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Effectiveness of Multimodal Pain Management Protocol in Total Knee Arthroplasty Patients

Lewis, Cynthia; Gunta, Kathleen; Mitchell, Kimberly; Bobay, Kathleen

doi: 10.1097/NOR.0b013e3182558d0b
Original Articles: Research

BACKGROUND: Numerous methods for postoperative pain management after total knee arthroplasty (TKA) are reported. Multimodal pain management approaches, including peripheral nerve blocks and systemic analgesia, have been shown to decrease patient pain, increase patient satisfaction with pain control, decrease length of stay (LOS), and improve patient outcomes.

PURPOSE/METHODS: To compare patient outcomes (pain scores, LOS, postoperative nausea and vomiting, and movement) between 66 TKA patients of a single orthopaedic surgeon in 2010 who received a multimodal approach to 45 historical (control) patients in 2009 who did not receive a multimodal pain management protocol.

RESULTS: Patients who were treated with the multimodal pain protocol had significantly lower pain scores in the immediate postoperative period, less postoperative nausea and vomiting day of surgery, and a decrease in LOS by half a day despite increased buckling and increased level of assistance with ambulation.

CONCLUSION: The multimodal pain approach improved patient outcomes in TKA patients.

Cynthia Lewis, MSN, RN, ACNS-BC, Perioperative Clinical Nurse Specialist, Aurora Health Care St. Luke's Medical Center, Milwaukee, WI.

Kathleen Gunta, MSN, RN, OCNS-C, Orthopaedic Clinical Nurse Specialist, Aurora Health Care St Luke's Medical Center, Milwaukee, WI.

Kimberly Mitchell, BSN, RN, CNOR, Perioperative Clinical Nurse Specialist, Aurora Health Care St. Luke's Medical Center, Milwaukee, WI.

Kathleen Bobay, PhD, RN, NEA-BC, Nurse Researcher, Center for Nursing Research and Practice-Metro Region, Aurora Health Care, Milwaukee, WI.

The authors have disclosed no conflict of interest.

© 2012 National Association of Orthopaedic Nurses