The role of pain for early rehabilitation in fast track surgery.: A descriptive study of function and pain for 100 inpatients undergoing total knee arthroplasty.

Bente Holm; Morten Tange Kristensen; Lis Myhrmann; Henrik Husted; Niels Kristian Stahl Kri Otte; Lasse Andersen; Billy Bjarne Kristensen; Kehlet Henrik

The role of pain for early rehabilitation in fast track surgery.: A descriptive study of function and pain for 100 inpatients undergoing total knee arthroplasty.

Bente Holm, Morten Tange Kristensen, Lis Myhrmann, Henrik Husted, Niels Kristian Stahl Kri Otte, Lasse Andersen, Billy Bjarne Kristensen, Kehlet Henrik

Department of Clinical Medicine

Abstract

Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections of anaesthetics-technique (LIA), together with multimodal systematic analgesics.

Methods: Between November 2006 and May 2007, one hundred consecutive patients admitted for primary, unilateral TKA to the Department of Orthopaedic Surgery, Hvidovre University Hospital were included, median age 70 years, range: 40 - 88 years (68 female). Patients were operated in spinal anaesthesia supplemented with local wound analgesic injections used peri- and postoperatively for 24 hours, subsequently gabapentin, paracetamol, and a COX-2 inhibitor initiated preoperatively using oxycodone or rescue analysis. They followed the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing, pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using "Timed Up & Go" (TUG), walking distance and length of stay (LOS).

Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate independently with pain intensity of 4.0 (VAS). The remaining part of patients was restricted by pain 7.0 (VAS) (53%), dizziness (32%) and exhaustion (15%). Range of motion was assessed to 10-70⁰ (for 93% of the patients), TUG to 28.1 sec. with highwalker and 19.9 sec. with crutches (for 68% of the patients), and 73% of the patients walked more than 70 meters.

At discharge patients showed improved range of motion: 10-80⁰, TUG: 19.1 sec. and walking distance > 70 meters for all patients. All median values. Patients were discharged on median day 3 (range 1-7), mean 2.76 (0.965). There was a significant relationship between TUG and VAS in connection with transfer and ambulation on POD 1 (Spearman´s Rho= 0.303-0.332). On DOD no significant correlations was found.

Conclusion: Using the LIA technique in fast-track programs for TKA patients, pain intensity reached a low level postoperatively, and pain is not a restricting factor for early rehabilitation.

Original language	English
Publication date	2008
Publication status	Published - 2008

Cite this

@conference{4808e79faca6439eb3d28afb53f1d463,

title = "The role of pain for early rehabilitation in fast track surgery.: A descriptive study of function and pain for 100 inpatients undergoing total knee arthroplasty.",

abstract = " Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections of anaesthetics-technique (LIA), together with multimodal systematic analgesics.Methods: Between November 2006 and May 2007, one hundred consecutive patients admitted for primary, unilateral TKA to the Department of Orthopaedic Surgery, Hvidovre University Hospital were included, median age 70 years, range: 40 - 88 years (68 female). Patients were operated in spinal anaesthesia supplemented with local wound analgesic injections used peri- and postoperatively for 24 hours, subsequently gabapentin, paracetamol, and a COX-2 inhibitor initiated preoperatively using oxycodone or rescue analysis. They followed the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing, pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using {"}Timed Up & Go{"} (TUG), walking distance and length of stay (LOS).Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate independently with pain intensity of 4.0 (VAS). The remaining part of patients was restricted by pain 7.0 (VAS) (53%), dizziness (32%) and exhaustion (15%). Range of motion was assessed to 10-700 (for 93% of the patients), TUG to 28.1 sec. with highwalker and 19.9 sec. with crutches (for 68% of the patients), and 73% of the patients walked more than 70 meters.At discharge patients showed improved range of motion: 10-800, TUG: 19.1 sec. and walking distance > 70 meters for all patients. All median values. Patients were discharged on median day 3 (range 1-7), mean 2.76 (0.965). There was a significant relationship between TUG and VAS in connection with transfer and ambulation on POD 1 (Spearman´s Rho= 0.303-0.332). On DOD no significant correlations was found. Conclusion: Using the LIA technique in fast-track programs for TKA patients, pain intensity reached a low level postoperatively, and pain is not a restricting factor for early rehabilitation.",

author = "Bente Holm and Kristensen, {Morten Tange} and Lis Myhrmann and Henrik Husted and Otte, {Niels Kristian Stahl Kri} and Lasse Andersen and Kristensen, {Billy Bjarne} and Kehlet Henrik",

note = "Sider: 1",

year = "2008",

language = "English",

}

TY - ABST

T1 - The role of pain for early rehabilitation in fast track surgery.

T2 - A descriptive study of function and pain for 100 inpatients undergoing total knee arthroplasty.

AU - Holm, Bente

AU - Kristensen, Morten Tange

AU - Myhrmann, Lis

AU - Husted, Henrik

AU - Otte, Niels Kristian Stahl Kri

AU - Andersen, Lasse

AU - Kristensen, Billy Bjarne

AU - Henrik, Kehlet

N1 - Sider: 1

PY - 2008

Y1 - 2008

N2 - Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections of anaesthetics-technique (LIA), together with multimodal systematic analgesics.Methods: Between November 2006 and May 2007, one hundred consecutive patients admitted for primary, unilateral TKA to the Department of Orthopaedic Surgery, Hvidovre University Hospital were included, median age 70 years, range: 40 - 88 years (68 female). Patients were operated in spinal anaesthesia supplemented with local wound analgesic injections used peri- and postoperatively for 24 hours, subsequently gabapentin, paracetamol, and a COX-2 inhibitor initiated preoperatively using oxycodone or rescue analysis. They followed the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing, pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using "Timed Up & Go" (TUG), walking distance and length of stay (LOS).Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate independently with pain intensity of 4.0 (VAS). The remaining part of patients was restricted by pain 7.0 (VAS) (53%), dizziness (32%) and exhaustion (15%). Range of motion was assessed to 10-700 (for 93% of the patients), TUG to 28.1 sec. with highwalker and 19.9 sec. with crutches (for 68% of the patients), and 73% of the patients walked more than 70 meters.At discharge patients showed improved range of motion: 10-800, TUG: 19.1 sec. and walking distance > 70 meters for all patients. All median values. Patients were discharged on median day 3 (range 1-7), mean 2.76 (0.965). There was a significant relationship between TUG and VAS in connection with transfer and ambulation on POD 1 (Spearman´s Rho= 0.303-0.332). On DOD no significant correlations was found. Conclusion: Using the LIA technique in fast-track programs for TKA patients, pain intensity reached a low level postoperatively, and pain is not a restricting factor for early rehabilitation.

AB - Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections of anaesthetics-technique (LIA), together with multimodal systematic analgesics.Methods: Between November 2006 and May 2007, one hundred consecutive patients admitted for primary, unilateral TKA to the Department of Orthopaedic Surgery, Hvidovre University Hospital were included, median age 70 years, range: 40 - 88 years (68 female). Patients were operated in spinal anaesthesia supplemented with local wound analgesic injections used peri- and postoperatively for 24 hours, subsequently gabapentin, paracetamol, and a COX-2 inhibitor initiated preoperatively using oxycodone or rescue analysis. They followed the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing, pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using "Timed Up & Go" (TUG), walking distance and length of stay (LOS).Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate independently with pain intensity of 4.0 (VAS). The remaining part of patients was restricted by pain 7.0 (VAS) (53%), dizziness (32%) and exhaustion (15%). Range of motion was assessed to 10-700 (for 93% of the patients), TUG to 28.1 sec. with highwalker and 19.9 sec. with crutches (for 68% of the patients), and 73% of the patients walked more than 70 meters.At discharge patients showed improved range of motion: 10-800, TUG: 19.1 sec. and walking distance > 70 meters for all patients. All median values. Patients were discharged on median day 3 (range 1-7), mean 2.76 (0.965). There was a significant relationship between TUG and VAS in connection with transfer and ambulation on POD 1 (Spearman´s Rho= 0.303-0.332). On DOD no significant correlations was found. Conclusion: Using the LIA technique in fast-track programs for TKA patients, pain intensity reached a low level postoperatively, and pain is not a restricting factor for early rehabilitation.

M3 - Conference abstract for conference

ER -