This randomized controlled trial aims to evaluate the effects of stress ball use and breathing exercises on procedural pain and vital signs during drain removal in patients undergoing total knee arthroplasty. Although drain removal is a short procedure, it is often associated with sudden and intense pain and may trigger physiological stress responses such as increased heart rate, blood pressure, and respiratory rate.

A total of 105 patients will be randomly assigned to three groups: stress ball group, breathing exercise group, and standard care group. The interventions will be applied starting one minute before drain removal, continuing throughout the procedure, and for two minutes afterward.

Pain levels will be assessed using the Numeric Rating Scale (NRS), and vital signs (heart rate, blood pressure, respiratory rate, and oxygen saturation) will be measured at predefined time points before, during, and after the procedure. The findings of this study are expected to provide evidence on the effectiveness of simple, non-pharmacological interventions in reducing procedural pain and improving physiological stability during drain removal

Inclusion Criteria:

• Adults aged 18 years and older undergoing primary total knee arthroplasty
• Patients with a surgical drain in place and scheduled for drain removal in the postoperative period
• Able to provide informed consent
• Able to communicate and understand instructions

Exclusion Criteria:

• Patients with chronic pain syndromes or regular opioid use
• Patients with cognitive impairment, delirium, or communication difficulties
• Patients with contraindications to drain removal (e.g., active bleeding, hemodynamic instability)
• Patients with neurological conditions affecting pain perception