Gestión del dolor en pacientes del programa Rapid Recovery (RR), en Artroplastia Total de Rodilla (ATR) / Pain management in patients of Rapid Recovery (Rr) Program in Total Knee Arthroplasty (TKA)

La artroplastia total de rodilla (ATR) es una cirugía consistente en la sustitución artificial de la articulación, debido a una lesión traumática o bien a un proceso degenerativo o de artrosis, con un dolor importante asociado que en ocasiones afecta de forma negativa a la recuperación del paciente. La elección de la prótesis dependerá de las características anatómicas del paciente y del criterio del cirujano. El concepto de «cirugía de recuperación rápida» fue introducido en 1997 por Khelet y significó el inicio del modelo Fast Track o de Rapid Recovery (RR), ligado a una rehabilitación acelerada, un alta precoz y la optimización de todos los aspectos de la experiencia del paciente pre, intra y posoperatoria. La recuperación rápida es un proceso quirúrgico que pretende conseguir la máxima autonomía del paciente mediante la educación, el control del dolor y la movilización precoz. El instrumento fundamental para la recuperación rápida es conseguir la implicación del paciente mediante el empoderamiento, es decir, por medio de la educación preoperatoria del paciente, que contribuirá a reducir la ansiedad y facilitará que se involucre en su propia recuperación. Así, será partícipe de una terapia física posoperatoria eficaz, utilizando todas aquellas herramientas necesarias para aumentar su capacidad de gestionar los problemas de salud. El empoderamiento del paciente forma parte del modelo de enfermería del Hospital Clínic de Barcelona (HCB) adoptado por la Dirección de Enfermería en diciembre del año 2012. La cirugía convencional de ATR en Cataluña hasta el inicio de la cirugía RR ocasionó 14 132 intervenciones en el año 2008, con hospitalización convencional posterior. Este artículo describe los cuidados y los resultados de las intervenciones enfermeras, definidas en la vía clínica RR de ATR dirigidas a la minimización del dolor, y las repercusiones sobre la movilización de los pacientes. Se efectuó en una unidad monográfica de un hospital terciario de Barcelona en el año 2013 (AU)

Total knee arthroplasty (TKA) is a surgery consisting on the artificial joint replacement, due to a traumatic injury or a degenerative process or arthrosis. This surgery causes an important pain to patients, and sometimes affects negatively on their recovery. The choice of the prostheses will depend on the anatomical features of the patient and the surgeon criterion. The concept of «rapid recovery surgery» was introduced in 1997 by Khelet and meant the beginning of the Fast Track model or the Rapid Recovery (RR) linked to an accelerated rehabilitation, an early discharge and the optimization of all the aspects of pre, intra and post-operative patient experience. Fast recovery is a surgical process which aims to achieve maximum autonomy of the patient through education, pain control and early mobilization. The key of the rapid recovery is to get the involvement of the patient thanks to the empowerment, which means a preoperative patient education that will help to reduce anxiety and it will make easier to engage in their own recovery. Furthermore the patient will take part of an effective post-operative physical therapy, using all the necessary tools to increase their ability to manage their own health problems. The empowerment of these patients is part of the Nursing Model in the Hospital Clinic de Barcelona (HCB), adopted by the Nursing Management in December of 2012. In Catalonia, until the start of the RR surgery, 14 132 interventions in 2008 where done by TKA conventional surgery, needing subsequent conventional hospitalization. This article describes the care and outcomes of nurse interventions, defined in the RR of TKA clinical way, which is focused on the pain’s minimization and the impact on patients’ mobilization. It was performed in a monographic unit from a tertiary-level hospital in Barcelona in 2013 (AU)

A review of knee pain in adolescent females.

Primary care practitioners are in a position to educate patients and parents about the risk factors that may increase the incidence of knee pain in adolescent females. This article highlights patellofemoral pain syndrome, Sinding-Larsen-Johansson syndrome, Osgood-Schlatter disease, and meniscal tears.

Health-related profile and quality of life among nursing home residents: does pain matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.

Acute pain transfusion reaction.

A 34-year-old woman with a diagnosis of hemophagocytic lymphohistocytosis (HLH) received a double umbilical cord blood transplantation following a myeloablative chemotherapy preparative regimen with busulfan and cyclophosphamide. HLH is a rare, potentially fatal hematologic disorder characterized by the overactivation of histocytes and T lymphocytes, leading to organ infiltration and acute illness. On day 25 post-transplantation, the patient required a platelet transfusion for a platelet count of 6,000 per ml (normal range = 150,000-450,000 per ml). The patient's blood type prior to the cord blood transplantation was B positive and, although both umbilical cord blood donors were O positive, the patient was still B positive per blood bank testing on that day. Although the recipient of an allogenic stem cell transplantation will eventually become the blood type of the donor, the time for this process to occur varies for each person. That process must be monitored by the blood bank for the purpose of cross-matching blood products to decrease hemolysis as much as possible. The patient was premedicated with the facility's standard for platelet transfusions: acetaminophen 650 mg and diphenhydramine 25 mg about 30 minutes prior to the platelet transfusion.

Arthrocentesis: the latest on joint pain relief.

Arthrocentesis is a procedure in the diagnostic workup and treatment of joint pain that has few complications. Analysis of joint fluid yields important treatment data. Corticosteroid and local anesthetic injections provide longer pain relief.

A closer look at hand and wrist complaints.

Hand or wrist pain is a common complaint in primary care. This pain can be very disabling and can significantly impair a person's quality of life. With the appropriate clinical knowledge and skills, nurse practitioners can effectively evaluate, diagnose, and treat many of the common hand and wrist complaints seen in primary care.

Osteoarthritis 1: Physiology, risk factors and causes of pain.

Osteoarthritis (OA) is a synovial joint disorder characterised by pain, stiffness, and restricted function. It is often classed as a degenerative disease because the affected joints deteriorate over time. This article, the first in a three-part series, describes the complex pathophysiology and causes of pain in OA, risk factors, and how it is diagnosed.

The effectiveness of an aquarobic exercise program for patients with osteoarthritis.

Aquarobics, a combination of the words aqua and aerobics, is based on the idea that much more energy is consumed during exercise when resisting water rather than air. The aquarobic exercise program is composed of patient education and aquarobic exercise. The program was effective in enhancing self-efficacy, decreasing pain, and improving depression levels, body weight, and blood lipid levels in patients with osteoarthritis. Therefore, this program can be widely used in a community setting for the management of osteoarthritis.

A 15-year-old male with persistent knee pain.

Most children and adolescents who present with extremity pain in the emergency department (ED) have minor injuries or musculoskeletal problems that are easily diagnosed and managed. A history of a child or teenager with persistent extremity pain lasting more than a few weeks or pain that wakes the child at night is of clinical concern and requires investigation. There are serious clinical etiologies that must be included in the differential diagnosis of this group of patients. It is essential to take the time during the initial screening examination to determine the real reason for each patient ED visit and review previous medical care.

Avaliação cinesiológica e sintomatológica de membros inferiores de costureiros industriais / Avaliación quinesiologica e sintomatologica del miembros inferiores del costureros industriais / Kinesiologic and symptomatologic evaluation of lower members in industrial dressmakers

O estudo objetivou avaliar a incidência e intensidade de dor músculo-esquelética nos membros inferiores de costureiros industriais. Realizou-se pesquisa de campo e exploratória em uma cooperativa de costura de roupas esportivas, na cidade de Rifaina (SP), em janeiro e fevereiro de 2004, analisando-se 34 trabalhadores, a maioria do sexo feminino. Elaborou-se um questionário que abordava os aspectos pessoais, organizacionais e sintomatológicos e um protocolo que identificava os movimentos e posturas empregados durante a atividade, constando os principais movimentos articulares e faixas de amplitude do movimento, considerados de risco para o desenvolvimento de lesões. Os resultados mostraram que os trabalhadores apresentaram alta incidência e intensidade de dor, e as diferentes atividades foram igualmente lesivas devido ao posicionamento estático associado a amplitudes de risco. Concluiu-se que as situações identificadas mostraram-se como risco no ambiente de trabalho, tendo este fato sido corroborado pelo relato dos trabalhadores com relação às dores por eles percebidas.

The study evaluated the incidence and intensity of lower member musculoskeletal pain in industrial dressmakers. An exploratory field study conducted in January and February 2004 in a sports garment sewing cooperative in Rifaina, São Paulo State - Brazil, examined 34, mostly female, workers by applying a questionnaire to record personal, organizational and symptomatologic particulars and a protocol to identify the movements and postures used during the activity, record the main joint movements and ranges of movement considered as risks for developing injuries. The results showed high incidence and intensity of pain and that the various different activities were detrimental because of static positioning associated with risk-related ranges of movement. It was concluded that the situations identified were sources of workplace risk, which was corroborated by the workers’ reports of the pain they felt.

El estudio tuvo como objetivo evaluar la incidencia y la intensidad de dolor músculo-esquelético en las extremidades inferiores de los sastres. Se realizó investigación de campo y exploratoria en una cooperativa de costura de ropa de deportes en la ciudad de Rifaina (SP) – Brasil, en enero y febrero de 2004, analizándose 34 trabajadores, en su mayoría mujeres. Se elaboró un cuestionario que se ocupó de las cuestiones personales, de organización y de los síntomas y un protocolo que identificaba los movimientos y posturas utilizados durante la actividad, constando los principales movimientos articulares y la amplitud del movimiento, considerados de riesgo para desarrollar lesiones. Los resultados mostraron que los empleados tenían alta incidencia e intensidad de dolor, y las diversas actividades también fueron lesivas debido a la posición estática asociada con rangos de riesgo. Se llegó a la conclusión de que las situaciones se han identificado como un riesgo en el lugar de trabajo, y este hecho corrobora la historia de los trabajadores en relación con el dolor que sentían.

Care management for depression and osteoarthritis pain in older primary care patients: a pilot study.

OBJECTIVE: To establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late-life depression and osteoarthritis. METHODS: Treatment development pilot study in three university affiliated primary care clinics. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months. RESULTS: Fourteen patients participated in the pilot program. Between baseline and 6 months, mean HSCL-20 depression scores dropped from 1.78 (SD 0.56) to 1.06 (SD 0.59), a standardized effect size of 1.27 (p = 0.004). Pain intensity scores dropped from 5.67 (SD 1.69) to 4.18 (SD 1.98), an effect size of 0.88 (p = 0.021) and pain interference scores dropped from 4.91 (SD 1.75) to 3.49 (SD 2.14), an effect size of 0.81 (p = 0.013). Patients also experienced improvements in self efficacy, in satisfaction with depression care, and in timed 8-m walk and transfer tests. CONCLUSION: The combined intervention was feasible and well-received by patients. Preliminary outcomes are promising and comparisons to an earlier trial of care management for depression alone suggest that the combined program may be equally effective for depression but more effective for pain.

[The effects of Dogbi(ST35) & Sulan moxibustion on knee joint pain, range of motion and discomfort during ADL in the aged].

PURPOSE: The purpose of this research was to test the effects of ST35 & Sulan moxibustion on knee joint pain, range of motion, and discomfort during Activies of Daily Living (ADL) in elderly with knee joint pain. METHOD: A nonequivalent control group pre-post test research design was used. Thirty four elderly who had knee joint pain were studied. Of them, sixteen were in the experimental group and eighteen the control group. The instruments used for this study were NRS, goniometer, and a modified ADL questionnaire developed by Lee. RESULT: The pain scores of right & left knee joint after moxibustion were significantly different between the experimental group and the control group (Right: F=26.27, p=0.000, Left: F=20.77, p=0.000). Right and left knee ROM scores were significantly different between the experimental group and the control group after moxibustion (Right: F=10.74, p=0.003, Left: F=9.239, p=0.005). Discomfort during ADL scores were significantly different between the experimental group and the control group after moxibustion (F= 32.31, p=0.000). CONCLUSION: It is necessary that nurses provide the elderly with knee joint pain with moxibustion to reduce joint pain and to increase knee ROM as an alternative therapy.

Osteoarthritis in older adults: current treatments.

Although there is no cure for osteoarthritis, numerous treatments are available for symptom relief. Pharmacological treatments primarily focus on pain relief; however, in older adults there is continuing concern related to the risk of side effects and interactions with other medications. In contrast, non-pharmacological treatments, such as exercise, joint protection, and stress reduction, provide symptom relief with few side effects. In addition, alternative treatments such as nutritional supplements, herbal preparations, acupuncture, and tai chi are being investigated for their efficacy. Nurses should encourage patients to use a combination of treatments that provide optimum symptom relief with the fewest side effects.