, 2016, 13(8): 135-136.
9. 童莺歌, 成燕, 刘冬华, 等. 术后疼痛护理评分与患者静息及活动性疼痛自评结果的比较. 护理学杂志, 2015, 30(6): 15-18.
10. 王云霞, 李亚锋, 汤静. 急诊疼痛患者与护士疼痛评估的差异分析. 护理学杂志, 2015, 30(9): 51-52.
11. 曾玉, 席淑新, 朱艳梅, 等. 成人低视力患者自我效能感与生活质量的调查分析. 中华护理杂志, 2013, 48(3): 197-199.
12. van den Akker-Scheek I, Stevens M, Groothoff JW, et al. Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty?. Patient Educ Couns, 2007, 66(1): 92-99.
13. 王海燕, 许燕玲, 胡三莲, 等. 自我效能增强干预对膝关节置换术病人膝关节功能的影响. 护理研究, 2015(20): 2526-2528.
14. 沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中华骨与关节外科杂志, 2016, 9(2): 91-97.
15. Werner BC, Evans CL, Carothers JT, et al. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty, 2015, 30(5): 849-853.
16. Yvonne D. Compact clinical guide to acute pain manage ment: an evidence-based approach for nurse. New York: Springer Publishing Company, 2011: 39-45.
17. 代月娥, 文传兵, 刘慧. 老年人疼痛评估及治疗研究进展. 华西医学, 2009, 24(2): 517-519.

West China Medical Journal

Application of self-assessment of pain in perioperative pain management of total knee arthroplasty

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