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Original Research: The Effects of Active Warming on Patient Temperature and Pain After Total Knee Arthroplasty

Benson, Ember E. MN, RN; McMillan, Diana E. PhD, RN; Ong, Bill MD, FRCPC

AJN The American Journal of Nursing: May 2012 - Volume 112 - Issue 5 - p 26–33
doi: 10.1097/
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Background Total knee arthroplasty (TKA) is a procedure with associated risks of inadvertent perioperative hypothermia and significant postoperative pain. Hypothermia may affect patients’ experience of postoperative pain, although the link is not well understood.

Objective The aim of this prospective, randomized controlled trial was to determine the efficacy of a patient-controlled active warming gown in optimizing patients’ perioperative body temperature and in diminishing postoperative pain after TKA.

Methods Thirty patients who would be undergoing TKA received either a standard hospital gown and prewarmed standard cotton blanket (n = 15) or a patient-controlled, forced-air warming gown (n = 15).

Results Although pain scores were not significantly different in the two groups (P = 0.08), patients who received warming gowns had higher temperatures (P < 0.001) in the postanesthesia care unit, used less opioid (P = 0.05) after surgery, and reported more satisfaction (P = 0.004) with their thermal comfort than did patients who received standard blankets. These findings indicate that patient-controlled, forced-air warming gowns can enhance perioperative body temperature and improve patient satisfaction. Patients who use warming gowns may also need less opioid to manage their postoperative pain.

Conclusions Nurses should ensure that effective patient warming methods are employed in all patients, particularly in patients with compromised thermoregulatory systems (such as older adults), and in surgeries considered to be exceptionally painful (such as TKA).

This study sought to determine the efficacy of a patient-controlled active warming gown in optimizing patients' perioperative body temperature and in diminishing postoperative pain.

Ember E. Benson is a surgery inpatient educator at Seven Oaks General Hospital in Winnipeg, Manitoba, Canada. Diana E. McMillan is an associate professor in the Faculty of Nursing and Bill Ong is a professor in the Department of Anesthesia, both at the University of Manitoba in Winnipeg. This research was supported by an unrestricted educational grant from the Fort Garry Branch Royal Canadian Legion Poppy Fund. The Bair Paws warming systems were provided gratis by Arizant Healthcare Inc., and the oral thermometers were provided gratis by Welch Allyn. Contact author: Ember E. Benson, The authors have disclosed no potential conflicts of interest, financial or otherwise.

© 2012 Lippincott Williams & Wilkins, Inc.