Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.
Patient Educ Couns. 2019 Feb;102(2):383-387. doi: 10.1016/j.pec.2018.09.001. Epub 2018 Sep 5.
Effects of patient education on perioperative analgesic utilization are not well defined. We designed a simple pain management educational card for total knee arthroplasty (TKA) patients and retrospectively reviewed clinical data before and after implementation to test the hypothesis that more informed patients will use less opioid.
With IRB approval, we analyzed clinical data collected perioperatively on all TKA patients one month before (PRE) and one month after (POST) card implementation. The card was designed using a modified Delphi method; the front explained all analgesic medications and the Defense and Veterans Pain Rating Scale was on the back. The primary outcome was total opioid dosage in morphine milligram equivalents (MME) for the first two postoperative days. Secondary outcomes included daily opioid usage, pain scores, ambulation distance, hospital length of stay and use of antiemetics.
There were 20 patients in each group with no differences in baseline characteristics. Total two-day MME [median (10th-90th percentiles)] was 71 (32-285) for PRE and 38 (1-117) for POST (p = 0.001). There were no other differences.
Educating TKA patients in multimodal pain management using a simple tool decreases opioid usage.
Empowering TKA patients with education can reduce opioid use perioperatively.
患者教育对围手术期镇痛药物使用的影响尚不清楚。我们为全膝关节置换术（TKA）患者设计了一种简单的疼痛管理教育卡，并回顾性分析了实施前后的临床数据，以验证一个假设，即接受更多信息的患者将使用更少的阿片类药物。
在获得机构审查委员会批准的情况下，我们分析了所有 TKA 患者在实施卡片前一个月（PRE）和后一个月（POST）收集的围手术期临床数据。该卡片采用改良 Delphi 方法设计；正面解释了所有的镇痛药物，背面是防御和退伍军人疼痛评分量表。主要结局指标是术后前两天的吗啡等效剂量（MME）总阿片类药物用量。次要结局指标包括每日阿片类药物使用量、疼痛评分、步行距离、住院时间和止吐药的使用。
每组各有 20 名患者，基线特征无差异。总两天 MME [中位数（10 到 90 百分位数）]为 PRE 组的 71（32-285）和 POST 组的 38（1-117）（p=0.001）。没有其他差异。
使用简单工具对 TKA 患者进行多模式疼痛管理教育可减少阿片类药物的使用。
通过教育增强 TKA 患者的能力可以减少围手术期阿片类药物的使用。
