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Luo Z, Zeng W, Chen X, Xiao Q, Chen A, Chen J, Wang H, Zhou Z. Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Int J Clin Pract 2024; 2024:3697846. [PMID: 38450292 PMCID: PMC10917473 DOI: 10.1155/2024/3697846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/26/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024] Open
Abstract
Background Local infiltration analgesia (LIA) provides postoperative analgesia for total knee arthroplasty (TKA). The purpose of this study was to evaluate the analgesic effect of a cocktail of ropivacaine, morphine, and Diprospan for TKA. Methods A total of 100 patients from September 2018 to February 2019 were randomized into 2 groups. Group A (control group, 50 patients) received LIA of ropivacaine alone (80 ml, 0.25% ropivacaine). Group B (LIA group, 50 patients) received an LIA cocktail of ropivacaine, morphine, and Diprospan (80 ml, 0.25% ropivacaine, 0.125 mg/ml morphine, and 62.5 μg/ml compound betamethasone). The primary outcomes were the levels of inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6), pain visual analog scale (VAS) scores, opioid consumption, range of motion (ROM), functional tests, and sleeping quality. The secondary outcomes were adverse events, satisfaction rates, HSS scores, and SF-12 scores. The longest follow-up was 2 years. Results The two groups showed no differences in terms of characteristics (P > 0.05). Group B had lower resting VAS pain scores (1.54 ± 0.60, 95% CI = 1.37 to 1.70 vs. 2.00 ± 0.63, 95% CI = 2.05 to 2.34) and active VAS pain scores (2.64 ± 0.62, 95% CI = 2.46 to 2.81 vs. 3.16 ± 0.75, 95% CI = 2.95 to 3.36) within 48 h postoperatively than Group A (P < 0.001), while none of the pain differences exceeded the minimal clinically important difference (MCID). Group B had significantly lower CRP levels (59.49 ± 13.01, 95% CI = 55.88 to 63.09 vs. 65.95 ± 14.41, 95% CI = 61.95 to 69.94) and IL-6 levels (44.11 ± 13.67, 95% CI = 40.32 to 47.89 vs. 60.72 ± 15.49, 95% CI = 56.42 to 65.01), lower opioid consumption (7.60 ± 11.10, 95% CI = 4.52 to 10.67 vs. 13.80 ± 14.68, 95% CI = 9.73 to 17.86), better ROM (110.20 ± 10.46, 95% CI = 107.30 to 113.09 vs. 105.30 ± 10.02, 95% CI = 102.52 to 108.07), better sleep quality (3.40 ± 1.03, 95% CI = 3.11 to 3.68 vs. 4.20 ± 1.06, 95% CI = 3.90 to 4.49), and higher satisfaction rates than Group A within 48 h postoperatively (P < 0.05). Adverse events, HSS scores, and SF-12 scores were not significantly different within 2 years postoperatively. Conclusions A cocktail of ropivacaine, morphine, and Diprospan prolongs the analgesic effect up to 48 h postoperatively. Although the small statistical benefit may not result in MCID, the LIA cocktail still reduces opioid consumption, results in better sleeping quality and faster rehabilitation, and does not increase adverse events. Therefore, cocktails of ropivacaine, morphine, and Diprospan have good application value for pain control in TKA. This trial is registered with ChiCTR1800018372.
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Affiliation(s)
- Zhenyu Luo
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Weinan Zeng
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xi Chen
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qiang Xiao
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Anjing Chen
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jiali Chen
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
- Department of Orthopedics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Haoyang Wang
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zongke Zhou
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
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Haynes N, Mclean C, Collins J, de Lima J. "Persistent Post-Operative Pain in Children - An Argument for a Transitional Pain Service in Pediatrics". Pain Manag Nurs 2022; 23:784-790. [PMID: 35931646 DOI: 10.1016/j.pmn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 05/15/2022] [Accepted: 06/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Persistent post-operative pain continues to occur in pediatric patients. Despite the growing amount of literature on causes, there is little discussion on treatment and prevention with a majority of studies focusing on specific surgeries. AIM The aim of this retrospective chart study is to identify risk factors and clinical features of persistent post-operative pain after any surgery in a pediatric quaternary complex pain service, describe the pharmacologic and non-pharmacologic management in children, and explore options to improve outcomes, in particular, the introduction of a transitional pain service. METHODS A retrospective chart review recorded demographics, gender, age, pain location and surgery type, treatment, and outcomes of 31 children identified through relevant registers over a 2-year period. RESULTS A total of 31 children were positively identified as having persistent post-operative pain and were seen in the complex pain clinic. Consistent with the literature, most cases represented neuropathic pain and persistent post-operative pain was most commonly seen after orthopedic surgery. All but four children had resolution of their pain after implementing the pain management plan. Management was characterized by early intervention, emphasis on non-pharmacologic strategies, and conservative use of opioids. CONCLUSIONS Identifying risk factors is useful, however putting strategies into place for prevention is necessary. Early intervention and the implementation of strategies before and immediately after are best provided by a transitional pain service.
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Affiliation(s)
- Natasha Haynes
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia.
| | - Catriona Mclean
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - John Collins
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia; Department of Paediatrics & Child Health, Sydney Medical School, Sydney, Australia
| | - Jonathan de Lima
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia
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He Y, Chen W, Qin L, Ma C, Tan G, Huang Y. The Intraoperative Adherence to Multimodal Analgesia of Anesthesiologists: A Retrospective Study. Pain Ther 2022; 11:575-589. [PMID: 35275381 PMCID: PMC9098701 DOI: 10.1007/s40122-022-00367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction Multimodal analgesia (MMA) is a critical component of enhanced recovery after surgery (ERAS). However, little research revealed its intraoperative implementation by anesthesiologists, who are on the front line defending against surgical pain. Therefore, the objective of our study is to assess the adherence of anesthesiologists to MMA comprehensively. Methods A retrospective study was conducted involving patients undergoing lung resection, knee arthroplasty, and radical mastectomy from pre/post-implementation year of MMA (Jan 1, 2013, to Dec 31, 2013, vs. 2019). Intraoperative analgesia regimens (analgesic mode) and hourly rated morphine milligram equivalents (MME) were compared. In addition, patient characteristics associated with continued opioid use after surgery, surgical types, and position level of anesthesiologists (attending-junior; above attending-senior) were also analyzed. Results After MMA initiation, the rate of multimodal analgesic regimen (mode ≥ 2) was significantly increased (post- vs. pre-implementation, 31.57 vs. 21.50%, p < 0.05). However, MME did not show significant difference (post- vs. pre-implementation, 0.402 vs. 0.456, p > 0.05). Patient-level predictors of persistent opioid use after surgery were not related to increased analgesic mode. Lung resection [coefficient, − 0.538; 95% confidence interval (CI), − 0.695 to − 0.383, p < 0.001] and knee arthroplasty (coefficient, − 1.143; 95% CI, − 1.366 to − 0.925, p < 0.001) discouraged multiple analgesic mode, while senior anesthesiologists (coefficient, 0.674; 95% CI 0.548–0.800, p < 0.001) promoted it. Conclusions Although anesthesiologists used more analgesics after promoting MMA, the “opioid-sparing” principle was not followed properly. The analgesic mode was not instructed by patients’ characteristics appropriately. In addition, surgeries with cumbersome preparation/process impeded the use of multiple analgesic modes, while senior anesthesiologists preferred multiple analgesic modes.
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Affiliation(s)
- Yumiao He
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
| | - Wei Chen
- Department of Gastroenterology, Beijing Friendship Hospital, National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Linan Qin
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chao Ma
- Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China
| | - Gang Tan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China. .,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, China.
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Rajamäki TJ, Moilanen T, Puolakka PA, Hietaharju A, Jämsen E. Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty? Clin Orthop Relat Res 2021; 479:2268-2280. [PMID: 33982976 PMCID: PMC8445559 DOI: 10.1097/corr.0000000000001793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mental health disorders can occur in patients with pain conditions, and there have been reports of an increased risk of persistent pain after THA and TKA among patients who have psychological distress. Persistent pain may result in the prolonged consumption of opioids and other analgesics, which may expose patients to adverse drug events and narcotic habituation or addiction. However, the degree to which preoperative use of antidepressants or benzodiazepines is associated with prolonged analgesic use after surgery is not well quantified. QUESTION/PURPOSES (1) Is the preoperative use of antidepressants or benzodiazepine medications associated with a greater postoperative use of opioids, NSAIDs, or acetaminophen? (2) Is the proportion of patients still using opioid analgesics 1 year after arthroplasty higher among patients who were taking antidepressants or benzodiazepine medications before surgery, after controlling for relevant confounding variables? (3) Does analgesic drug use decrease after surgery in patients with a history of antidepressant or benzodiazepine use? (4) Does the proportion of patients using antidepressants or benzodiazepines change after joint arthroplasty compared with before? METHODS Of the 10,138 patients who underwent hip arthroplasty and the 9930 patients who underwent knee arthroplasty at Coxa Hospital for Joint Replacement, Tampere, Finland, between 2002 and 2013, those who had primary joint arthroplasty for primary osteoarthritis (64% [6502 of 10,138] of patients with hip surgery and 82% [8099 of 9930] who had knee surgery) were considered potentially eligible. After exclusion of another 8% (845 of 10,138) and 13% (1308 of 9930) of patients because they had revision or another joint arthroplasty within 2 years of the index surgery, 56% (5657 of 10,138) of patients with hip arthroplasty and 68% (6791 of 9930) of patients with knee arthroplasty were included in this retrospective registry study. Patients who filled prescriptions for antidepressants or benzodiazepines were identified from a nationwide drug prescription register, and information on the filled prescriptions for opioids (mild and strong), NSAIDs, and acetaminophen were extracted from the same database. For the analyses, subgroups were created according to the status of benzodiazepine and antidepressant use during the 6 months before surgery. First, the proportions of patients who used opioids and any analgesics (that is, opioids, NSAIDs, or acetaminophen) were calculated. Then, multivariable logistic regression adjusted with age, gender, joint, Charlson Comorbidity Index, BMI, laterality (unilateral/same-day bilateral), and preoperative analgesic use was performed to calculate odds ratios for any analgesic use and opioid use 1 year postoperatively. Additionally, the proportion of patients who used antidepressants and benzodiazepines was calculated for 2 years before and 2 years after surgery. RESULTS At 1 year postoperatively, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for any analgesics than were patients without a history of antidepressant or benzodiazepine use (adjusted odds ratios 1.9 [95% confidence interval 1.6 to 2.2]; p < 0.001 and 1.8 [95% CI 1.6 to 2.0]; p < 0.001, respectively). Similarly, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for opioids than patients without a history of antidepressant or benzodiazepine use (adjusted ORs 2.1 [95% CI 1.7 to 2.7]; p < 0.001 and 2.0 [95% CI 1.6 to 2.4]; p < 0.001, respectively). Nevertheless, the proportion of patients who filled any analgesic prescription was smaller 1 year after surgery than preoperatively in patients with a history of antidepressant (42% [439 of 1038] versus 55% [568 of 1038]; p < 0.001) and/or benzodiazepine use (40% [801 of 2008] versus 55% [1098 of 2008]; p < 0.001). The proportion of patients who used antidepressants and/or benzodiazepines was essentially stable during the observation period. CONCLUSION Surgeons should be aware of the increased risk of prolonged opioid and other analgesic use after surgery among patients who were on preoperative antidepressant and/or benzodiazepine therapy, and they should have candid discussions with patients referred for elective joint arthroplasty about this possibility. Further studies are needed to identify the most effective methods to reduce prolonged postoperative opioid use among these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Tuomas J Rajamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - Pia A Puolakka
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Kim MS, Koh IJ, Choi KY, Yang SC, In Y. Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty. PLoS One 2021; 16:e0253641. [PMID: 34214098 PMCID: PMC8253394 DOI: 10.1371/journal.pone.0253641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following total knee arthroplasty (TKA). Methods Among 944 patients, 290 (30.7%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated. Results There was no significant difference in pain VAS score, WOMAC Pain and Function score, at each time point between before and after surgery (all p>0.05). Fifteen (9.8%) patients in the opioid group and six (4.4%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p>0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p>0.05). There was no difference in the incidence of side effects between the two groups (p>0.05). Conclusion Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA. Although large-scale randomized controlled trials are still required to further confirm the side effects of duloxetine, it can be considered as an alternative to opioid for postoperative pain control following TKA.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Eunpyeong-gu, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sung Cheol Yang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
- * E-mail:
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Abdeen A. CORR Insights®: Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women. Clin Orthop Relat Res 2020; 478:1466-1468. [PMID: 31794477 PMCID: PMC7310407 DOI: 10.1097/corr.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Ayesha Abdeen
- A. Abdeen, Assistant Professor, Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Rajamäki TJ, Puolakka PA, Hietaharju A, Moilanen T, Jämsen E. Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements. Arthritis Res Ther 2020; 22:89. [PMID: 32317021 PMCID: PMC7175525 DOI: 10.1186/s13075-020-02184-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors. Methods All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated. Results Of the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65–74.9 years (reference < 65), 1.1 (1.03–1.2); age > 75 years, 1.2 (1.1–1.3); female gender, 1.2 (1.1–1.3); BMI 30–34.9 kg/m2 (reference < 25 kg/m2), 1.1 (1.04–1.2); BMI > 35 kg/m2, 1.4 (1.3–1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1.2 (1.1–1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5–2.8), and knee surgery, 1.2 (1.1–1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77–0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions Obesity (especially BMI > 35 kg/m2) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.
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Affiliation(s)
| | - Pia A Puolakka
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland.,Department of Neurology, Tampere University Hospital, Tampere, Finland
| | | | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland.,Coxa, Hospital for Joint Replacement, Tampere, Finland
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9
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Foley C. Letter to the Editor on "Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia". J Arthroplasty 2019; 34:1297. [PMID: 30930151 DOI: 10.1016/j.arth.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/01/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Colin Foley
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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Abstract
Effective pain management for orthopaedic major joint replacement is key to achieving earlier recovery, better functioning, and high rates of patient satisfaction. In an effort to decrease opioid dependency, practitioners are turning to multimodal pain management, which involves the use of multiple analgesic agents and techniques. To utilize this technique, a patient's history of and preoperative consumption of medications to treat pain impacts the success of this regimen. Multimodal pain management involves the use of nonsteroidal anti-inflammatory drugs, acetaminophen, N-methyl-D-aspartate antagonists, gabapentin, serotonin inhibitors, regional techniques, and opioids as needed. It is necessary for the nurse to understand the mechanism of pain and how the multimodal adjuncts target the pain response to benefit the patient's perioperative course as well as his or her postoperative and discharge management.
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Croke L. Strategies to address the U.S. opioid crisis in the perioperative setting. AORN J 2019; 109:P7-P10. [PMID: 30811575 DOI: 10.1002/aorn.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- Matthew Corriere
- Department of Surgery, Section of Vascular Surgery Center for Health Outcomes and Policy; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor Michigan, MI, USA
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Jiranek WA. Introduction: How Should the Joint Surgeon Respond to the Opioid Crisis? J Arthroplasty 2018; 33:3371. [PMID: 30177301 DOI: 10.1016/j.arth.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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