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Rationale: While total knee replacements (TKA) are one of the most commonly performed surgical procedures in the United States, this procedure can also be very painful. Postoperative mobilization and rehabilitation is vital to a patient's recovery, but inadequate pain control can impede patients' progress. Diaphragmatic breathing is an additional non-pharmacological and non-invasive tool with no adverse effects that could aid in recovery. This will serve as a pilot study for a possible larger controlled trials.
Study population: Patients (participants) undergoing total knee arthroplasty at Keck USC Hospital at HC3
Study methodology: Patients (participants) will be taught with the aide of a handout and instructional videos preoperatively and in the recovery room on how to perform diaphragmatic breathing exercises for post-operative pain control. Patient (participant) pain levels will be assessed using the visual analog scale (VAS). The investigators will then be comparing VAS scores and daily opioid doses (morphine equivalents) between the study group and a control group. The control group will include prior patients (participants) over the past year who underwent TKA at Keck Hospital and also had pain scores and opioid usage measured, but did not receive the breathing treatment.
Study endpoints: Endpoints will include: pain levels via VAS scale, anxiety levels via VAS scale, and opioid usage (morphine equivalents).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | Retrospective review of patients (participants) with standard analgesia post total knee arthroplasty | ||
| Diaphragmatic Breathing | Intervention: Participants will perform diaphragmatic breathing exercises postoperatively as part of their multi-modal pain regimen. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Diaphragmatic Breathing | Behavioral | Simple diaphragmatic breathing exercise |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain Level | Verbal Analog Pain Score - rate pain on 0-10 scale where 0=no pain, 10= worst possible pain | Prior to intervention |
| Opioid Usage (morphine equivalents) | Opioid Usage for pain | Prior to intervention |
| Anxiety Level | Verbal Analog Score -rate anxiety on 0-10 scale where 0= no anxiety, 10= worst possible anxiety | Prior to intervention |
| Pain Level | Verbal Analog Pain Score - rate pain on 0-10 scale where 0 =no pain, 10 = worst possible pain | 15 minutes after intervention |
| Opioid Usage (morphine equivalents) | Opioid Usage for pain | 15 minutes after intervention |
| Anxiety Level | Verbal Analog Score - rate anxiety on 0-10 scale where 0 =no anxiety, 10 = worst possible anxiety | 15 minutes after intervention |
| Pain Level | Verbal Analog Pain Score - rate pain on 0-10 scale where 0 =no pain, 10 = worst possible pain | 6 hours after intervention |
| Opioid Usage (morphine equivalents) | Opioid Usage for pain |
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Inclusion Criteria:
Exclusion Criteria:
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Patients (participants) undergoing total knee arthroplasty with placement of continuous peripheral nerve block catheter between the ages of 50-90 years of age at the Keck Hospital of USC who want to participate and consent to participate in the study. The control group will be made up of patients( 50-90 years of age) who underwent total knee arthroplasty with placement of a continuous peripheral nerve block catheter over the year prior, without participation in breathing exercises, at the Keck Hospital of USC.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Linda J Rever, MD | Contact | 3234427400 | rever@usc.edu |
| Name | Affiliation | Role |
|---|---|---|
| Linda J Rever, MD | University of Southern California | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Keck Hospital of USC | Recruiting | Los Angeles | California | 90033 | United States |
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| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| 6 hours after intervention |
| Anxiety Level | Verbal Analog Score- rate anxiety on 0-10 scale where 0 =no anxiety, 10 = worst possible anxiety | 6 hours after intervention |
| Pain Level | Verbal Analog Pain Score - rate pain on 0-10 scale where 0 =no pain, 10 = worst possible pain | 1 day after intervention |
| Opioid Usage (morphine equivalents) | Opioid Usage for pain | 1 day after intervention |
| Anxiety Level | Verbal Analog Score - rate anxiety on 0-10 scale where 0 = no anxiety, 10 = worst possible pain | 1 day after intervention |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |