RESUMO
The purpose of this study was to compare the efficacy and safety of extended-release epidural morphine (EREM) and perineural infusion (PNI) to control pain after total knee arthroplasty. A convenience sample of 200 patients was obtained using a retrospective chart review of patients who underwent a total knee arthroplasty. Institutional review board approval was obtained, and 100 charts of patients who received EREM and 100 patient charts for PNI were reviewed. The main end points were pain scores up to 48 hours postoperatively, and the ancillary end points were supplemental opioid requirements and adverse effects. Data were analyzed using the Pearson chi2 where appropriate or the Fisher exact test, and all continuous variables were examined using a Wilcoxon rank test. The results of the study showed no significant differences between the 2 groups for the levels of pain preoperatively, immediately postoperatively, and at 48 hours postoperatively. However, at both 12 hours and 24 hours postoperatively, the PNI group had a significantly higher pain score than the EREM group. The EREM group had better pain scores; however, one must look at a number of different variables when deciding if EREM is the correct choice for postoperative pain management.
Assuntos
Analgesia Epidural , Analgésicos Opioides/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Morfina/administração & dosagem , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgesia Epidural/métodos , Análise de Variância , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Seleção de Pacientes , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Segurança , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this descriptive study is to determine what strategies were most helpful for women to begin and maintain a walking program. METHOD: Data from the field notes of a randomized clinical trial to promote walking in 97 women were used for the qualitative analysis discussed in this article. FINDINGS: Overall, the majority of participants met the study goal of walking 90 minutes per week. CONCLUSIONS: In addition, the participants reported other benefits, including becoming more physically fit, mental and emotional satisfaction, and stress reduction. Some of the barriers mentioned by participants were personal and/or professional obligations, weather, injuries and/or illnesses, and psychosocial factors. When benefits outweighed barriers, the participants had greater success meeting their walking goals. IMPLICATIONS: Furthermore, the participants stated that making time, problem solving, internal motivation, and the support of family and/or friends were the most helpful factors in achieving their walking goals.