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Abstract
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Background and Aims St Albans City Hospital, part of West Hertfordshire Teaching Hospitals NHS Trust, specialises in elective surgeries like total knee (TKR) and hip replacements (THR). This study assessed pain scores on postoperative days 1 and 2 for TKR and THR patients, along with rescue analgesia requirements and their effect on hospital stay.
Methods We developed an observational questionnaire for postoperative and ward nurses to record pain scores at rest and on mobility. We documented surgery type, anaesthesia, peripheral nerve block (PNB), intraoperative analgesia, rescue analgesia, complications, and hospital stay duration. We benchmarked the ERAS data from our hospital during that period.
Results Amongst n=67, spinal anaesthesia was preferred in n=56 (n=35 for THR and n=21 for TKR). PNB was preferred in n=1, and LIA was n=48. 69% received unimodal intraoperative analgesia (65% IV Paracetamol alone, 4% IV Morphine alone) and 31% multimodal (in GA). All patients received oral Oxycodone postoperatively. Pain scores were nil on day 0, moderate-severe on day 1 and mild-moderate on day 2. Higher pain scores highlighted discharge delays due to pain (TKR) and mobility (THR), also seen in the ERAS dataset.
Conclusions Our study suggested introducing PNBs, which was reflected as a new protocol including iPACK and adductor canal block for TKR to aim for day-case arthroplasty, scanning sessions to teach these blocks, standardising pain entry with an NRS scorecard and targeting analgesia on Day 1. We plan to reaudit pain scores by implementing these regional anaesthetic techniques and evaluating their impact on hospital discharge times.
Pain (immediate post-operative period, day 1 and day 2) and analgesia choices
Causes for delay in discharge (Analgesia study: THR and TKR) were pain and reduced mobility