Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Reinbacher, P.
The Implementation of a Multimodal Concept in the Treatment of Orthopaedic and Traumatological Patients
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2024. pp. 98
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Fischerauer Stefan Franz
- Leal Garcia Sabrina
- Scheipl Susanne
- Altmetrics:
- Abstract:
- Introduction: Austria's healthcare system grapples with the rising incidence of orthopaedic and traumatological conditions, impacting patient quality of life and daily functioning. Recognizing the body's complexity, traditional single treatments may fall short in ensuring comprehensive recovery. This dissertation explores a multimodal treatment approach for these patients, hypothesizing its efficacy in improving outcomes and satisfaction. Emphasizing analgesic medication, it evaluates practical implementation and effectiveness across various clinical contexts. The study underscores the importance of multimodal treatment and robust pain management in orthopaedics and traumatology, advocating for its widespread adoption in clinical practice. Methods: We conducted prospective cross-sectional observational research in the University Hospital's orthopaedics and traumatology department, encompassing the Urgent Care Centre (UCC) and the outpatient department (OPD). Pain intensity and physical function were assessed using the National Rating Scale for Pain (NRS) and Patient- Reported Outcomes Measurement Information System (PROMIS). Various questionnaires evaluated Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) factors. Post-consultation surveys evaluated patient satisfaction and perception of VUCA solutions. Another study evaluated the effectiveness of local and regional dexmedetomidine infiltration in patients undergoing total knee arthroplasty (TKA). Patients were randomly allocated to receive either local infiltration anaesthesia (LIA) or ultrasound-guided nerve blocks (USRA), to show an eventual difference between these two methods. Postoperative opioid consumption, pain scores, and complications were monitored. Follow-up assessments were conducted over a two- year period. Additionally, neuropathic pain assessment involved various questionnaires and examinations, alongside demographic and treatment-specific data collection. Results: This cross-sectional observational study investigated orthopaedic patients at a university hospital, focusing on demographics, pain, and VUCA factors. Patients visiting the Urgent Care Centre (UCC) were younger with a higher trauma rate, while those at the Outpatient Department (OPD) were older with more non-traumatic injuries. Patients at the OPD reported higher volatility, uncertainty, and ambiguity. Post-interventional surveys showed no significant differences in satisfaction between departments. For the patient’s satisfaction in doctor-patient consultation regarding the VUCA-factors of volability, understanding, clarity and adaptability no difference between the UCC and OPD was shown. Additionally, a study evaluating local dexmedetomidine infiltration in knee arthroplasty patients found higher opioid consumption in the infiltration group, with no adverse effects observed. Neuropathic pain assessment revealed significant differences between high-risk and low-risk groups postoperatively, with improvements in pain scores over time for both groups. A follow-up 6 weeks after the infiltration of dexmedetomidine revealed, that significant more patients in the group of local infiltration reported wellbeing, than in the group threated with ultrasound-guided regional anaesthesia. Conclusion: This study sheds light on enhancing doctor-patient communication, leading to increased therapy satisfaction. Significant advancements in local dexmedetomidine infiltration (LIA) during total knee arthroplasty (TKA) were revealed, showing reduced patient pain and opioid consumption compared to ultrasound-guided regional anaesthesia (USRA). Follow-up examinations uncovered nuanced dynamics, with LIA patients experiencing higher pain but improved well-being and similar functional outcomes postoperatively. Preoperative neuropathic pain assessment proved crucial, impacting TKA outcomes, underscoring the need for tailored treatments and further research to optimize patient selection criteria.