POSTOPERATIVE PAIN MANAGEMENT FOR TKR

A Study of Pain Management Strategies for Adults undergoing Total Knee Replacement Surgery



ACKNOWLEDGMENT

I would first like to express my gratitude for my research supervisor, colleagues, peers and family whose immense and constant support has been a source of continuous guidance and inspiration.

DECLARATION

I [type your full first names & surname here], declare that the following dissertation/thesis and its entire content has been an individual, unaided effort and has not been submitted or published before. Furthermore, it reflects my opinion and take on the topic and is does not represent the opinion of the University.

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Abstract

The study was conducted to find the best possible solution to provide ease in the post operative pain of total knee replacement. The aim of the research was to identify the most effective method of post-operative pain control following total knee replacement surgery. The method of the research was qualitative and literature was collected and analyzed in depth for finding out the best solution and study conduction in regard and relation to the total knee replacement. It was found from various studies that there is no single effective method to relieve pain following Total Knee Replacement (TKR) surgery. One recommended approach is the combined femoral nerve block. The author concludes that the most effective strategy to control postoperative pain following TKR surgery is use of a multimodal approach, taking into consideration the individual patient's condition, availability of appropriate equipment & the skills & knowledge of the clinician. It has been suggested that further study needs to be conducted involving current concepts in femoral nerve blockade for postoperative pain. The pain after total knee arthroplasty can be managed with use of continuous femoral nerve blockade. Patients with primary, unilateral, non cemented total knee arthroplasty have been found to take less oral opioid and stool softener post-operatively and have enhanced mobilization. As anaesthesia providers become more proficient at catheter placement, and physicians become more aware of the potential benefits of femoral nerve blockade, the need for general anaesthesia may be reduced to the point that only monitored anaesthesia providing moderate postoperative pain relief can be accomplished thereby further lessening the effects of postoperative complications and pains.

TABLE OF CONTENTS

ACKNOWLEDGMENTii

DECLARATIONiii

Abstractiv

Rationale1

Objective1

CHAPTER 01: INTRODUCTION2

1.1 Background2

1.1.a Definition of Pain2

1.1.b Theory of Pain3

Gate Control Theory3

1.1.c Physiology of Pain4

1.1.d Pathophysiology of pain5

Endocrine System5

Cardiovascular system5

Respiratory System6

Genitourinary System6

Gastrointestinal System7

Musculoskeletal System7

Immune System7

1.2 Methods used to Control Postoperative Pain7

1.2.a Systemic Opioids8

1.2.b Paracetamol8

1.2.c Non-Steroidal Anti-Inflammatory Drug8

1.2.d Patient Controlled Analgesia8

1.2.e Patient Controlled epidural Analgesia9

1.2.f Continuous Peripheral Nerve Blockade9

1.2.g Femoral Nerve Block10

1.2.h Total Knee Arthroplasty10

1.3 Mobilization11

CHAPTER 02: METHODOLOGY12

2.1 Search strategy:12

2.2 Keywords:12

2.3 Scope of the study:13

2.4 Data collection:13

2.5 Data analysis:13

CHAPTER 03: LITERATURE REVIEW15

3.1 Peripheral Nerve Block16

3.2 Epidural Analgesia17

3.3 Local Anaesthetic Infiltration22

3.4 Intra-Articular Injection25

3.5 NSAIDs celeccoxib-2 selective inhibitor25

3.6 Stress Response26

CHAPTER 04: DISCUSSION29

4.1 Pain Management33

4.2 Preemptive Analgesia35

4.3 Femoral Nerve Blockade36

4.4 Potential Adverse Events37

CHAPTER 05: CONCLUSION AND RECOMMENDATIONS39

5.1 Implications for Research40

5.2 Implications for Theory41

5.3 Implications for Practice42

5.4 Conclusion43

References44

Rationale

Patients undergoing major total joint surgery must be monitored closely. Nursing priorities post-operatively are: (a) prevention of complication, (b) managing pain, and (c) discharge education about ...