Evaluating Pain Relief Using Total Pain Relief (Totpar) In Operative Orthopedic Patients
Keywords:
TOTPAR, Postoperative pain, Orthopedic surgery, Multimodal analgesia, NRSAbstract
Background: Postoperative pain is a major concern for orthopedic patients, as it can delay recovery and prolong rehabilitation. This study aimed to evaluate the efficacy of pain relief using the Total Pain Relief (TOTPAR) score in postoperative orthopedic patients. Additionally, it aimed to analyze the role of multimodal analgesia in improving pain management and enhancing recovery outcomes.
Methods: A prospective observational study was conducted involving 148 patients who underwent various orthopedic surgeries. Pain levels were assessed using the Numerical Rating Scale (NRS) and the TOTPAR score over a 48-hour period following surgery. Standardized analgesic regimens, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (e.g., tramadol), and adjunctive therapies, were administered to manage postoperative pain. The effectiveness of these analgesic treatments was measured by changes in NRS and TOTPAR scores.
Results: The study found a significant reduction in postoperative pain intensity. NRS scores decreased from a mean of 7.77±0.72 before treatment to 6.66±0.71 after treatment, indicating notable pain relief. The TOTPAR scores showed consistent improvement, rising from a baseline of 0.24±1.71 to 32.14±6.13 at 48 hours, further demonstrating the effectiveness of pain management. NSAIDs were the most commonly used analgesics, followed by tramadol and other adjuncts, supporting the role of multimodal analgesia in postoperative pain relief. However, no significant correlation was found between the TOTPAR score and the length of hospital stay, suggesting that factors other than pain relief may influence recovery duration.
Conclusion: The study concluded that the TOTPAR score is a reliable and comprehensive tool for evaluating postoperative pain relief in orthopedic patients. The findings underscore the importance of individualized pain management strategies and the effectiveness of multimodal analgesia in optimizing pain control and improving recovery outcomes. By utilizing a combination of analgesic approaches, healthcare providers can better address postoperative pain and enhance the patient experience during recovery.
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References
Schug SA, Pogatzki-Zahn EM, Cameron PJ. Optimizing postoperative pain management. Curr Opin Anaesthesiol 2016;29(6):662-6.
Kehlet H, Dahl JB. Multimodal analgesia for postoperative pain. J Clin Anesth 2016; 33:265-75.
Loeser JD, Schug SA, Pogatzki-Zahn EM. Chronic pain after orthopedic surgery. Pain Res Treat 2020; 2020:9849563.
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Advances in multimodal pain management. Anesth Analg 2019;129(1):168-74.
Joshi GP, Schug SA. Postoperative pain management in orthopedics. Orthopedics 2019;42(3): e295-305.
Smith HS, Sang CN, Bookbinder SA. Non-opioid analgesics in pain management. Clin J Pain 2018;34(3):285-93.
Wang L, Guo C, Gao J, Wang W. Systemic magnesium and ketamine for postoperative pain. J Pain Res 2020; 13:1425-35.
Ryu J, Choi JB, Kim YS, Yoo YH, Kim J. Comparative efficacy of analgesic regimens. Pain Physician 2020;23(2): E171-81.
Hah JM, Bakshi SG, Kang DH, Lim SB, You HJ. Regional anesthesia in orthopedic surgery. Pain Med 2020;21(5):879-89.
Albrecht E, Chin KJ. Regional anesthesia in orthopedic surgeries. Anesth Analg 2017;124(4):1421-30.
Turner PV, Chen H, Taylor WM, Smith AC. Adjunctive pain management strategies. Front Vet Sci 2020; 7:22.
Hayek SM, Hanes MC, McKay WP, Khan A, Kapural L. Multimodal analgesia in orthopedic patients. Pain Med 2019;20(6):1054-61.
Kaye AD, Urman RD, Cornett EM, et al. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol 2017;31(1):113-23.
Kim H, Park JY, Choi G, et al. Innovations in pain management post-surgery. Int J Clin Pharm 2023;45(1):40-50.
Moore RA, McQuay HJ, Gavaghan D. TOTPAR as a measure of analgesic efficacy. Pain 2015;156(6):1037-43.
Derry CJ, Wiffen PJ, Moore RA. Pain measurement in clinical trials. Br J Clin Pharmacol 2017;83(4):900-12.
Vaughan D, Godolphin PJ, Stevens E. Implementing pain assessment tools in practice. J Perioper Pract 2021;31(5):163-70.
Mehta P, Joshi GP, Jensen MP. TOTPAR and patient outcomes in orthopedic surgery. Clin Orthop Relat Res 2022;480(3):584-91.
Gonzalez NA, Horwitz DL, Allen HM. Role of NSAIDs in postoperative pain relief. J Orthop Surg Res 2018;13(1):22.
Aminoshariae A, Khan F, Schooley AM. Efficacy of acetaminophen in multimodal analgesia. J Clin Pharmacol 2020;60(9):1150-7.
O'Connor AB, Dworkin RH, Turk DC. Impact of patient variability on pain outcomes. Pain Med 2017;18(8):1522-8.
Elsharydah A, Alshahrani M, Roberts WJ. Personalizing postoperative pain care. J Clin Med 2021;10(4):856.
Jain A, Gupta S, Shah B. Trends in multimodal postoperative pain management. J Pain Res 2021; 14:2345-53.
Finnerup NB, Haroutounian S, Kamerman PR, et al. Standardizing postoperative pain assessment. Lancet Neurol 2015;14(2):162-73.
Zhai L, Zhao L, Yang S, Yu X, Xie Y. Comparative analysis of pain assessment tools. J Clin Pain 2021;37(4):280-6.
Jadon A. Pain management in orthopedic patients. In: Bajwa SJS, editor. Essentials of Anesthesia in Orthopedic Surgery. London: Springer; 2020. p. 114.
Schug SA, Pogatzki-Zahn EM. The role of NSAIDs in postoperative care. Curr Pain Headache Rep 2021;25(1):18-25.
Joshi GP, Brennan TJ, Apfelbaum JL. Patient-controlled analgesia in orthopedic surgery. Orthopedics 2019;42(3): e318-25.
Hayek SM, Rathmell JP, O'Brien D. Long-term outcomes of multimodal pain protocols. Pain Med 2020;21(9):1007-14.
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