Enhanced preoperative education about continuous femoral nerve block with patient-controlled analgesia improves the analgesic effect for patients undergoing total knee arthroplasty and reduces the workload for ward nurses

Xiaona Lin,Jing Zhang,Jun Wang,Zhengqian Li,Hongcai Zheng,Kaixi Liu,Bin Han,Yang Zhou,Xiangyang Guo,Xiaoxiao Wang

doi:10.1186/s12871-019-0826-3

Xiaona Lin, Jing Zhang + Show 8 more

Open Access

https://doi.org/10.1186/s12871-019-0826-3

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Abstract

BackgroundTotal knee arthroplasty (TKA) is the most common treatment for end-stage knee osteoarthritis and continuous femoral nerve block (CFNB) has become the gold standard for analgesia. But the lack of knowledge about CFNB and patient-controlled analgesia (PCA) often leads to inappropriate dose of medications and increased workload for ward nurses.MethodsAfter retrospectively registering to http://www.chictr.org.cn (ChiCTR1800018957), 60 patients undergoing unilateral TKA were randomly divided into groups A and B (n = 30 each). Patients in group B and their families received a nurse-led preoperative visit the day before surgery focusing on PCA educational pamphlets for postoperative pain management. Before returning to the ward, patients and their families in both groups received face-to-face PCA pump operation training. The usual postoperative follow-up was performed by nurse anesthetists for 2 consecutive days. Visual Analogue Scale (VAS) scores at rest and during movement, knowledge of the PCA evaluated by a ten-question questionnaire, knee flexion angles, and the number of PCA-related nurse calls were recorded.ResultsThe VAS scores at rest and during movement of the patients in group B were both significantly lower than in group A on postoperative days 1 and 2. The questionnaire scores of the patients in group B were much higher than those in group A on postoperative day 1, but not on day 2. Patients in the 2 groups had similar knee flexion on postoperative days 1 and 2. Patients in group B asked for assistance from the ward nurses with the PCA fewer times than those in group A, and the ward nurses were more satisfied with the analgesic protocol in group B.ConclusionsEnhanced preoperative education for CFNB with PCA can provide patients with a better grasp of postoperative pain management, improve the postoperative analgesic effect after TKA, and reduce the PCA-related workload for ward nurses.Trial registrationThis study was retrospectively registered to ChiCTR (identifier: ChiCTR1800018957) on October 18, 2018.

Highlights

Total knee arthroplasty (TKA) is the most common treatment for end-stage knee osteoarthritis and continuous femoral nerve block (CFNB) has become the gold standard for analgesia
We explored whether preoperative CFNB education could improve postoperative analgesic efficacy; we evaluated whether preoperative CFNB education could reduce the patient-controlled analgesia (PCA)-related workload for ward nurses after TKA
23 patients received CFNB in the post anesthesia care unit (PACU) and 7 patients received it in the operating room (p > 0.05), and there was no significant difference between the groups in the timing of the CFNB

Summary

Introduction

Total knee arthroplasty (TKA) is the most common treatment for end-stage knee osteoarthritis and continuous femoral nerve block (CFNB) has become the gold standard for analgesia. The lack of knowledge about CFNB and patient-controlled analgesia (PCA) often leads to inappropriate dose of medications and increased workload for ward nurses. The lack of knowledge by patients and their families about CFNB and patient-controlled analgesia (PCA) often leads to under-dosing or over-dosing of medications, a decrease in general analgesic efficacy, an increased workload for ward nurses, and an increased risk of falls [5]. We explored whether preoperative CFNB education could improve postoperative analgesic efficacy; we evaluated whether preoperative CFNB education could reduce the PCA-related workload for ward nurses after TKA

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Results

Conclusion