A prospective study evaluating the new local infiltration analgesia protocol for fast-track primary total knee arthroplasty at UNN Tromsø.

Abstract

Introduction: A new local infiltration analgesia (LIA) protocol was implemented for fast-track primary total knee arthroplasty (TKA) at UNN Tromsø in January 2017. The objective of this master thesis was to evaluate the new protocol, as well as postoperative pain, postoperative nausea and vomiting (PONV) and patient satisfaction following fast-track primary TKA at UNN Tromsø. Materials and methods: A prospective study was performed at UNN Tromsø running from 12 January 2017 until 20 June 2017. All patients who received fast-track primary TKA at UNN Tromsø during the study period were included. Data concerning adherence to the new protocol was collected from the electronical health record. Postoperative pain, PONV and patient satisfaction were assessed at seven points during the first 24 hours postoperative using a specific pain- and satisfaction form. Results: 28 patients were recruited to the study and included for analysis. Only three patients received premedication according to the new protocol and only nine patients received postoperative medication according to the new protocol. Most patients received too low dose of LIA according to the new protocol and timing of antibiotic prophylaxis was wrong in many of the patients. Median postoperative resting pain level (NRS) ranged 0-4 during the first 24 hours postoperative. A total of seven patients reported severe pain (NRS ≥ 7) at one or more of the assessments. The highest incidence of PONV was recorded in six patients at two separate assessments. Patient satisfaction was generally high, but four patients were unsatisfied with their patient journey. Conclusion: Adherence to the new LIA protocol for fast-track primary TKA at UNN Tromsø was low. Despite low adherence to the new protocol patient satisfaction following fast-track primary TKA at UNN Tromsø was high. Postoperative pain scores and PONV following fast track primary TKA at UNN Tromsø were acceptable but may be improved with increased adherence to the new protocol.