Preoperative Non-Opioid Analgesia in Total Joint Patients to Decrease Postoperative Pain

Abstract

Problem & Purpose: Postoperative pain remains a fundamental concern for adult patients undergoing total joint replacement surgeries. Postoperative pain has negative physiologic effects including increased heart rate and blood pressure, decreased intestinal motility, and decreased immune function. At a small rural medical center, 30% of adult total joint patients undergoing general anesthesia reported a severe postoperative pain score greater than seven on the numeric rating scale. The purpose of this quality improvement project was to implement and evaluate the compliance of administering preoperative non-opioid pain medications (Tylenol, Gabapentin, & Celebrex) in adult total joint replacement patients. Methods: The setting of this project was 13 operating rooms with an implementation team consisting of perioperative nurses and anesthesia providers. A protocol form was used to screen eligible patients and non-opioid analgesics were then administered to adults undergoing total joint replacement surgeries. Compliance with administration and documentation of preoperative non-opioid analgesics, postoperative pain scores, and postoperative administration of opioids were tracked via chart audits. Results: Chart audits were completed for 48 patients over a 15-week period. On average, 74% of anesthesia providers were compliant with administering preoperative non-opioid medications and 91% of patients denied having severe pain postoperatively. Conclusions: Data suggested this was a feasible project with a positive correlation between administering preoperative non-opioid analgesia for patients undergoing total joint replacement surgeries to decrease postoperative pain.