Application of fast track surgery in perioperative period of total knee arthroplasty

Objective To evaluate the effect of multi-modal analgesic on pain and functional exercise results of patients undergone Total Knee Arthroplasty (TKA) based on the fast track surgery (FTS). Methods Two hundred patients who undergone TKA from January to December 2018 were selected in Department of Joint Surgery. Patients included in odd-numbered months were assigned as the controlled group for routine perioperative nursing and patients included in double-numbered months were assigned to the observation group for multi-modal analgesia based on FTS, including preoperative propaganda and pain assessment, post-operative pain assessment, drug analgesia and observation, early eating, early exercise and other measures. Professional rehabilitation nurses guided and assisted by bedside and collected data. The pain degree (VAS score), the first time of straight-leg raising, the time of getting out of bed, ranges of joint flexion and HSS score were compared between the two groups. Results The VAS scores of the observation group at the time of returning to the room, 6 hours, 12 hours, 24 hours and 48 hours after operation were significantly lower than that of the controlled group. For the first time, the average time of straight leg elevation and the average time of getting out of bed activity in the observation group were 26.5(22.5,36.0)h and 38.0(24.0,49.0)h, respectively, earlier than those in the control group 49.0(31.0,58.0)h and 75.0(48.0,87.0)h. On the 3rd and 5th day after operation, the joint flexion degrees of the observation group were 83.0(65.0,98.0) degrees and 92.0(83.0,107.0) degrees, respectively, which were significantly higher than those of the control group 70.0(45.0,95.0) degrees and 81.0(64.0,102.0) degrees. The HSS scores of the observation group in 1 and 3 months after operation were 86.0(73.0,91.0) and 75.0(68.0,82.0), respectively, which were significantly higher than those of the control group in 1 and 3 months after operation 67.5(60.5,71.0) and 74.0(66.5,80.0). Conclusion Multi-modal analgesic nursing based on the concept of FTS can significantly reduce the degree of pain after total knee arthroplasty and improve the effect of functional exercise.