1
|
Biesemans S, Schuermans B, Voets E, Feyen H. Efficacy of local infiltration analgesia on recovery after total hip arthroplasty using direct anterior approach under spinal anaesthesia: a randomized, double-blind, placebo-controlled trial. Acta Orthop Belg 2024; 90:11-15. [PMID: 38669643 DOI: 10.52628/90.1.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The utilization of local infiltration analgesia (LIA) is a common practice in total hip arthroplasty (THA) procedures to mitigate postoperative pain and diminish the necessity for opioids. However, contemporary literature reports conflicting results. Our working hypothesis was that LIA renders better postoperative VAS-scores and reduces the need for oral analgetics. We performed a randomized, double-blind, placebo-controlled trial aimed at examining the effectiveness of LIA in THA. A total of 90 patients were included for statistical analysis. Our primary endpoint was the Visual Analogue Scale, VAS, (0: no pain, 10: unbearable pain) preoperatively, at the 1st, 2nd, 3rd, 4th and 12th hour postoperative intervals and at discharge. Our secondary endpoints included the postoperative opioid consumption, as well as patient satisfaction at 2 and 6 weeks postoperatively, measured using the Numeric Rating Scale, NRS. LIA has a tendency for superior results regarding VAS- Scores at 3 and 4 hours postoperatively. There were no notable statistical distinctions observed in terms of patients necessitating rescue opioid consumption. Patient satisfaction using the NRS at both the 2-week and 6-week postoperatively did not differ significantly between both groups. The administration of LIA could offer advantages during the initial stages of postoperative recovery, which could be particularly valuable in rapid recovery programs.
Collapse
|
2
|
Kessler P. [Old and New Regional Anesthesia Procedures Under Review - Abdomen to Toe]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:159-179. [PMID: 38513641 DOI: 10.1055/a-2065-7660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Ultrasound (US) technology has significantly expanded the spectrum of regional anesthesiological procedures in recent years. Abdominal wall blocks are becoming an increasingly integral part of a multimodal postoperative pain concept after abdominal surgery, gynecological or urological interventions. Thoracic epidural analgesia remains the gold standard for extensive surgery. The requirement for rapid postoperative mobilization and discharge after lower extremity surgery has led to the abandonment of neuroaxial or plexus blocks in favor of selective, peripheral blocks such as the PENG block or adductor canal block. The following article is intended to show the reader the change in the use of regional anesthesiological procedures for abdominal wall and lower extremity blocks using selected blockages.
Collapse
|
3
|
Chang RWML, Nunes JC, Batista BB, Borborema TCVBD. A eficácia da infiltração periarticular anestésica na analgesia pós-operatória de artroplastia total do quadril. Rev Bras Ortop 2022; 58:252-256. [DOI: 10.1055/s-0042-1744294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/20/2022] [Indexed: 10/17/2022] Open
Abstract
Resumo
Objetivo Este estudo tem como objetivo avaliar a eficácia da técnica de infiltração periarticular do quadril no pós-operatório de artroplastia total do quadril.
Métodos Estudo clínico randomizado duplo-cego controlado. O estudo foi realizado nos pacientes com fratura de colo femoral ou osteoartrose de quadril, submetidos ao procedimento cirúrgico de artroplastia total do quadril em nossa instituição. A técnica de infiltração periarticular consistiu na aplicação da combinação de um anestésico (levobupivacaína) com um corticosteroide (dexametasona) nos tecidos ricos em nociceptores do quadril, após a colocação dos implantes ortopédicos. No grupo controle, foi realizada infiltração de soro fisiológico 0,9% nos mesmos tecidos. Após 24 e 48 horas do procedimento, foram avaliados os quesitos de dor, amplitude de movimentos, uso de analgésicos opióides, presença de efeitos adversos, período do início da deambulação e o tempo total de hospitalização.
Resultados Trinta e quatro pacientes foram estatisticamente avaliados no estudo. Foi observada uma redução no consumo de opioides entre 24 e 48 h no grupo experimental. Uma redução maior da pontuação de dor foi observada no grupo placebo.
Conclusão A infiltração periarticular anestésica como método de analgesia pós-operatória de artroplastia total do quadril, neste estudo, reduziu as taxas de consumo de opioides quando comparamos a evolução entre 24 e 48h. Não houve benefícios quanto às taxas de dor, mobilidade, tempo de internação ou intercorrências com este método.
Collapse
Affiliation(s)
- Rafael Wei Min Leal Chang
- Serviço de Ortopedia e Traumatologia do Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | - Juscimar Carneiro Nunes
- Faculdade de Medicina da UFAM e Universidade do Estado do Amazonas, Manaus, AM, Brasil
- Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | - Bruno Bellaguarda Batista
- Serviço de Ortopedia e Traumatologia do Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | | |
Collapse
|
4
|
Makino H, Seki S, Kamei K, Yahara Y, Kawaguchi Y. Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis. BMC Musculoskelet Disord 2022; 23:208. [PMID: 35246097 PMCID: PMC8897906 DOI: 10.1186/s12891-022-05158-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Severe postsurgical pain in posterior spinal fusion is common. Multimodality analgesia, including opioid-based patient-controlled analgesia (PCA), is commonly used, but opioid-related adverse events such as nausea and vomiting are sometimes a problem. We used a ropivacaine-epinephrine-dexamethasone mixture given as one-time local bilateral submyofascial injections at the operated levels added to conventional multimodality analgesia including PCA for postoperative pain control in one group of patients to confirm whether administration of this mixture reduced postoperative pain and opioid use status post posterior spinal fusion. Methods We retrospectively reviewed 67 consecutive patients who had undergone posterior fusion surgery for adolescent idiopathic scoliosis (AIS), 35 of whom were treated with conventional analgesia that consisted mainly of PCA (control group) and 32 of whom were treated with one-time submyofascial injections of a ropivacaine-epinephrine-dexamethasone mixture (submyofascial injection group) added to conventional multimodality analgesia. We compared postsurgical pain levels and the amount of opioid use over the first 48 h after surgery, as well as physical activity levels and adverse events 2 weeks after surgery. Results Postsurgical pain quantified by a numeric rating scale (1–10) in the submyofascial injection group was significantly lower than that in the control group. The amount of fentanyl use was significantly less in the submyofascial injection group at 24 h, 48 h, and all subsequent periods after surgery. In addition, Walking Recovery Time (WRT) defined as the number of days until the first event of ambulation was significantly less in the submyofascial injection group (3.3 d vs 4.1 d, P = 0.0007)). Laxative use was significantly less in the submyofascial injection group (0.3 times vs 1.3 times, P = 0.02). Conclusions One-time submyofascial injections at the operated levels with a ropivacaine-epinephrine-dexamethasone mixture after spinal fusion surgery reduced pain, opioid consumption, and opioid-related adverse events. This technique can contribute significantly to postoperative analgesia.
Collapse
Affiliation(s)
- Hiroto Makino
- Department of Orthopaedic Surgery, University of Toyama, Faculty of Medicine, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, Faculty of Medicine, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, University of Toyama, Faculty of Medicine, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yasuhito Yahara
- Department of Orthopaedic Surgery, University of Toyama, Faculty of Medicine, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, University of Toyama, Faculty of Medicine, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| |
Collapse
|
5
|
In Situ Gelling System for Sustained Intraarticular Delivery of Bupivacaine and Ketorolac in Sheep. Eur J Pharm Biopharm 2022; 174:35-46. [DOI: 10.1016/j.ejpb.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/18/2022]
|
6
|
Keeka M, Tran P, Tirosh O. The effect of a postoperative local anaesthetic pain pump in anterior total hip arthroplasty: a randomised control trial. Hip Int 2022; 33:360-364. [PMID: 35067080 DOI: 10.1177/11207000211069860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This project aims to determine if an addition of a local anaesthetic pain pump for 48 hours postoperatively effects verbal pain scores (VRS), opioid usage and length of stay (LOS) after anterior approach total hip arthroplasty (THA). METHODS This was a single-centre, single-surgeon, randomised, parallel-group study with balanced randomisation involving 108 patients. Randomisation and blinding were computer generated into 2 groups: local infiltration anaesthetic (LIA) only (Control Group) and LIA+ continuous postoperative infusion of local anaesthetic for 48 hours via a pain pump (Intervention Group). Postoperatively VRS (first 30 minutes, 1 hour, 2 hours and every 4 hours postoperatively up to 48 hours), opioid consumption, length of hospital admission, antiemetic and laxative usage were recorded. Statistical analysis utilised independent sample t-tests and repeated ANOVA. RESULTS Demographics and duration of surgery were similar across both cohorts. On average, compared to the control group, the intervention group required 2 mg less of opioid consumption over 48 hours (p = 0.41). VRS between the 2 groups showed no statistically significant difference. Scores ranged from 0 to 7, with an average of 1.28 in the intervention group and 1.29 in the control group (p = 0.31). 9 patients in the intervention group and 10 in the control group required antiemetics. There was no difference in the LOS or postoperative constipation. No complications or adverse events occurred. CONCLUSIONS Our study has shown the addition of a continuous postoperative infusion of local anaesthetic for 48 hours post an anterior THA had no effect on VRS, opioid consumption, LOS and antiemetic usage.
Collapse
Affiliation(s)
- Maya Keeka
- Department of Orthopaedics, Western Health, Footscray Hospital, Footscray, VIC, Australia
| | - Phong Tran
- Department of Orthopaedics, Western Health, Footscray Hospital, Footscray, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Australia
| | - Oren Tirosh
- Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
7
|
Panzenbeck P, von Keudell A, Joshi GP, Xu CX, Vlassakov K, Schreiber KL, Rathmell JP, Lirk P. Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis. Br J Anaesth 2021; 127:110-132. [PMID: 34147158 DOI: 10.1016/j.bja.2021.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND For most procedures, there is insufficient evidence to guide clinicians in the optimal timing of advanced analgesic methods, which should be based on the expected time course of acute postoperative pain severity and aimed at time points where basic analgesia has proven insufficient. METHODS We conducted a systematic search of the literature of analgesic trials for total hip arthroplasty (THA), extracting and pooling pain scores across studies, weighted for study size. Patients were grouped according to basic anaesthetic method used (general, spinal), and adjuvant analgesic interventions such as nerve blocks, local infiltration analgesia, and multimodal analgesia. Special consideration was given to high-risk populations such as chronic pain or opioid-dependent patients. RESULTS We identified and analysed 71 trials with 5973 patients and constructed pain trajectories from the available pain scores. In most patients undergoing THA under general anaesthesia on a basic analgesic regimen, postoperative acute pain recedes to a mild level (<4/10) by 4 h after surgery. We note substantial variability in pain intensity even in patients subjected to similar analgesic regimens. Chronic pain or opioid-dependent patients were most often actively excluded from studies, and never analysed separately. CONCLUSIONS We have demonstrated that it is feasible to construct procedure-specific pain curves to guide clinicians on the timing of advanced analgesic measures. Acute intense postoperative pain after THA should have resolved by 4-6 h after surgery in most patients. However, there is a substantial gap in knowledge on the management of patients with chronic pain and opioid-dependent patients.
Collapse
Affiliation(s)
- Paul Panzenbeck
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvind von Keudell
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, RX, USA
| | - Claire X Xu
- Department of Anesthesiology, Pain and Critical Care Medicine, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James P Rathmell
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
8
|
Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, Raeder J. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76:1082-1097. [PMID: 34015859 DOI: 10.1111/anae.15498] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/11/2022]
Abstract
The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.
Collapse
Affiliation(s)
- M Anger
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - T Valovska
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - H Beloeil
- Department of Anesthesiology, Henry Ford Health Systems, Wayne State School of Medicine, Detroit, MI, USA
| | - P Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Anaesthesiology, UZLeuven, Leuven, Belgium
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.,Division of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | | |
Collapse
|
9
|
Ramesh V, Aspari AR, Lakshman K, Chandrashekara NS, Paramashivaiah N. Postoperative Analgesia: Randomized Prospective Study Comparing Epidural Catheter Infusion and Continuous Wound Catheter Infusion of Local Anaesthesia. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
10
|
Qi BC, Yu J, Qiao WS. Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2020; 99:e21971. [PMID: 32899035 PMCID: PMC7478411 DOI: 10.1097/md.0000000000021971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. METHODS Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. RESULTS We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). CONCLUSIONS LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.
Collapse
Affiliation(s)
- Bao-chang Qi
- Department of Orthopedic Traumatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Jing Yu
- Department of The First Operating Room, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei-song Qiao
- Department of Orthopedic Traumatology, the First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
11
|
Peng XQ, Fei ZG, Sun CG, Zhou QJ. Efficacy and safety of local infiltration analgesia for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial. Medicine (Baltimore) 2020; 99:e20640. [PMID: 32481477 DOI: 10.1097/md.0000000000020640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Local infiltration analgesia (LIA) has become popular in postoperative pain relief after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The aim of this meta-analysis was to compare the efficacy and safety of LIA with intrathecal morphine and epidural analgesia after THA and TKA. METHODS A systematic article search was performed from PubMed, Embase, and Web of Science databases, up to February 21, 2019. The main outcomes included visual analog scale for assessment of pain, morphine equivalent consumption, length of hospital stay, and adverse events. The data were calculated using weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (95% CIs). RESULTS Eleven studies with a total of 707 patients met the inclusion criteria and were included in this meta-analysis. LIA provided better pain control than other 2 techniques at 24-hour (WMD = 10.61, 95% CI: 3.36-17.87; P = .004), 48-hour (WMD = 16.0, 95% CI: 8.87-23.13; P < .001), and 72-hour (WMD = 11.31, 95% CI: 3.78-18.83; P < .001). Moreover, LIA had similar morphine consumption and duration of hospital stay with intrathecal morphine and epidural analgesia. There was significantly lower incidence of adverse events with LIA than with the other 2 techniques. CONCLUSION LIA provided better postoperative pain control and less adverse events than intrathecal morphine and epidural analgesia after THA and TKA.
Collapse
Affiliation(s)
- Xiao-Qiang Peng
- Department of Orthopaedics, Funing People's Hospital, Jiangsu Province, China
| | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND In 2017, the average length of stay for primary hip replacement patients in Germany was 10.2 days. In our hospital, we have been able to reduce the length of stay in the last 10 years to an average of 3.8 days. OBJECTIVES Since September 2015, we offer the 'Hip-in-a-Day' program. This ultra-fast-track pathway consists of a hip arthroplasty procedure with the same day discharge of a well-prepared and explicitly selected patient with maximum intensive interdisciplinary care. The aim is to present the philosophy, treatment principles and daily routine during the pre-, intra- and postoperative phase. The challenges in the German health care system will be discussed. MATERIAL AND METHODS From September 2015 to November 2019, we operated on 97 patients (50 F: 47 M, ages: 43-77 years, ⌀ 55 years) who had undergone the Hip-in-a-Day pathway. All 97 patients received general anesthesia. Surgery was performed via the direct anterior approach (DAA) to the hip. Patients stayed in the day clinic less than 24 h after surgery. Of these, 30 patients were discharged on the day of surgery (⌀ 12 h stay), and 67 patients left the clinic the day after the operation (⌀ 20 h stay). Due to integrated health-care contracts with health-care providers, we were eligible to receive bundled reimbursement for this patient population. RESULTS All 97 patients completed the Ultra-Fast-Track pathway and were able to meet the discharge criteria within 24 h after surgery. 96 of the 97 (98.9%) patients were able to complete Hip-in-a-Day without readmission. One patient had to undergo revision surgery after 10 days due to cup loosening. All patients (100%) were very satisfied with the routine of the day and the fast discharge from the hospital. CONCLUSION The aim of Hip-in-a-Day is to discharge patients within 24 h after surgery. The implementation of the setup at the day clinic is intensive interdisciplinary care of all participating departments, as well as the three cornerstones of anesthesiological management, minimally invasive surgical techniques and patient compliance. In our clinic, ultra-fast-track arthroplasty is routinely feasible and has produced great patient satisfaction. Statutory health-care providers should include short-stay hip arthroplasty into the DRG system, so that this care concept can be reimbursed and practiced nationwide in Germany.
Collapse
Affiliation(s)
- Dr M Krieger
- Abteilung Orthopädische Chirurgie, Klinikum GPR Rüsselsheim, Rüsselsheim, Deutschland.,Abteilung Orthopädische Chirurgie, Emma Klinik Seligenstadt, Seligenstadt, Deutschland
| | - I Elias
- Abteilung Orthopädische Chirurgie, Klinikum GPR Rüsselsheim, Rüsselsheim, Deutschland. .,, August-Bebel-Straße 59, 65428, Rüsselsheim am Main, Deutschland.
| | - T Hartmann
- Abteilung Anästhesie, Klinikum GPR Rüsselsheim, Rüsselsheim, Deutschland
| |
Collapse
|
13
|
Cai AL, Liu SJ, Wu B, Liu G. Intrathecal versus local infiltration analgesia for pain control in total joint arthroplasty. J Orthop Surg Res 2020; 15:110. [PMID: 32188483 PMCID: PMC7079456 DOI: 10.1186/s13018-020-01627-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to assess the efficacy of intrathecal morphine (ITM) analgesia and local infiltration analgesia (LIA) for pain control in total joint arthroplasty (TJA). METHODS Embase, PubMed, the Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs). All RCTs were comparing intrathecal analgesia and local infiltration analgesia in TJA. Primary outcomes were the visual analog scale (VAS) score with rest or mobilization up to 72 h. Secondary outcomes were the total morphine consumption, length of hospital stay, and morphine-related complications. RESULTS Compared with the intrathecal analgesia group, the LIA group was associated with a reduction in VAS score with rest up to 72 h. Moreover, LIA was associated with a decrease in VAS score with mobilization at 6 h, 12 h, 48 h, and 72 h. Moreover, LIA significantly reduced total morphine consumption (weighted mean difference (WMD) = - 15.37, 95% CI - 22.64 to - 8.83, P = 0.000), length of hospital stay (WMD = - 1.39, 95% CI - 1.67 to - 1.11, P = 0.000), and morphine-related complications (nausea and pruritus). CONCLUSIONS Local infiltration provided superior analgesia and morphine-sparing effects within the first 72 h compared with ITM following TJA.
Collapse
Affiliation(s)
- Ai-Lan Cai
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Sheng-Jie Liu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Bin Wu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China
| | - Geng Liu
- Anesthesiology Department, Liaocheng People's Hospital, No.67 DongChang West Road, Liaocheng, 252000, Shandong, China.
| |
Collapse
|
14
|
Peng J, Liu C, Liu J, Wang Y, Lu X, Sun H, Yu Y, Gao S, Zhang S. HYR-PB21-LA, a potential extended-release bupivacaine formulation, produces long-lasting local anesthesia in rats and guinea pigs. Reg Anesth Pain Med 2020; 45:367-372. [PMID: 32170037 DOI: 10.1136/rapm-2019-100730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Effective postoperative pain management plays a key role in enhancing recovery of patients after surgery. Bupivacaine hydrochloride is one of the most commonly local anesthetics used for the postoperative pain control. However, the relatively short anesthesia duration of bupivacaine preparations limited their clinical application. METHODS Both guinea pig pin-prick study and rat tail-flick test were performed to evaluate the local anesthesia efficacy of HYR-PB21-LA, a new microparticle suspension injection of bupivacaine pamoate. RESULTS In the pin-prick test, the complete cutaneous trunci muscle reflex inhibitions were observed at 30 min in all treatment groups containing bupivacaine. In comparison with 6.7 mg/mL HYR-PB21-LA, both 10 and 20 mg/mL HYR-PB21-LA groups had significantly higher area under effect time curve (AUEC) values (p<0.001 and p<0.0001) and slower offset time (p<0.0001). Significantly higher AUEC (p<0.0001) and slower offset time (p<0.0001) were also found in 10 mg/mL HYR-PB21-LA treatment group compared with bupivacaine liposome injectable suspension (liposomal bupivacaine). In the rat tail-flick test, significantly increased local anesthesia effect was lasted for 5 hours after 2.5 mg/mL HYR-PB21-LA administration, which was fivefold longer than bupivacaine hydrochloride. The longer lasted efficacy of significantly increased local anesthesia was also observed in 5 mg/mLHYR-PB21-LA than those in liposomal bupivacaine (8 hour vs 1 hour). CONCLUSIONS The results demonstrated that the HYR-PB21-LA produced longer local anesthesia effect than current clinical preparations of bupivacaine in two animal models. These findings raise the potential clinical value of HYR-PB21-LA as a long-lasting local anesthesia for controlling postsurgical pain in humans.
Collapse
Affiliation(s)
- Jiashi Peng
- Department of Chemistry, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Chang Liu
- Department of Orthopedics, First Affiliated Hospital of Anhui Medical University Department of Medical Oncology, Hefei, Anhui, China
| | - Jingjing Liu
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China.,Anhui Province Key Laboratory of Druggability Evaluation for New Drugs, Hefei, Anhui, China
| | - Yihua Wang
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Xiaorong Lu
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China.,Anhui Province Key Laboratory of Druggability Evaluation for New Drugs, Hefei, Anhui, China
| | - Hongzhang Sun
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Yunxian Yu
- Department of Epidemiology, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shu Gao
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| | - Shanchun Zhang
- Department of Pharmacodynamics, Hefei Cosource Pharmaceutical Co., Ltd, Hefei, Anhui, China
| |
Collapse
|
15
|
von Lewinski G, Weber C, Tücking LR. [Pain concepts in fast-track endoprosthetics]. DER ORTHOPADE 2020; 49:313-317. [PMID: 32086550 DOI: 10.1007/s00132-020-03892-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An effective and safe pain management is nowadays a pivotal component of fast-track endoprosthetics. The analgesic strategies should be opioid-sparing whenever possible because opioids induce side-effects that reduce the well-being of patients and are even associated with a risk of falling. This is not compatible with a fast mobilization. In order to achieve this goal, multimodal pain concepts have proven to be suitable. Decentralized analgesia with epidural and regional catheters as well as the use of local infiltration anesthesia (LIA) can be used; however, catheters are also associated with a muscular deficit and the danger of falling. Therefore, in the fast-track concepts LIA has become established. With respect to knee endoprosthetics many studies have shown that LIA achieves at least comparable results or even superiority in comparison with the use of catheters. It represents a safe and effective procedure with respect to postoperative analgesia and accelerated mobilization. A variety of protocols for the use of LIA can currently be found in the literature. In addition to analgesics the supportive administration of glucocorticoids is increasingly being used, which also reduce pain due to the anti-inflammatory effect; however, regarding this aspect relatively few prospective randomized studies in comparison to LIA are available in the literature.
Collapse
Affiliation(s)
- G von Lewinski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland.
| | - C Weber
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Hannover, Deutschland
| | - L-R Tücking
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Hannover, Deutschland
| |
Collapse
|
16
|
Tan NL, Gotmaker R, Barrington MJ. Impact of Local Infiltration Analgesia on the Quality of Recovery After Anterior Total Hip Arthroplasty: A Randomized, Triple-Blind, Placebo-Controlled Trial. Anesth Analg 2019; 129:1715-1722. [PMID: 31743193 DOI: 10.1213/ane.0000000000004255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Local infiltration analgesia (LIA) is commonly used in anterior total hip arthroplasty (THA) surgery; however, evidence for its efficacy is lacking. We hypothesized that LIA with 0.2% ropivacaine when compared with injection of placebo (0.9% saline) would improve patient quality of recovery on postoperative day (POD) 1, as measured by the Quality of Recovery-15 (QoR-15) score. METHODS Patients scheduled to have a primary unilateral anterior THA with a single surgeon in a tertiary level metropolitan hospital were randomized to receive LIA with either 2.5 mL/kg of 0.2% ropivacaine or 0.9% saline as placebo. Patients and clinical and study personnel were blinded to group allocation. Perioperative care was standardized and this included spinal anesthesia and oral multimodal analgesia. The primary outcome was a multidimensional (pain, physical comfort, physical independence, emotions, and psychological support) patient-reported quality of recovery scale, QoR-15, measured on POD 1. RESULTS One hundred sixty patients were randomized; 6 patients were withdrawn after randomization and 2 patients had incomplete outcome data. The intention-to-treat analysis included 152 patients. The median (interquartile range [IQR]) QoR-15 score on POD 1 of the ropivacaine group was 119.5 (102-124), compared with the placebo group which had a median (IQR) of 115 (98-126). The median difference of 2 (95% confidence interval [CI], -4 to 7; P = .56) was not statistically or clinically significant. An as-per-protocol sensitivity analysis of 146 patients who received spinal anesthesia without general anesthesia, and the allocated intervention, also showed no evidence of a significant difference between groups. Secondary outcomes (worst pain numerical rating scale at rest and with movement on POD 1, opioid consumption on PODs 1 and 2, mobilization on POD 1, Brief Pain Inventory severity and interference on POD 90, and length of stay) were similar in both groups. CONCLUSIONS LIA with 0.2% ropivacaine when compared with 0.9% saline as placebo did not improve quality of recovery 1 day after anterior THA.
Collapse
Affiliation(s)
- Nicole L Tan
- From the Department of Anaesthesia, Critical Care Institute, Epworth HealthCare, Melbourne, Australia
- Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Robert Gotmaker
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Michael J Barrington
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| |
Collapse
|
17
|
Sica A, Casale B, Dato MTD, Calogero A, Spada A, Sagnelli C, Santagata M, Buonavolontà P, Fiorelli A, Salzano A, Dodaro CA, Martinelli E, Saracco E, Troiani T, Tammaro D, Ciardiello F, Papa A. Cancer- and Non-cancer Related Chronic Pain: From the Physiopathological Basics to Management. Open Med (Wars) 2019; 14:761-766. [PMID: 31637307 PMCID: PMC6795027 DOI: 10.1515/med-2019-0088] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
The prevalence of chronic pain is between 33% to 64% and is due to cancer pain, but it has also been observed in non-cancer patients. Chronic pain is associated with lower quality of life and higher psychological distress and depressive/anxiety disorders in patients without a history of disorder. In this study we evaluated in clinical practice the effectiveness of the intrathecal pump in 140 patients who underwent pain therapy at our Center. These patients were consecutively enrolled from January 2010 to July 2018. Follow-up was carried out over these eight years regarding the infusion modalities. Pain relief was obtained in 71 (50,7%) patients out of the 140 that experienced satisfactory pain control globally. Intrathecal therapy is one of the best options for chronic severe refractory pain. The greatest advantage of this therapy is due to the possibility of treating the pain with minimal dosages of the drug, avoiding the appearance of troublesome side effects.
Collapse
Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Beniamino Casale
- Department of Pneumology and Tisiology, AO Dei Colli - V. Monaldi, Naples, Italy
| | | | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Spada
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santagata
- Multidisciplinary Department of Medical Surgery and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Salzano
- Pain Department, AO Dei Colli - V. Monaldi, Naples, Italy
| | - Concetta Anna Dodaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Erika Martinelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Teresa Troiani
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dario Tammaro
- Pain Department, AO Dei Colli - V. Monaldi, Naples, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alfonso Papa
- Pain Department, AO Dei Colli - V. Monaldi, Naples, Italy
| |
Collapse
|
18
|
Effect of Methylprednisolone on Pain Management in Total Knee or Hip Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin J Pain 2019; 34:967-974. [PMID: 29595528 DOI: 10.1097/ajp.0000000000000614] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Total joint arthroplasty (TJA) has been reported to be a successful strategy for patients with advanced osteoarthritis; however, early postoperative pain has become an unresolved issue. Perioperative methylprednisolone (MP) administration in TJA is an important and controversial topic. This study was conducted to assess the efficacy and safety of MP for pain management after total knee or hip arthroplasty (TKA/THA). MATERIALS AND METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials comparing MP versus placebo for patients undergoing TKA/THA. Related indicators that reflected the efficacy and safety for pain management were evaluated by meta-analysis. RESULTS Six randomized controlled trials involving a total of 350 patients met the inclusion criteria. The outcomes showed that intravenous MP significantly reduced pain scores at 6 and 24 hours during activity after TKA and THA but local use of MP had no clear benefit in reducing pain scores compared with the control group. There was no significant difference in VAS at 24 hours at rest and 48 hours during activity after TKA and THA. In addition, MP was associated with a reduction of morphine consumption at 24 hours after TKA. Furthermore, patients receiving MP had an obvious inflammatory control and improving postoperative nausea and vomiting and the use of MP was not associated with a significant increase in the risk of complications. There was no significant difference in the range of knee motion and length of hospital stay in both groups. CONCLUSIONS This study showed that intravenous MP significantly alleviated early postoperative pain and the incidence of postoperative nausea and vomiting after TKA and THA. For safety, intravenous MP as a promising strategy in rapid recovery to TJA.
Collapse
|
19
|
Geisler A, Dahl JB, Thybo KH, Pedersen TH, Jørgensen ML, Hansen D, Schulze LK, Persson EI, Mathiesen O. Pain management after total hip arthroplasty at five different Danish hospitals: A prospective, observational cohort study of 501 patients. Acta Anaesthesiol Scand 2019; 63:923-930. [PMID: 30883668 DOI: 10.1111/aas.13349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The available literature does not present a "gold standard" for post-operative pain treatment after total hip arthroplasty (THA). The aim of this prospective observational study was to explore and document post-operative pain treatment, including outcomes, in a large cohort of patients undergoing THA at five different Danish hospitals. METHODS This prospective, multicentre, observational cohort study of 501 THA patients was performed at five different hospitals in the Capital Region and at the Region Zealand in Denmark, from April 2014 to April 2016. The study had two co-primary outcomes: Pain during mobilisation at 6 hours post-operatively (numeric rating scale [NRS] [0-10]) and morphine consumption 0-24 hours post-operatively. RESULTS A large variety of analgesic treatments were used at the included hospitals and none of the hospitals used the same non-opioid basic analgesic regimen. For all patients at all hospitals, the NRS-pain level during mobilisation at 6 hours was 5 (3-6), (median [interquartile range]) and the 24-hour intravenous morphine (eqv) consumption was 25 mg (18-35). Although some statistically significant differences between hospitals were found for morphine use, no non-opioid analgesic regimen demonstrated consistent clinically relevant superior efficacy. In general, pain levels at rest were low to moderate and pain during mobilisation was moderate. CONCLUSIONS Analgesic treatment routines differed between hospitals. Pain levels, however, did not differ substantially and were in general low at rest and moderate during mobilisation. No non-opioid analgesic treatment demonstrated consistent analgesic superiority.
Collapse
Affiliation(s)
- Anja Geisler
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
- Department of Anaesthesiology, Centre of Head and Orthopaedics Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Jørgen B. Dahl
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Kasper H. Thybo
- Department of Anaesthesiology Næstved Hospital Næstved Denmark
| | - Tim H. Pedersen
- Department of Orthopedics Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | | | - Dina Hansen
- Department of Orthopedics Nykøbing Falster Hospital Nykøbing Falster Denmark
| | | | - Eva I. Persson
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
| | - Ole Mathiesen
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
| |
Collapse
|
20
|
Zeng Y, Wan J, Ren H, Lu J, Zhong F, Deng S. The influences of anesthesia methods on some complications after orthopedic surgery: a Bayesian network meta-analysis. BMC Anesthesiol 2019; 19:49. [PMID: 30967113 PMCID: PMC6456996 DOI: 10.1186/s12871-019-0701-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Although several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery. Methods According to the searching strategy, anesthesia associated studies in orthopedic surgery were screened from Pubmed, Embase, and the Cochrane Library up to Mar. 10th, 2018. Then, complications and demographic data were extracted and quality of studies was assessed using Cochrane Collaboration recommendations. ADDIS software was used to perform the network meta-analysis. Pooled effect size was calculated using random effective model or consistency model, and presented with odds ratio (OR) and 95% confidence interval (CI). Results According to the selective criteria, a total of 23 studies with 2393 patients were enrolled in this study. Quality assessment revealed all studies had an ordinary quality. Network meta-analyses revealed that nerve block analgesia (NBA) presented a lower effect on the occurrence of post-operative nausea or vomiting (PONV; OR = 0.17, 95% CI: 0.06–0.39) and urine retention (OR = 0.07, 95% CI: 0.01–0.37) compared with epidural anesthesia (EA). Interscalene block (ISB) and local infiltration analgesia (LIA) could significantly reduce the occurrence of back pain compared with EA (OR = 0.00, 95% CI = 0.00–0.30; OR = 0.00, 95% CI = 0.00–0.25). Conclusion NBA presented an effective role in reliving the occurrence of PONV and urine retention, and ISB and LIA relieved the back pain compared with EA after orthopedic surgery.
Collapse
Affiliation(s)
- Yuqing Zeng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China.,Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Junming Wan
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Haiyong Ren
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jianwei Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fuhua Zhong
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shu Deng
- Department of Hematology, The First Affliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang Province, People's Republic of China.
| |
Collapse
|
21
|
Aubrun F, Baillard C, Beuscart JB, Billard V, Boddaert J, Boulanger É, Dufeu N, Friggeri A, Khiami F, Salmon PK, Merloz P, Minville V, Molliex S, Mouchoux C, Pain L, Piriou V, Raux M, Servin F. Recommandation sur l’anesthésie du sujet âgé : l’exemple de fracture de l’extrémité supérieure du fémur. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
22
|
Soffin EM, Gibbons MM, Ko CY, Kates SL, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Anesth Analg 2019; 128:454-465. [DOI: 10.1213/ane.0000000000003663] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
23
|
Smith NK, Demaria S, Katz D, Tabrizian P, Schwartz M, Miller JC, Hill B, Cardieri B, Kim SJ, Zerillo J. Intrathecal Morphine Administration Does Not Affect Survival After Liver Resection for Hepatocellular Carcinoma. Semin Cardiothorac Vasc Anesth 2019; 23:309-318. [DOI: 10.1177/1089253219832647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction. Opioids may influence tumor recurrence and cancer-free survival in hepatocellular carcinoma (HCC). The relationship between intrathecal morphine administration, tumor recurrence, and patient survival after hepatectomy for HCC is unknown. Patients and Methods. This single-center, retrospective study included 1837 liver resections between July 2002 and December 2012; 410 cases were incorporated in the final univariate and multivariate analysis. Confirmatory propensity matching yielded 65 matched pairs (intrathecal morphine vs none). Primary outcomes were recurrence of HCC and survival. Secondary outcomes included characterization of factors associated with recurrence and survival. Results. Groups were similar except for increased coronary artery disease in the no intrathecal morphine group. All patients received volatile anesthesia. Compared with no intrathecal morphine (N = 307), intrathecal morphine (N = 103) was associated with decreased intraoperative intravenous morphine administration (median difference = 12.5 mg; 95% confidence interval [CI] = 5-20 mg). There was no difference in blood loss, transfusion, 3- or 5-year survival, or recurrence in the univariate analysis. Multivariate analysis identified covariates that significantly correlated with 5-year survival: intrathecal morphine (hazard ratio [HR] = 0.527, 95% CI = 0.296-0.939), lesion diameter (HR = 1.099, 95% CI = 1.060-1.141), vascular invasion (HR = 1.658, 95% CI = 1.178-2.334), and satellite lesions (HR = 2.238, 95% CI = 1.447-3.463). Survival analysis on the propensity-matched pairs did not demonstrate a difference in 5-year recurrence or survival. Discussion and Conclusion. Multivariate analysis revealed a significant association between intrathecal morphine and 5-year survival. This association did not persist after propensity matching. The association between intrathecal morphine and HCC recurrence and survival remains unclear and prospective work is necessary to determine whether an association exists.
Collapse
Affiliation(s)
| | - Samuel Demaria
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Katz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Myron Schwartz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bryan Hill
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Sang J. Kim
- Hospital for Special Surgery, New York, NY, USA
| | - Jeron Zerillo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
24
|
Lee DK, Bang S, Lee S. Anesthetic considerations for surgical treatment of geriatric hip fracture. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seunguk Bang
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Srampickal GM, Jacob KM, Kandoth JJ, Yadev BK, Palraj T, Oommen AT, George SP, Poonnoose PM. How effective is periarticular drug infiltration in providing pain relief and early functional outcome following total hip arthroplasty? J Clin Orthop Trauma 2019; 10:550-554. [PMID: 31061588 PMCID: PMC6492212 DOI: 10.1016/j.jcot.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED The aim of the study was to compare the efficacy of periarticular injection of a cocktail of analgesic drugs (PIC) with epidural infiltration (EA), in providing postoperative pain relief and early functional improvement following Total Hip Arthroplasty (THA). METHODS 50 patients undergoing unilateral THA were randomized to receive either EA or PIC for postoperative pain control. Postoperative pain relief, as determined by the visual analogue scale (VAS), functional recovery and side effects related to EA and PIC were assessed. RESULTS PIC resulted in significantly lower VAS scores [0.48(0.71) vs 3.04(2.07)] in the first 24 h after surgery [mean (SD)], when compared to EA. The pain relief continued to be significantly lower even on the 10th postoperative day. Functional recovery was significantly better in the PIC group, with patients being able to walk longer distances and climb steps more quickly following THA. EA, unlike PIC was associated with side effects like nausea, vomiting, motor weakness, back pain and urinary retention. The overall satisfaction rate with treatment was significantly better in PIC group (9.04/10) than those who received EA (7.76/10). CONCLUSION PIC provides significantly better pain control and functional recovery in the early postoperative period, with less side effects when compared with EA. PIC should be the choice for pain control following THA.
Collapse
Affiliation(s)
| | - Korula Mani Jacob
- Department of Orthopedics Unit II, Christian Medical College, Vellore, TN, 632004, India
| | - Jacob Joe Kandoth
- Department of Orthopedics Unit II, Christian Medical College, Vellore, TN, 632004, India
| | - Bijesh Kumar Yadev
- Department of Biostatistics, Christian Medical College, Vellore, 632004, India
| | - Tyagraj Palraj
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, 632004, India
| | - Anil Thomas Oommen
- Department of Orthopedics Unit II, Christian Medical College, Vellore, TN, 632004, India
| | - Sajan Philip George
- Department of Anaesthesia, Christian Medical College, Vellore, TN, 632004, India
| | - Pradeep Mathew Poonnoose
- Department of Orthopedics Unit II, Christian Medical College, Vellore, TN, 632004, India,Corresponding author.
| |
Collapse
|
26
|
Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin 2018; 36:403-415. [PMID: 30092937 DOI: 10.1016/j.anclin.2018.04.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Other techniques, such as selective obturator and/or lateral femoral cutaneous nerve blocks, represent alternatives. Newer approaches, such as quadratus lumborum block and local infiltration analgesia, require rigorous studies. To realize long-term outcome benefits, postoperative regional analgesia must be tailored to the individual patient and last longer.
Collapse
Affiliation(s)
- Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy.
| | - Valentina Bellini
- Department of Anesthesia and Pain Therapy, Parma University Hospital, Via Gramsci, 14, Parma 43126, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA
| |
Collapse
|
27
|
Sah AP, Liang K, Sclafani JA. Optimal Multimodal Analgesia Treatment Recommendations for Total Joint Arthroplasty. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.17.00137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
28
|
Cheah JW, Sing DC, Hansen EN, Aleshi P, Vail TP. Does Intrathecal Morphine in Spinal Anesthesia Have a Role in Modern Multimodal Analgesia for Primary Total Joint Arthroplasty? J Arthroplasty 2018; 33:1693-1698. [PMID: 29433962 DOI: 10.1016/j.arth.2018.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). METHODS We performed a retrospective study of primary TJA patients who underwent a standardized multimodal recovery pathway and received bupivacaine neuraxial anesthesia with ITM vs bupivacaine neuraxial anesthesia alone (control). RESULTS In total, 598 patients were identified (131 controls, 467 ITMs) with similar demographics. On postoperative day 0 (POD 0), ITM patients had significantly lower mean visual analog scale scores (1.5 ± 1.6 vs 2.5 ± 1.9, P < .001) and consumed less oral morphine equivalents (10.5 ± 25.4 vs 16.8 ± 27.2, P = .013). ITM patients walked further compared to controls by POD 1 (133.6 ± 159.6 vs 97.3 ± 141 m, P = .028) and were less likely to develop PONV during their entire hospital stay (38.5% vs 48.6%, P = .043). No significant differences were seen for total morphine equivalents consumption, rate of discharge to care facility, length of stay, and 90-day readmission rates. CONCLUSION ITM was associated with improved POD 0 pain scores and less initial oral/intravenous opioid consumption, which likely contributes to the subsequent improved mobilization and lower rates of PONV. In the setting of a modern regional anesthesia and multimodal analgesia recovery plan for TJA, ITM can still be considered for its benefits.
Collapse
Affiliation(s)
- Jonathan W Cheah
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, California
| | - David C Sing
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, California
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, California
| | - Pedram Aleshi
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco Medical Center, San Francisco, California
| | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, California
| |
Collapse
|
29
|
Bron JL, Verhart J, Sierevelt IN, De Vries D, Kingma HJ, Rademakers MV. No effect of double nerve block of the lateral cutaneous nerve and subcostal nerves in total hip arthroplasty. Acta Orthop 2018; 89:272-277. [PMID: 29493328 PMCID: PMC6055781 DOI: 10.1080/17453674.2018.1437951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of local infiltration anesthesia (LIA) has become one of the cornerstones of rapid recovery protocols in total knee arthroplasty patients during the past decade. In total hip arthroplasty (THR), however, the study results are more variable and LIA has therefore not yet been generally accepted. There is no consensus on which structure should be infiltrated and the cutaneous nerves are generally neglected. Hence, we hypothesized a pain-reducing effect of specifically blocking these nerves. Patients and methods - We performed a single-center randomized placebo-controlled trial in 162 subjects to evaluate the infiltration of the lateral cutaneous femoral and subcostal nerve with ropivacaine in patients undergoing total hip arthroplasty via a straight lateral approach. The primary endpoint was pain at rest after 24 hours. Patients were followed up to 6 weeks postoperatively. Results - After correction for multiple testing, no statistically significant differences in pain scores were found between the ropivacaine compared with the placebo group after surgery. In addition, no differences were observed in the use of escape pain medication, complications, and the length of hospital stay. Interpretation - We found no clinically meaningful differences in pain scores between placebo and ropivacaine patients in the postoperative period after THA performed via a straight lateral approach under spinal anesthesia and a multimodal pain regimen. Moreover, our primary endpoint, pain reduction after 24 hours, was not met. Further research should focus on the composition and volume of the LIA suspension, the optimal localization of the infiltration, and should be evaluated for every surgical approach separately.
Collapse
Affiliation(s)
- Johannes L Bron
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hoofdorp,Currently: Department of Orthopaedic Surgery, Antonius Hospital, Sneek, The Netherlands
| | - Jeanette Verhart
- Spaarne Gasthuis Academy (formerly: Lineaus Institute), Hoofddorp
| | | | - Dirk De Vries
- Department of Anaesthesiology, Spaarne Gasthuis Hoofddorp
| | - Hylke J Kingma
- Pharmacy Foundation of the Haarlem Hospitals (SAHZ), Haarlem
| | | |
Collapse
|
30
|
Etcheson JI, Gwam CU, George NE, Virani S, Mont MA, Delanois RE. Patients With Major Depressive Disorder Experience Increased Perception of Pain and Opioid Consumption Following Total Joint Arthroplasty. J Arthroplasty 2018; 33:997-1002. [PMID: 29129615 DOI: 10.1016/j.arth.2017.10.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pain in the immediate postoperative period following total joint arthroplasty is influenced by various patient factors, including major depressive disorder (MDD). Therefore, this study aimed to compare the patient perception of pain and opioid consumption between patients with and without MDD who received either a total knee arthroplasty (TKA) or total hip arthroplasty (THA). Specifically, we compared (1) pain intensity, (2) lengths of stay, (3) opioid consumption, and (4) patient perception of pain control. METHODS We reviewed our institutional Press Ganey database to identify patients with a diagnosis of MDD who received a THA (n = 48) and TKA (n = 68) between 2012 and 2016. An independent samples t-test and chi-square analyses were conducted to assess continuous and categorical variables, respectively. Analysis of covariance assessed the effects of depression on postoperative pain intensity. Mixed-design analysis of variance assessed the difference in opioid consumption between groups. RESULTS Patients with MDD who received THA or TKA demonstrated a higher mean pain intensity score when compared to those without MDD; however, this was not statistically different (235.6 vs 207.7; P = .264 and 214.8 vs 185.1; P = .055, respectively). Patients with MDD who received THA or TKA consumed more opioids when compared to those without MDD (P = .048 and P = .038, respectively). CONCLUSION Patients with MDD undergoing total joint arthroplasty consume more opioids compared to their matched cohort during the immediate postoperative period. Identifying patient-specific factors, such as MDD, could help arthroplasty surgeons modulate patients' course of recovery. These findings warrant more cooperation between arthroplasty surgeons and primary care providers to optimize outcome.
Collapse
Affiliation(s)
- Jennifer I Etcheson
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Chukwuweike U Gwam
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nicole E George
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sana Virani
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
31
|
Intraoperative Infiltration of Liposomal Bupivacaine vs Bupivacaine Hydrochloride for Pain Management in Primary Total Hip Arthroplasty: A Prospective Randomized Trial. J Arthroplasty 2018; 33:441-446. [PMID: 29033152 DOI: 10.1016/j.arth.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pain management after total hip arthroplasty is well studied. Nevertheless, there is no consensus regarding the "cocktail" to use in periarticular infiltration (PAI). Liposomal bupivacaine (LB) is a slow release local anesthetic that can be infiltrated during surgery. In this study, we compared LB to bupivacaine hydrochloride (HCL). METHODS Between September 2014 and March 2016, 181 patients were screened for this prospective randomized trial. A total of 107 patients were enrolled and studied. Patients were separated into LB and control groups. LB group (50) received PAI with LB and bupivacaine HCL with epinephrine and the control group (57) received PAI with bupivacaine HCL and epinephrine. Patient morphine equivalent consumption, pain score estimated on visual analog scale, time to first ambulation greater than 20 feet, time to discharge, drug-related side effects, and patient falls were documented. Data were collected up to 72 hours postoperation. RESULTS There was no significant difference in morphine equivalent consumption in any of the 12-hour time blocks, up to 72 hours. No patient falls were documented in either group. Time to first ambulation greater than 20 feet, ambulation same day as surgery, time to discharge, and drug-related side effects were not significantly different between groups. CONLCUSION Intraoperative PAI with LB did not result in significant differences in postoperative opioid consumption, pain scores, opioid-related side effects, time to first ambulation, and length of stay up to 72 hours following total hip arthroplasty compared to a control group.
Collapse
|
32
|
Korat PS, Kapupara PP. Local infiltration of the surgical wound with levobupivacaine, ibuprofen, and epinephrine in postoperative pain: An experimental study. Biomed Pharmacother 2017; 96:104-111. [DOI: 10.1016/j.biopha.2017.09.131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022] Open
|
33
|
Zhang X, Yang Q, Zhang Z. The efficiency and safety of local liposomal bupivacaine infiltration for pain control in total hip arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8433. [PMID: 29245214 PMCID: PMC5728829 DOI: 10.1097/md.0000000000008433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This meta-analysis aimed to compare the efficiency and safety of local liposomal bupivacaine infiltration and traditional cocktail analgesia for pain management in total hip arthroplasty (THA). METHODS PubMed, Embase, Web of science, Medline, and Cochrane library databases were systematically searched. INCLUSION CRITERIA Participants: patients planned for a THA with a diagnosis of hip osteoarthritis. INTERVENTIONS liposomal bupivacaine was administrated in the experimental groups for pain control. Comparisons: the control groups received local infiltration of traditional analgesics. OUTCOMES pain scores, opioids consumption, and postoperative complications among the patients. STUDY DESIGN randomized control trials (RCTs) and non-RCTs. Methodological Index for Non-Randomized Studies scale was used to assess the methodological quality of the included studies. Meta-analysis was conducted by Stata 11.0 software. Systematic review registration number is CRD42017120981. RESULTS Four articles involving 308 participants were included. Current meta-analysis revealed that there were significant differences regarding postoperative pain score at 12 hours (standard mean difference [SMD] = -0.496, 95% CI: -0.717 to -0.275, P = .000), 24 hours (SMD = -0.537, 95% CI: -0.760 to -0.313, P = .000), and 48 hours (SMD = -0.802, 95% CI: -1.029 to -0.576, P = .000). Liposomal bupivacaine intervention was found to significantly decrease opioid consumption at 12 hours (SMD = -0.544, 95% CI: -0.766 to -0.323, P = .000), 24 hours (SMD = -0.357, 95% CI: -0.577 to -0.138, P = .001), and 48 hours (SMD = -0.370, 95% CI: -0.589 to -0.151, P = .001). CONCLUSION Local liposomal bupivacaine infiltration could significantly reduce visual analogue scale (VAS) scores and opioid consumption within the first 48 hours following THA surgery. In addition, there was a decreased risk of nausea and vomiting in liposomal bupivacaine groups. The overall evidence level was low, which means that further research is likely to significantly alter confidence levels in the effect, as well as potentially changing the estimates. In any subsequent research, further studies should focus on the optimal dose of local anesthetics and the potential adverse side effects. In addition, surgeries that can improve pain relief and enable faster rehabilitation and earlier discharges should also be explored. Several potential limitations of this study should be noted. Four articles are included and the sample size in each trial is small. Some important outcome parameters such as range of motion were not fully described and could not be included in the meta-analysis. All included studies were retrospectives which may decrease evidence levels for the meta-analysis. The evidence quality for each outcome was low which may influence the results of the meta-analysis. Short-term follow-ups may lead to the underestimation of complications, such as neurotoxicity and cardiotoxicity. Publication bias is an inherent weakness that exists in all meta-analyses.
Collapse
|
34
|
Kuchálik J, Magnuson A, Lundin A, Gupta A. Local infiltration analgesia: a 2-year follow-up of patients undergoing total hip arthroplasty. J Anesth 2017; 31:837-845. [PMID: 28856511 PMCID: PMC5680378 DOI: 10.1007/s00540-017-2403-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/11/2017] [Indexed: 11/29/2022]
Abstract
Purpose Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA. Methods The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life–5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery. Results Pain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery. Conclusion Analysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.
Collapse
Affiliation(s)
- Ján Kuchálik
- Department of Anaesthesiology and Intensive Care, Institution for Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden
| | - Anders Lundin
- Department of Orthopaedic Surgery, Institution for Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Anil Gupta
- Department of Anaesthesiology and Intensive Care, Institution for Medicine and Health, Örebro University Hospital, Örebro, Sweden. .,Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna-Karolinska Institutet, Stockholm, 17176, Sweden.
| |
Collapse
|
35
|
Gao Z, Cui F, Cao X, Wang D, Li X, Li T. Local infiltration of the surgical wounds with levobupivacaine, dexibuprofen, and norepinephrine to reduce postoperative pain: A randomized, vehicle–controlled, and preclinical study. Biomed Pharmacother 2017; 92:459-467. [DOI: 10.1016/j.biopha.2017.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022] Open
|
36
|
Local infiltration analgesia or femoral nerve block for postoperative pain management in patients undergoing total hip arthroplasty. A randomized, double-blind study. Scand J Pain 2017; 16:223-230. [DOI: 10.1016/j.sjpain.2017.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
Abstract
Background and aims
Several methods for pain management following total hip arthroplasty (THA) have been described but the best postoperative pain management technique remains uncertain. We compared surgeon applied local infiltration analgesia (LIA) with anaesthesiologist performed femoral nerve block (FNB) using ultrasound. The primary aim was to assess pain intensity 24 h after THA.
Methods
In this randomized, double-blind study, 56 patients (ASA I-III) undergoing THA consented to participate. In Group FNB, patients received an ultrasound-guided femoral nerve block using 30 ml of ropivacaine 7.5 mg/ml (225 mg) while Group LIA received a similar volume of saline. Spinal anaesthesia was then performed and bupivacaine heavy, 3–3.5 ml injected depending on patient characteristics. During surgery, patients in Group LIA received a mixture of 300 mg (150 ml) ropivacaine, ketorolac 30 mg (1 ml) and adrenaline 0.5 mg (0.5 ml) (total volume 151.5 ml) peri-articularly and subcutaneously while Group FNB received 151.5 ml of saline peri-articularly in a systematic way by the surgeon. A multi-hole catheter was placed with the tip placed intra-articularly at the end of surgery in both groups. After 23 h, the LIA mixture consisting of 20 ml ropivacaine (7.5 mg/ml), ketorolac 30 mg (1 ml), adrenaline 0.1 mg (1 ml) (total volume 22 ml) was injected in Group LIA and the same volume of saline in Group FNB. Postoperative pain, analgesic consumption (postoperative and post-discharge), side effects, home discharge, quality of life and hip function were recorded, the latter up to 6 months after surgery.
Results
Postoperative pain intensity was significantly lower in Group LIA compared to Group FNB during mobilization at 24 h (primary endpoint), mean difference 1.8 NRS units (95% CI 0.7–2.9) (P = 0.006), at rest after 4 h (P = 0.029) and on standing after 24 (P = 0.0003) and 48 h (P = 0.043). Rescue morphine consumption was also significantly lower in Group LIA during 0–24, mean difference 13.5 mg (95% CI, 6.1–20.9) (P = 0.002) postoperatively. Motor block was greater at 6 h (P = 0.029) postoperatively in Group FNB. Two patients (one in each group) had persistent post-surgical pain (NRS > 3) at 3 months (3.6%) but none at 6 month. No other differences were found between the groups.
Conclusion
Local infiltration analgesia significantly reduces pain intensity on standing and mobilization, and rescue analgesic consumption compared to femoral nerve block without causing significant side effects. The superior analgesia in the LIA group may result from the secondary injection at 23 h postoperatively and needs to be furtherevaluated in future studies. No differences were found in home discharge, quality of life and hip dysfunction between the groups.
Implication
Local infiltration analgesia is the preferred method for postoperative pain management following THA compared to single-shot femoral nerve block.
© 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Collapse
|
37
|
Meng J, Li L. The efficiency and safety of dexamethasone for pain control in total joint arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e7126. [PMID: 28614232 PMCID: PMC5478317 DOI: 10.1097/md.0000000000007126] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to evaluate the efficiency and safety of dexamethasone administration in total knee and hip arthroplasties. METHODS Two researchers search the relevant studies independently including Embase (1980-017.04), PubMed (1966-017.04), ScienceDirect (1985-017.04), Web of Science (1950-2017.03), and Cochrane Library for potential relevant studies. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as risk difference (RD) with a 95% confidence intervals (CIs). For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with a 95% confidence intervals (CIs) was applied for assessment. Meta-analysis was performed using Stata 11.0 software. RESULTS Four randomized controlled trials (RCTs) including 361 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 12 hours (SMD = -0.579, 95% CI: -0.780 to -0.357, P = .000), 24 hours (SMD = -0.820, 95% CI: -1.036 to -0.604, P = .000), and 48 hours (SMD = -0.661, 95% CI: -1.149 to -0.172, P = .008). Dexamethasone was associated with a lower opioid consumption at 12 hours (SMD = -0.245, 95% CI: -0.465 to -0.025, P = .029), 24 hours (SMD = -0.285, 95% CI: -0.505 to -0.064, P = .011), and 48 hours (SMD = -0.989, 95% CI: -1.710 to -0.267, P = .007). CONCLUSION Dexamethasone could significantly reduce postoperative pain scores and opioid consumption within the 1st 48 hours following total joint arthroplasty (TJA). The overall evidence quality was moderate to low, further high-quality RCTs are needed to identify the optimal dose of dexamethasone for reducing pain after TJA.
Collapse
Affiliation(s)
| | - Lin Li
- Department of Joint Surgery, The First People's Hospital of Jining, Jining, Shandong, China
| |
Collapse
|
38
|
Kuchálik J, Magnuson A, Tina E, Gupta A. Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty? A randomized, double-blind study. BMC Anesthesiol 2017; 17:63. [PMID: 28468607 PMCID: PMC5415732 DOI: 10.1186/s12871-017-0354-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023] Open
Abstract
Background Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation. Methods This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro- and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively. Results There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups. Conclusion Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes. Trial registration EudraCT Number 2012-003875-20. Registered 3 December 2012
Collapse
Affiliation(s)
- J Kuchálik
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - E Tina
- Clinical Research Laboratory, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - A Gupta
- Perioperative Medicine and Intensive Care, Institution for Physiology and Pharmacology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden. .,Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.
| |
Collapse
|
39
|
Hayden JM, Oras J, Karlsson OI, Olausson KG, Thörn SE, Gupta A. Post-operative pain relief using local infiltration analgesia during open abdominal hysterectomy: a randomized, double-blind study. Acta Anaesthesiol Scand 2017; 61:539-548. [PMID: 28374466 DOI: 10.1111/aas.12883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/21/2017] [Accepted: 02/26/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Post-operative pain is common and often severe after open abdominal hysterectomy, and analgesic consumption high. This study assessed the efficacy of local infiltration analgesia (LIA) injected systematically into different tissues during surgery compared with saline on post-operative pain and analgesia. METHODS Fifty-nine patients were randomized to Group LIA (n = 29) consisting of 156 ml of a mixture of 0.2% ropivacaine + 30 mg ketorolac + 0.5 mg (5 ml) adrenaline, where the drugs were injected systematically in the operating site, around the proximal vagina, the ligaments, in the fascia and subcutaneously, or to saline and intravenous ketorolac, Group C (Control, n = 28), in a double-blind study. Post-operative pain, analgesic consumption, side-effects, and home discharge were analysed. RESULTS Median dose of rescue morphine given 0-24 h after surgery was significantly lower in group LIA (18 mg, IQR 5-25 mg) compared with group C (27 mg, IQR 15-43 mg, P = 0.028). Median time to first analgesic injection was significantly longer in group LIA (40 min, IQR 20-60 min) compared with group C (20 min, IQR 12-30 min, P = 0.009). NRS score was lower in the group LIA compared with group C in the direct post-operative period (0-2 h). No differences were found in post-operative side-effects or home discharge between the groups. DISCUSSION Systematically injected local infiltration analgesia for pain management was superior to saline in the primary endpoint, resulting in significantly lower rescue morphine requirements during 0-24 h, longer time to first analgesic request and lower early post-operative pain intensity.
Collapse
Affiliation(s)
- J. M. Hayden
- Department of Anesthesiology and Intensive Care; Institute of Clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. Oras
- Department of Anesthesiology and Intensive Care; Institute of Clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - O. I. Karlsson
- Department of Anesthesiology and Intensive Care; Institute of Clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K. G. Olausson
- Department of Anesthesiology and Intensive Care; Institute of Clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Thörn
- Department of Anesthesiology and Intensive Care; Institute of Clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - A. Gupta
- Institute of Physiology and Pharmacology; Karolinska Institutet, Karolinska University Hospital; Stockholm, Solna Sweden
| |
Collapse
|
40
|
Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial. Int J Surg 2017; 40:97-108. [PMID: 28254422 DOI: 10.1016/j.ijsu.2017.02.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty. METHODS We systemically searched electronic databases including Embase (1980-2016.7), Medline (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), web of science (1950-2016.7) and Cochrane Library for relevant articles. All calculation was carried out by Stata 11.0. RESULTS Four randomized controlled trials (RCTs) involving 242 patients met the inclusion criteria. The meta-analysis showed that there were significant differences in terms of postoperative pain scores at 24 h during rest (P = 0.008) and mobilization (P = 0.049) following total knee and hip arthroplasty. Significant difference was found regarding the incidence of nausea (P = 0.030), vomiting (P = 0.005), and pruritus (P = 0.000) between two groups. There was no significant difference between groups in terms of morphine equivalent consumption at postoperative 24 or 48 h. CONCLUSIONS Local infiltration analgesia (LIA) provided superior analgesic effects within the first 24 h compared to intrathecal morphine (ITM) following total knee and hip arthroplasty. There were fewer adverse effects in LIA. Doses of morphine consumption were similar in the two groups.
Collapse
|
41
|
Xu X, Wen H, Hu Y, Liu Z, Pan X. Efficacy of intra-articular magnesium for postoperative analgesia in total hip arthroplasty. Biomed Rep 2017; 6:232-236. [PMID: 28357078 DOI: 10.3892/br.2017.837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to compare the efficacy of intra-articular magnesium sulphate and a saline placebo for postoperative pain control following total hip arthroplasty (THA). Sixty patients underwent THA and were randomly allocated into two groups to receive intra-articular injections of either 10 ml magnesium sulphate (100 mg/ml; magnesium group, n=30) or 10 ml normal saline solution (control group, n=30). Postoperative analgesia was maintained by intravenous morphine injection. The outcome measurements were visual analogue score (VAS), morphine consumption and Harris hip score (HHS). The two groups were well matched. The outcome of VAS at rest was significantly lower at postoperative hours 6 and 12 in the magnesium group as compared with the control group, although the difference was insignificant preoperatively and at postoperative hours 2, 4, 24 and 48, and days 3, 7 and 14. This indicator during activity was also lower in the magnesium group at postoperative hour 24 than that of the control group, although the difference was insignificant preoperatively and at hour 48, and days 7 and 14. The consumption of morphine (the total quantity) at 0-6, 6-12 and 0-48 h in the magnesium group was significantly lower than in the control group, although no significant differences were observed at 12-24 and 24-48 h between the groups. The improvements of HHS from preoperative to postoperative scores were statistically significant, however, no significant differences were identified between groups. Thus, the findings indicate that intra-articular magnesium sulphate injections provided improved pain control and reduced the need for morphine when compared with a saline placebo following THA.
Collapse
Affiliation(s)
- Xinxian Xu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hong Wen
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuezheng Hu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhongtang Liu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaoyun Pan
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| |
Collapse
|
42
|
Srinivasan AK, Shrivastava D, Kurzweil RE, Weiss DA, Long CJ, Shukla AR. Port Site Local Anesthetic Infiltration Vs Single-dose Intrathecal Opioid Injection to Control Perioperative Pain in Children Undergoing Minimal Invasive Surgery: A Comparative Analysis. Urology 2016; 97:179-183. [PMID: 27450349 DOI: 10.1016/j.urology.2016.04.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the efficacy of the intrathecal opiate vs wound site local anesthetic infiltration for perioperative pain control during and after surgery in patients undergoing minimally invasive pediatric urologic procedures. METHODS Using an Institutional Review Board-approved registry database, we identified patients who underwent minimally invasive urologic procedures at our institution between 2009 and 2013. We collected all relevant preoperative variables and postoperative outcomes. Patients in intrathecal injection of opioids (ITO) group were matched with patients who received local anesthetic infiltration (LAI) based on age, diagnosis, and procedure. Perioperative analgesic requirements were converted to morphine equivalents standardized to body weight. Statistical analysis was performed using SPSS, and parametric comparisons were completed to determine difference in morphine equivalents between the 2 groups. RESULTS One hundred thirty children (78 girls and 52 boys) were included in our study. Sixty-six patients underwent ITO and 66 received LAI. Sixty-six patients underwent ureteral reimplantation, 60 underwent pyeloplasty, and 4 underwent nephrectomy. Ages ranged from 0.5 to 19.9 years. There was no significant difference in cumulative morphine equivalents or weight administered between the ITO and LAI groups for the total period of hospitalization (0.76 units vs 0.79 units, P > .05). Multivariate regression analysis predicted that older age corresponds to higher analgesic requirements. CONCLUSION ITO does not impact total analgesic requirements during the hospital stay compared to LAI following minimally invasive surgery. Considering the potential complications of ITO, LAI may be the preferred modality for pain management for minimally invasive surgery in children.
Collapse
Affiliation(s)
- Arun K Srinivasan
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Dhiren Shrivastava
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rebecca E Kurzweil
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dana A Weiss
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher J Long
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aseem R Shukla
- Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
43
|
Güler G, Atıcı Ş, Kurt E, Karaca S, Yılmazlar A. Current Approaches in Hip and Knee Arthroplasty Anaesthesia. Turk J Anaesthesiol Reanim 2016; 43:188-95. [PMID: 27366493 DOI: 10.5152/tjar.2015.26096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 01/19/2023] Open
Abstract
Risk assesment, preoperative drug regulation, the anesthesia and analgesia techniques are very important and the effectivity on success of surgery is great. So, these topics in arthroplasty were reviewed under current knowledge.
Collapse
Affiliation(s)
- Gülen Güler
- Department of Anaesthesiology and Reanimation, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Şebnem Atıcı
- Department of Anaesthesiology and Reanimation, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ercan Kurt
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy, Ankara, Turkey
| | - Saffet Karaca
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Aysun Yılmazlar
- Department of Anaesthesiology and Reanimation, Private Medicabil Hospital, Bursa, Turkey
| |
Collapse
|
44
|
|
45
|
Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study. INTERNATIONAL ORTHOPAEDICS 2016; 40:2255-2260. [DOI: 10.1007/s00264-016-3133-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/08/2016] [Indexed: 01/24/2023]
|
46
|
Jiménez-Almonte JH, Wyles CC, Wyles SP, Norambuena-Morales GA, Báez PJ, Murad MH, Sierra RJ. Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis. Clin Orthop Relat Res 2016; 474:495-516. [PMID: 26573322 PMCID: PMC4709309 DOI: 10.1007/s11999-015-4619-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/29/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. QUESTIONS/PURPOSES We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? METHODS We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA. A total of 35 RCTs at low risk of bias based on the recommended Cochrane Collaboration risk assessment tool were included in the network meta-analysis (2296 patients). Primary outcomes for this review were patient pain scores at rest and cumulative opioid consumption, both assessed at 24 hours after THA. Because of substantial heterogeneity (variation of outcomes between studies) across included trials, a random effect model for meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI. The gray literature was searched with the same inclusion criteria as published trials. Only one unpublished trial (published abstract) fulfilled our criteria and was included in this review. All other studies included in this systematic review were full published articles. Bayesian network meta-analysis included all RCTs that compared local infiltration analgesia or peripheral nerve blocks with placebo (or no intervention), epidural analgesia, and intrathecal morphine. RESULTS Compared with placebo, local infiltration analgesia reduced patient pain scores (WMD, -0.61; 95% CI, -0.97 to -0.24; p = 0.001) and opioid consumption (WMD, -7.16 mg; 95% CI, -11.98 to -2.35; p = 0.004). Peripheral nerve blocks did not result in lower pain scores or reduced opioid consumption compared with placebo (WMD, -0.43; 95% CI, -0.99 to 0.12; p = 0.12 and WMD, -3.14 mg, 95% CI, -11.30 to 5.02; p = 0.45). However, network meta-analysis comparing local infiltration analgesia with peripheral nerve blocks through common comparators showed no differences between postoperative pain scores (WMD, -0.36; 95% CI, -1.06 to 0.31) and opioid consumption (WMD, -4.59 mg; 95% CI, -9.35 to 0.17), although rank-order analysis found local infiltration analgesia to be ranked first in more simulations than peripheral nerve blocks, suggesting that it may be more effective. CONCLUSIONS Using the novel statistical network meta-analysis approach, we found no differences between local infiltration analgesia and peripheral nerve blocks in terms of analgesia or opioid consumption 24 hours after THA; there was a suggestion of a slight advantage to peripheral nerve blocks based on rank-order analysis, but the effect size in question is likely not large. Given the slight difference between interventions, clinicians may choose to focus on other factors such as cost and intervention-related complications when debating which analgesic treatment to use after THA. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
MESH Headings
- Analgesics, Opioid/therapeutic use
- Anesthesia, Local/adverse effects
- Anesthesia, Local/methods
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Arthroplasty, Replacement, Hip/adverse effects
- Chi-Square Distribution
- Hip Joint/surgery
- Humans
- Nerve Block/adverse effects
- Nerve Block/methods
- Odds Ratio
- Pain Management/adverse effects
- Pain Management/methods
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Peripheral Nerves/drug effects
- Randomized Controlled Trials as Topic
- Treatment Outcome
Collapse
Affiliation(s)
- José H Jiménez-Almonte
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
- Mayo Clinic Graduate School, Rochester, MN, USA
| | | | | | | | | | - Mohammad H Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|
47
|
Abstract
This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants). This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
| |
Collapse
|
48
|
Hofstad JK, Winther SB, Rian T, Foss OA, Husby OS, Wik TS. Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty. Acta Orthop 2015; 86:654-8. [PMID: 25997827 PMCID: PMC4750762 DOI: 10.3109/17453674.2015.1053775] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA. PATIENTS AND METHODS 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day. RESULTS The levels of pain during mobilization-both in the recovery unit and on the day after surgery-and consumption of opioids on the first postoperative day were similar in the 2 groups. INTERPRETATION LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.
Collapse
Affiliation(s)
| | - Siri B Winther
- Orthopedic Research Center, Department of Orthopaedic Surgery
| | - Torbjørn Rian
- Department of Anesthesiology, Trondheim University Hospital, Trondheim, Norway
| | - Olav A Foss
- Orthopedic Research Center, Department of Orthopaedic Surgery
| | - Otto S Husby
- Orthopedic Research Center, Department of Orthopaedic Surgery
| | - Tina S Wik
- Orthopedic Research Center, Department of Orthopaedic Surgery
| |
Collapse
|
49
|
Forrest P. Antibiotic prophylaxis for surgery: time to get our house in order. Anaesth Intensive Care 2015; 43:445-6. [PMID: 26099754 DOI: 10.1177/0310057x1504300403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
50
|
Abstract
PURPOSE OF REVIEW Pain following total knee arthroplasty is a challenging task for healthcare providers. Concurrently, fast recovery and early ambulation are required to regain function and to prevent postoperative complications. Ideal postoperative analgesia provides sufficient pain relief with minimal opioid consumption and preservation of motor strength. Regional analgesia techniques are broadly used to answer these expectations. Femoral nerve blocks are performed frequently but have suggested disadvantages, such as motor weakness. The use of lumbar epidurals is questioned because of the risk of epidural hematoma. Relatively new techniques, such as local infiltration analgesia or adductor canal blocks, are increasingly discussed. The present review discusses new findings and weight between known benefits and risks of all of these techniques for total knee arthroplasty. RECENT FINDINGS Femoral nerve blocks are the gold standard for total knee arthroplasty. The standard use of additional sciatic nerve blocks remains controversial. Lumbar epidurals possess an unfavourable risk/benefit ratio because of increased rate of epidural hematoma in orthopaedic patients and should be reserved for lower limb amputation; peripheral regional techniques provide comparable pain control, greater satisfaction and less risk than epidural analgesia. Although motor weakness might be greater with femoral nerve blocks compared with no regional analgesia, new data point towards a similar risk of falls after total knee arthroplasty with or without peripheral nerve blocks. Local infiltration analgesia and adductor canal blockade are promising recent techniques to gain adequate pain control with a minimum of undesired side-effects. SUMMARY Femoral nerve blocks are still the gold standard for an effective analgesia approach in knee arthroplasty and should be supplemented (if needed) by oral opioids. An additional sciatic nerve blockade is still controversial and should be an individual decision. Large-scale studies are needed to reinforce the promising results of newer regional techniques, such as local infiltration analgesia and adductor canal block.
Collapse
|