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Astini R, Riberto M. Acupuncture in the Treatment of a Series of Patients with Chronic Pain Associated with Hip Osteoarthritis. Rev Bras Ortop 2023; 58:e750-e754. [PMID: 37908518 PMCID: PMC10615607 DOI: 10.1055/s-0043-1776134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 11/02/2023] Open
Abstract
Objective Hip osteoarthritis (HO) causes pain and deranges functioning. Surgical treatment is the preferred approach in severe cases, but clinical comorbidities, age and the long waiting list may compromise quality of life. This study aimed to describe the results of acupuncture for the control pain and improvement of functioning in subjects with HO. Method Twelve severe HO patients were treated with ten weekly sessions of a standardized acupuncture point protocol. Pain intensity was assessed with the Visual Analog Pain Scale (VAS) and quality of life with WOMAC Index. Results Pain intensity (VAS) reduced from 75.8 ± 18.8 mm to 20.0 ± 22.6 mm after 10 acupuncture sessions and 48.3 ± 26.6mm in the follow-up (ANOVA F = 7.99; p < 0.001). WOMAC Index values reduced from 74.7 ± 12.7 to 45.7 ± 22.1 and 54.6 ± 22.9 at the same timepoints. Conclusion Acupuncture is an effective conservative rehabilitation strategy to reduce pain and improve quality of life in subjects with severe HO.
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Affiliation(s)
- Rafael Astini
- Programa de Pós-Graduação em Ciências da Saúde Aplicadas ao Aparelho Locomotor da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Marcelo Riberto
- Programa de Pós-Graduação em Ciências da Saúde Aplicadas ao Aparelho Locomotor da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Ueshima H, Tanaka N, Otake H. Greater analgesic effect with intermittent compared with continuous mode of lumbar plexus block for total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med 2019; 44:632-636. [DOI: 10.1136/rapm-2018-100091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/15/2019] [Accepted: 03/08/2019] [Indexed: 11/03/2022]
Abstract
This article has been retracted
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Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2019; 44:rapm-2018-000019. [PMID: 30635506 DOI: 10.1136/rapm-2018-000019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.
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Affiliation(s)
- De Q Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, Swedish Medical Center, Seattle, Washington, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
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4
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Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty. Reg Anesth Pain Med 2017; 42:446-450. [DOI: 10.1097/aap.0000000000000589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saporito A, Anselmi L, Borgeat A, Aguirre JA. Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery. J Clin Anesth 2016; 32:119-26. [DOI: 10.1016/j.jclinane.2016.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/09/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
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Atchabahian A, Schwartz G, Hall CB, Lajam CM, Andreae MH. Regional analgesia for improvement of long-term functional outcome after elective large joint replacement. Cochrane Database Syst Rev 2015; 2015:CD010278. [PMID: 26269416 PMCID: PMC4566967 DOI: 10.1002/14651858.cd010278.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Regional analgesia is more effective than conventional analgesia for controlling pain and may facilitate rehabilitation after large joint replacement in the short term. It remains unclear if regional anaesthesia improves functional outcomes after joint replacement beyond three months after surgery. OBJECTIVES To assess the effects of regional anaesthesia and analgesia on long-term functional outcomes 3, 6 and 12 months after elective major joint (knee, shoulder and hip) replacement surgery. SEARCH METHODS We performed an electronic search of several databases (CENTRAL, MEDLINE, EMBASE, CINAHL), and handsearched reference lists and conference abstracts. We updated our search in June 2015. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing regional analgesia versus conventional analgesia in patients undergoing total shoulder, hip or knee replacement. We included studies that reported a functional outcome with a follow-up of at least three months after surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We contacted study authors for additional information. MAIN RESULTS We included six studies with 350 participants followed for at least three months. All of these studies enrolled participants undergoing total knee replacement. Studies were at least partially blinded. Three studies had a high risk of performance bias and one a high risk of attrition bias, but the risk of bias was otherwise unclear or low.Only one study assessed joint function using a global score. Due to heterogeneity in outcome and reporting, we could only pool three out of six RCTs, with range of motion assessed at three months after surgery used as a surrogate for joint function. All studies had a high risk of detection bias. Using the random-effects model, there was no statistically significant difference between the experimental and control groups (mean difference 3.99 degrees, 95% confidence interval (CI) - 2.23 to 10.21; P value = 0.21, 3 studies, 140 participants, very low quality evidence).We did not perform further analyses because immediate adverse effects were not part of the explicit outcomes of any of these typically small studies, and long-term adverse events after regional anaesthesia are rare.None of the included studies elicited or reported long-term adverse effects like persistent nerve damage. AUTHORS' CONCLUSIONS More high-quality studies are needed to establish the effects of regional analgesia on function after major joint replacement, as well as on the risk of adverse events (falls).
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Affiliation(s)
- Arthur Atchabahian
- NYU School of MedicineDepartment of Anesthesiology, Perioperative Care, and Pain MedicineNew YorkNYUSA
| | - Gary Schwartz
- Maimonides Medical CenterDepartment of Anesthesiology4802 10th AvenueBrooklynNew YorkUSA11219
| | - Charles B Hall
- Albert Einstein College of Medicine, Mazer 220ADivision of Biostatistics, Department of Epidemiology and Population Health, Saul
B Korey Department of Neurology1300 Morris Park AvenueBronxNYUSA10461
| | - Claudette M Lajam
- NYU Langone Medical CenterDepartment of Orthopedic SurgeryNew YorkNYUSA
| | - Michael H Andreae
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111E 210th Street,#N4‐005New YorkNYUSA10467‐2401
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Fredrickson MJ, Danesh-Clough TK. Spinal Anaesthesia with Adjunctive Intrathecal Morphine versus Continuous Lumbar Plexus Blockade: A Randomised Comparison for Analgesia after Hip Replacement. Anaesth Intensive Care 2015; 43:449-53. [DOI: 10.1177/0310057x1504300405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following elective total hip replacement, both continuous lumbar plexus blockade and spinal anaesthesia (with adjunctive intrathecal morphine) have shown early outcome benefits over opioid analgesia and single-injection nerve block. However, the two techniques have not been compared in a prospective randomised manner. Our study examined 50 patients undergoing elective hip joint replacement who were randomised to receive spinal anaesthesia (with adjunctive intrathecal morphine 0.1 mg) or patient-controlled continuous lumbar plexus blockade. All surgery was conducted under general anaesthesia. Measured outcomes included numerically rated postoperative pain, supplemental opioid consumption and indices of mobilisation together with complications. Results show that block placement time was marginally shorter for the spinal group (5 versus 7 minutes, P=0.01). The primary outcome, worst pain on movement/mobilisation during the first 24 hours, was not statistically significantly different between groups. Patients in the lumbar plexus group were given more intraoperative opioid and rescue morphine in the post-anaesthesia care unit (median = 4 versus 0 mg, P <0.001), with correspondingly higher pain scores (median 5/10 versus 0/10, P <0.001). Pain scores during the subsequent 24 hours were similar between groups, but more patients in the spinal group were given rescue morphine (5 versus 0, P=0.02). Physiotherapy mobilisation indices appeared similar between groups. More spinal group patients reported pruritus (12 versus 5, P=0.01), but antiemetic requirements, episodes of disorientation, arterial oxygen desaturation and falls were all similar between groups. Postoperative symptoms suggestive of neurological irritation or injury did not differ between groups. We found that following elective hip joint replacement, compared to continuous lumbar plexus blockade, spinal anaesthesia incorporating adjunctive intrathecal morphine did not result in a statistically significant difference in worst pain on movement/mobilisation during the first 24 hours, although it was associated with better analgesia in the post-anaesthesia care unit. Subsequently, however, these patients appeared to require more rescue morphine and more of them reported pruritus.
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Affiliation(s)
- M. J. Fredrickson
- Department of Anaesthesia, University of Auckland, Auckland, New Zealand
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Long-term Functional Outcomes after Regional Anesthesia: A Summary of the Published Evidence and a Recent Cochrane Review. ACTA ACUST UNITED AC 2015; 43:15-26. [PMID: 26456997 DOI: 10.1097/asa.0000000000000033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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Nye ZB, Horn JL, Crittenden W, Abrahams MS, Aziz MF. Ambulatory continuous posterior lumbar plexus blocks following hip arthroscopy: a review of 213 cases. J Clin Anesth 2013; 25:268-74. [DOI: 10.1016/j.jclinane.2012.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 10/12/2012] [Accepted: 11/11/2012] [Indexed: 10/26/2022]
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Deumens R, Steyaert A, Forget P, Schubert M, Lavand’homme P, Hermans E, De Kock M. Prevention of chronic postoperative pain: Cellular, molecular, and clinical insights for mechanism-based treatment approaches. Prog Neurobiol 2013; 104:1-37. [DOI: 10.1016/j.pneurobio.2013.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 01/15/2013] [Accepted: 01/31/2013] [Indexed: 01/13/2023]
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Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract 2012; 2012:560879. [PMID: 22761615 PMCID: PMC3385590 DOI: 10.1155/2012/560879] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/10/2012] [Accepted: 04/17/2012] [Indexed: 12/29/2022] Open
Abstract
A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.
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Affiliation(s)
- José Aguirre
- Division of Anesthesiology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Alicia Del Moral
- Department of Anesthesiology, General University Hospital of Valencia, 46014 Valencia, Spain
| | - Irina Cobo
- Department of Anesthesiology, General University Hospital of Valencia, 46014 Valencia, Spain
| | - Alain Borgeat
- Division of Anesthesiology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Stephan Blumenthal
- Department of Anesthesiology, Triemli Hospital, 8063 Zurich, Switzerland
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Continuous Peripheral Nerve Block Compared With Single-Injection Peripheral Nerve Block. Reg Anesth Pain Med 2012; 37:583-94. [DOI: 10.1097/aap.0b013e31826c351b] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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From preemptive to preventive analgesia: time to reconsider the role of perioperative peripheral nerve blocks? Reg Anesth Pain Med 2011; 36:4-6. [PMID: 21455081 DOI: 10.1097/aap.0b013e31820305b8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Phillips DP, Knizner TL, Williams BA. Economics and practice management issues associated with acute pain management. Anesthesiol Clin 2011; 29:213-232. [PMID: 21620339 DOI: 10.1016/j.anclin.2011.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The use of regional anesthesia (RA) improves cost benefit (hospital-centered) and cost utility (patient-centered) over general anesthesia with volatile agents (GAVA), based upon research in outpatient populations. To make the cost savings a reality, the authors recommend: (1) avoidance of GAVA or at least volatile agents, (2) adopting published postanesthesia care unit (PACU)-bypass criteria conducive to RA, (3) maximizing PACU-bypass rates, and (4) utilizing a block induction area. Inpatient-based acute pain services are not uniform, which makes cost analyses and comparison between practices unreliable. Additional review and commentary address surgical site infections, cancer recurrence, blood transfusions, and chronic postsurgical pain.
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Affiliation(s)
- Dennis P Phillips
- Department of Anesthesiology, University of Pittsburgh Medical Center, Liliane S. Kaufmann Building, 3471 Fifth Avenue Suite 910, Pittsburgh, PA 15213, USA.
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McGuirk S, Fahy C, Costi D, Cyna AM. Use of invasive placebos in research on local anaesthetic interventions. Anaesthesia 2011; 66:84-91. [PMID: 21254982 DOI: 10.1111/j.1365-2044.2010.06560.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Placebos play a vital role in clinical research, but their invasive use in the context of local anaesthetic blocks is controversial. We assessed whether recently published randomised controlled trials of local anaesthetic blocks risked harming control group patients in contravention of the Declaration of Helsinki. We developed the 'SHAM' (Serious Harm and Morbidity) scale to assess risk: grade 0 = no risk (no intervention); grade 1 = minimal risk (for example, skin allergy to dressing); grade 2 = minor risk (for example, subcutaneous haematoma, infection); grade 3 = moderate risk (with or without placebo injection) (for example, neuropraxia); and grade 4 = major risk (such as blindness, pneumothorax, or liver laceration). Placebo interventions of the 59 included trials were given a SHAM grade. Nine hundred and nineteen patients in 31 studies, including six studies with 183 children, received an invasive placebo assessed as SHAM grade ≥ 3. A high level of agreement (78%, κ = 0.80, p < 0.001) for SHAM grades 0-4 increased to 100% following discussion between assessors. More than half of the randomised controlled study designs subjected patients in control groups to risks of serious or irreversible harm. A debate on whether it is justifiable to expose control group patients to risks of serious harm is overdue.
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Affiliation(s)
- S McGuirk
- Women's and Children's Hospital, North Adelaide, SA, Australia
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Perineural catheter techniques. Int Anesthesiol Clin 2010; 48:71-84. [PMID: 20881528 DOI: 10.1097/aia.0b013e3181f89b95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Indications and management of continuous infusion of local anesthetics at home. Curr Opin Anaesthesiol 2010; 23:650-5. [DOI: 10.1097/aco.0b013e32833e27bc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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