Role of Strong Opioids in an Effective Discharge for Lower-Limb Large Joint Arthroplasty Patients: A Patient-Based Analysis.
| Autor: | Mussab RM; Orthopaedics and Trauma, Jinnah Postgraduate Medical Centre, Karachi, PAK.; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR., Jawad A; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR., Iqbal MT; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR., Iqbal MA; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR., Palaparthy P; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR., Ali F; Orthopaedics and Trauma, Russells Hall Hospital, Dudley, GBR. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Nov 29; Vol. 16 (11), pp. e74727. Date of Electronic Publication: 2024 Nov 29 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.74727 |
| Abstrakt: | 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). Conclusion: 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. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Dudley Group NHS Foundation Trust (Audit Management and Tracking (AMAT)) issued approval QI/2023-24/03. This study is registered with the Trust Regulatory Authority with registration no. QI/2023-24/03. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Mussab et al.) |
| Databáze: | MEDLINE |
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