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Patient Educ Couns. 2019 Feb;102(2):383-387. doi: 10.1016/j.pec.2018.09.001. Epub 2018 Sep 5.

Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery.

Author information

1
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA. Electronic address: meghanayajnik@gmail.com.
2
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: jnhill@stanford.edu.
3
Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: Oluwatobi.Hunter@va.gov.
4
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: showard@stanford.edu.
5
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: tekim@stanford.edu.
6
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: kharriso@stanford.edu.
7
Department of Anesthesiology, Perioperative and Pain Medicine, MC 5640, 300 Pasteur Drive, Room H3580, Stanford, CA, 94305, USA; Anesthesiology and Perioperative Care Service, MC 112A, 3801 Miranda Avenue, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. Electronic address: emariano@stanford.edu.

Abstract

OBJECTIVE:

Effects of patient education on perioperative analgesic utilization are not well defined. We designed a simple pain management educational card for total knee arthroplasty (TKA) patients and retrospectively reviewed clinical data before and after implementation to test the hypothesis that more informed patients will use less opioid.

METHODS:

With IRB approval, we analyzed clinical data collected perioperatively on all TKA patients one month before (PRE) and one month after (POST) card implementation. The card was designed using a modified Delphi method; the front explained all analgesic medications and the Defense and Veterans Pain Rating Scale was on the back. The primary outcome was total opioid dosage in morphine milligram equivalents (MME) for the first two postoperative days. Secondary outcomes included daily opioid usage, pain scores, ambulation distance, hospital length of stay and use of antiemetics.

RESULTS:

There were 20 patients in each group with no differences in baseline characteristics. Total two-day MME [median (10th-90th percentiles)] was 71 (32-285) for PRE and 38 (1-117) for POST (pā€‰=ā€‰0.001). There were no other differences.

CONCLUSION:

Educating TKA patients in multimodal pain management using a simple tool decreases opioid usage.

PRACTICE IMPLICATIONS:

Empowering TKA patients with education can reduce opioid use perioperatively.

KEYWORDS:

Multimodal analgesia; Opioids; Patient education; Postoperative pain; Quality improvement; Total knee arthroplasty

PMID:
30219634
DOI:
10.1016/j.pec.2018.09.001

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