2017 ISAKOS Biennial Congress IFOSMA ePoster #5100

 

Results of a gradient-based program for perioperative pain management and enhanced recovery in patients undergoing joint surgery

Gang Dai, Lanzhou, Gansu CHINA
Huan Yu, Lanzhou, Gansu CHINA

Gansu Provincial Hospital of Chinese Medicine, lanzhou, gansu, china

FDA Status Not Applicable

Summary

It is well-known that enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, no standardized programs in dealing with patients undergoing joint surgery can be found within the literature and perioperative pain management plays a great important role in establishing a successful ERAS program.

Abstract

Objective

It is well-known that enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, no standardized programs in dealing with patients undergoing joint surgery can be found within the literature and perioperative pain management plays a great important role in establishing a successful ERAS program. We propose a standardized gradient-based program for perioperative pain management and enhanced recovery in patients undergoing joint surgery.The purpose of t his study is to present the results of our proposed program .
Method(s):
Patients undergoing joint operation were classified in 4 different types according to the severity of surgical trauma,including common arthroscopic surgery,ligament reconstruction surgery ,intraoarticular fracture surgery and Joint replacement surgery in our department .These patients were enrolled according to inclusive criteria and randomly assigned to the subgroup receiving our standardized gradient-based program for perioperative pain management and enhanced recovery and the controlled subgroup.The program involved perioperative strategies including preadmission counseling, avoidance of preoperative bowel preparation, use of multimodal anesthesia, intraoperative goal-directed fluid therapy, and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and catheters, as well as encouraging early feeding, early mobilization, timely removal of tubes and drains postoperatively. Multimodal gradient analgesia is the key element through the whole program. Visual analogue scale(VAS) scores were evaluated both preoperatively and after 12hours, 24hours, 48hours, and 72hours postoperatively. International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated both preoperatively and after 2 weeks, 4 weeks, 2months, and 3months postoperatively. The length of hospital stay and hospital cost were also recorded.
Result(s):
A total of 250 continuous patient were included in our study,of which 78 cases were common arthroscopic surgery,42 cases were ligament reconstruction surgery ,52 cases were intraoarticular fracture surgery and 78 cases were joint replacement surgery .VAS scores decreased significantly in the four groups but more larger in the subgroup reveiving the gradient-based program than that of the controlled subgroup.IKDC and Lysholm scores increased significantly in the four groups but more faster and larger in the subgroup reveiving the gradient-based program compared with controlled subgroup.Significant difference were also found in the length of hospital stay and hospital cost between subgroups.
Conclusion(s):
The introduced gradient-based program showed good results on perioperative pain control and function recovery,as well as shorter length of hospital stay, a lower hospital costs and improvements in patient satisfaction.