Affiliations: [a] Southern New England Rehabilitation Center, Providence, RI 02907, USA | [b] Boston University Medical Center, Department of Physical Medicine and Rehabilitation, Boston University, Boston, MA, USA | [c] Department of Orthopedics and Rehabilitation, Brown University, Providence, RI, USA | [d] Tufts University, Medford, MA, USA
Correspondence:
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Address for correspondence: Dr. Jon Mukand, Southern New England Rehabilitation Center, 21 Peace St., Providence, RI 02907, USA. Tel.: +1 401 456 4500; Fax: +1 401 456 4519
Abstract: Objective:To evaluate the efficacy of pain management in a clinical pathway for rehabilitation after hip and knee arthroplasty, in which scheduled medications are rapidly tapered and prn medications are continued throughout the inpatient stay. Study design:A prospective cross-sectional study. Setting:General rehabilitation unit of a regional acute rehabilitation center. Patients:Twenty-nine patients admitted consecutively to the rehabilitation unit in three months. Outcome measures:Number of pills/day of prn pain medication, pain scores at admission and discharge, frequency of constipation and nausea, Functional Independence Measure (FIM) gain, and length of stay (LOS). Results:For all patients, prn pain medication use was 2.4 pills/day/patient; the mean FIM gain was 22.1; and the average LOS was 9.8 days. In comparison to the Vicodin group, patients on Darvocet N-100 had significantly fewer requests for prn pain medication each day (3.1 vs. 1.1, p < 0.01), significantly better FIM gains better (18.9 vs. 24.1, p < 0.05), and fewer side effects (nausea and constipation). Conclusion:Choosing the right pain medication is imperative for achieving optimal efficiency in clinical pathways for orthopedic rehabilitation. In this pilot study, Darvocet N-100 is the preferred narcotic over codeine and its derivatives.
