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Journal of Nursing

Post-Operative pain management in Total Joint Replacements: Finding a Balance

Michele E. White, RN, BSN [email protected]



Post-operative pain after Total Joint Replacement can place patients at high risk for complications. It’s no secret that patients will experience pain after surgery but maintaining a tolerable level of pain can be challenging. Moderate to Severe pain can prevent patients from actively participating in the rehabilitation process, increase LOS (length of stay), place them at high risk for infection, and incur higher costs for medical care, treatment, and more. Post-operative pain effects morale, motivation, and overall performance with daily activities.

Finding a balance of what patients consider to be tolerable pain levels through the use of multiple methods and techniques can result in better outcomes and recovery. More than ever Surgeons and Anesthesiologist collaborating together have an opportunity to improve the overall patient experience thus resulting in higher patient satisfaction results. Pain Management/pain control is a well-known key performance marker on patient satisfaction surveys. When the patient reports how well their pain was or was not kept under control the data collectively is used to rank different healthcare facilities that ultimately can affect reimbursement and influence the patients future choice of healthcare facilities. Making improvements to pain management processes will avoid a downward spiral in satisfaction, and recovery. Ranking of facilities is available to view online influencing patients on their selection of one healthcare facility over another.
Having a dedicated team of surgeons, anesthesiologists, pharmacy, physical therapist, and nursing committed to improving the overall patient experience using communication and coordination across the clinical care continuum is more important than ever.

Several physical consequences can develop from poorly controlled pain. Severe post-operative pain can result in sleep deprivation causing lethargy and lack of participation in the therapy/rehabilitation process. Obviously, lack of motivation in therapy and mobility can significantly impair range of motion needed for daily activities like walking, mood and social relationships.

Considerations such as Opioids have been used for a long time as the first treatment of choice yet continues to result in nausea, constipation, and vomiting. Because opioids and several other medications are often ordered as PRN, many patients wait too long to request something for pain relief causing extended length of time in getting any relief. Educating your patients on regular administration of pain medications and the significance of results will aid in better pain control. Although opioids will continue to be an important part of the clinical regimen, as clinicians we need to consider more effective strategic pain management options involving a combination of multiple applications. The goal should be to administer a combination of agents and techniques while avoiding complete reliance on opioids, which can decrease respiratory function. Strong communication and breaking Silo’s takes time however is vital to improving processes. Using a team approach will allow for creative and customization of care plans designed for each individual based on co-morbidities, past medical history and allergies or sensitivity to medications.

Medication is only one segment of the care plan. We have the opportunity to implement several options such as diversional activities. Such activities may include relaxation videos, spa music, hand massages, ice therapy and so much more. Diversional activities may include educational interactive games during a group setting promoting support, camaraderie, and help the patient concentrate on something other than their pain. These pain management techniques and diversional methods are only a small part of the ongoing search for ways in which to reduce post-operative pain, improve functionality without increasing the incidence of analgesic-related side effects. Common side effects of nausea, vomiting, and sedation can limit and delay recovery due to lack of participation in group therapy.

Despite improvements in pain management delivery systems we continue to struggle with pain control issues in post-operative joint replacements. Collaboration among the entire orthopedic team is the key to a successful pain management approach with improvement in the overall patient experience and recovery. Having a dedicated team working toward finding the balance in the best interest of the patient for pain control is a win-win situation.

Michele E. White, RN, BSN

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