Diaphragmatic Breathing Exercises in Total Knee Arthroplasty Patients

Study Overview
=================
Brief Summary
-----------------
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.

Detailed Description
-----------------
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).

Official Title
-----------------
Diaphragmatic Breathing Exercises As An Analgesia Adjunct in Total Knee Arthroplasty Patients in the Perioperative Period

Conditions
-----------------
Anesthesia and Analgesia

Intervention / Treatment
-----------------
* Behavioral: Diaphragmatic Breathing


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients (participants) undergoing total knee arthroplasty with a continuous peripheral nerve block catheter Exclusion Criteria: Inability to perform or learn diaphragmatic breathing exercises or do not wish to participate in diaphragmatic breathing or study protocol Pregnant patients Patients without continuous peripheral nerve block catheter

Ages Eligible for Study
-----------------
Minimum Age: 50 Years
Maximum Age: 90 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br>Retrospective review of patients (participants) with standard analgesia post total knee arthroplasty | |
| Diaphragmatic Breathing<br>Intervention: Participants will perform diaphragmatic breathing exercises postoperatively as part of their multi-modal pain regimen. | Behavioral: Diaphragmatic Breathing<br>* Simple diaphragmatic breathing exercise<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | 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 | 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 |