Mussab Raja Muhammad, Jawad Aiman, Iqbal Muhammad Tahir, Iqbal Muhammad Awais, Palaparthy Prakash, Ali Faris
Orthopaedics and Trauma, Jinnah Postgraduate Medical Centre, Karachi, PAK.
Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR.
Cureus. 2024 Nov 29;16(11):e74727. doi: 10.7759/cureus.74727. eCollection 2024 Nov.
BACKGROUND/OBJECTIVE: Adequate postoperative analgesics are an essential element in the recovery and rehabilitation of large joint lower-limb arthroplasty patients in their acute postoperative phase. In this study, we will establish that strong opioids like morphine should be included as postoperative analgesics to improve patient satisfaction. Material: This retrospective cross-sectional study was conducted in the Arthroplasty Ward, Trauma, and Orthopaedics Department in a district general hospital of the United Kingdom. Fifty patients operated in January 2024 were enrolled in this study, out of which 25 had total hip replacement and 25 had total knee replacement. Patients were divided into two groups based on analgesics given at the time of discharge. Group A had a strong opioid and Group B had a non-steroidal anti-inflammatory drug (NSAID) plus weak opioids upon discharge. Patients with hospital stays of more than four days and patients with allergies to any analgesics were excluded. Results: Forty percent (40%) of the patients in the total hip replacement (THR) group and fifty percent (50%) in the total knee replacement (TKR) group were discharged on adequate analgesia (NSAID + weak opioids + strong opioids) and all reported manageable postoperative pain. A significant difference in pain scores on the fifth postoperative day (POD) was observed between the two groups (p = 0.001). Patient satisfaction levels also differed notably between the groups, with significant variance (p = 0.011). Group A showed a higher rate of "very satisfied" patients (n = 3).
Adequate analgesics prescribing is an integral part of enhanced recovery after surgery (ERAS) guidelines for patients undergoing knee and hip arthroplasties. Pain has catabolic systemic consequences for patients and delays postoperative recovery. We have proposed the step ladder pattern of analgesics for such patients, in which strong opioids should be given to aid in pain relief. Apart from this, a virtual consultation should be done by an arthroplasty nurse within one week of operation for their pain assessment as the pain scale.
背景/目的：充足的术后镇痛药是下肢大关节置换术患者术后急性期恢复和康复的关键要素。在本研究中，我们将证实应将吗啡等强效阿片类药物纳入术后镇痛药以提高患者满意度。
本回顾性横断面研究在英国一家地区综合医院的创伤与骨科关节置换病房进行。纳入2024年1月接受手术的50例患者，其中25例行全髋关节置换术，25例行全膝关节置换术。根据出院时给予的镇痛药将患者分为两组。A组出院时使用强效阿片类药物，B组出院时使用非甾体抗炎药（NSAID）加弱阿片类药物。排除住院时间超过4天的患者以及对任何镇痛药过敏的患者。
全髋关节置换术（THR）组40%的患者和全膝关节置换术（TKR）组50%的患者出院时使用了充足的镇痛药（NSAID + 弱阿片类药物 + 强效阿片类药物），且所有患者均报告术后疼痛可耐受。两组术后第5天（POD）的疼痛评分存在显著差异（p = 0.001）。两组患者的满意度水平也存在显著差异（p = 0.011）。A组“非常满意”的患者比例更高（n = 3）。
对于接受膝关节和髋关节置换术的患者，合理开具镇痛药是术后加速康复（ERAS）指南的重要组成部分。疼痛会给患者带来分解代谢的全身影响，并延迟术后恢复。我们为此类患者提出了镇痛药的阶梯模式，其中应给予强效阿片类药物以缓解疼痛。除此之外，关节置换护士应在术后一周内进行虚拟咨询，以评估患者的疼痛程度作为疼痛量表。
