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Zhang S, Kong X, Chai W. [Opioids in primary total joint arthroplasty: Interpretation of 2020 AAHKS/ASRA/AAOS/THS/TKS clinical practice guidelines]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1396-1402. [PMID: 34779164 DOI: 10.7507/1002-1892.202103090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
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Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, Beijing, 100853, P.R.China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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Bigalke S, Maeßen TV, Schnabel K, Kaiser U, Segelcke D, Meyer-Frießem CH, Liedgens H, Macháček PA, Zahn PK, Pogatzki-Zahn EM. Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty. Pain 2021; 162:1914-1934. [PMID: 33492036 DOI: 10.1097/j.pain.0000000000002209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
ABSTRACT The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty. We followed the Cochrane recommendations for systematic reviews, searching PubMed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain "pain"/"pain intensity" most commonly assessed (98.3%), followed by "analgesic consumption" (88.8%) and "side effects" (75.3%). By contrast, "physical function" (53.5%), "satisfaction" (28.8%), and "psychological function" (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain descriptions and utilization in trials comparing for effectiveness of pain interventions after total knee arthroplasty. This points towards the need for harmonizing outcome domains, eg, by consenting on a core outcome set of domains which are relevant for both stakeholders and patients. Such a core outcome set should include at least 3 domains from 3 different health core areas such as pain intensity, physical function, and one psychological domain.
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Affiliation(s)
- Stephan Bigalke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Timo V Maeßen
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Kathrin Schnabel
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Ulrike Kaiser
- University Pain Centre, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Daniel Segelcke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Christine H Meyer-Frießem
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | | | - Philipp A Macháček
- Faculty of Electrical Engineering and Information Technology, Ruhr-University Bochum, Bochum, Germany
| | - Peter K Zahn
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
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Hannon CP, Fillingham YA, Nam D, Courtney PM, Curtin BM, Vigdorchik JM, Buvanendran A, Hamilton WG, Della Valle CJ. Opioids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty 2020; 35:2709-2714. [PMID: 32571594 DOI: 10.1016/j.arth.2020.05.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Hannon CP, Fillingham YA, Nam D, Courtney PM, Curtin BM, Vigdorchik J, Mullen K, Casambre F, Riley C, Hamilton WG, Della Valle CJ. The Efficacy and Safety of Opioids in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis. J Arthroplasty 2020; 35:2759-2771.e13. [PMID: 32571589 DOI: 10.1016/j.arth.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Opioids are frequently used to treat pain after total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of opioids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management. METHODS The MEDLINE, EMBASE, and Cochrane Central Register of controlled trials were searched for studies published before November 2018 on opioids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of opioids. RESULTS Preoperative opioid use leads to increased opioid consumption and complications after TJA along with a higher risk of chronic opioid use and inferior patient-reported outcomes. Scheduled opioids administered preemptively, intraoperatively, or postoperatively reduce the need for additional opioids for breakthrough pain. Prescribing fewer opioid pills after discharge is associated with equivalent functional outcomes and decreased opioid consumption. Tramadol reduces postoperative opioid consumption but increases the risk of postoperative nausea, vomiting, dry mouth, and dizziness. CONCLUSION Moderate evidence supports the use of opioids in TJA to reduce postoperative pain and opioid consumption. Opioids should be used cautiously as they may increase the risk of complications, such as respiratory depression and sedation, especially if combined with other central nervous system depressants or used in the elderly.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - P Maxwell Courtney
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Jonathan Vigdorchik
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Kyle Mullen
- Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL
| | - Francisco Casambre
- Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL
| | - Connor Riley
- Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL
| | | | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Aleissa MM, Ahern KL, Stern GM. Peri-operative opioid and sedation requirements in patients who use marijuana and are undergoing total knee or total hip arthroplasty: A retrospective study. J Clin Anesth 2020; 66:109953. [PMID: 32619794 DOI: 10.1016/j.jclinane.2020.109953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Muneerah M Aleissa
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
| | - Krystina L Ahern
- Department of Pharmacy Services, UMass Memorial Medical Center University Campus, 55 N Lake Ave, Worcester, MA 01655, USA.
| | - Gretchen M Stern
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
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Summers S, Mohile N, McNamara C, Osman B, Gebhard R, Hernandez VH. Analgesia in Total Knee Arthroplasty: Current Pain Control Modalities and Outcomes. J Bone Joint Surg Am 2020; 102:719-727. [PMID: 31985507 DOI: 10.2106/jbjs.19.01035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Spencer Summers
- Departments of Orthopaedics and Rehabilitation (S.S., N.M., C.M., and V.H.H.), and Anesthesiology, Perioperative Medicine, and Pain Management (B.O. and R.G.), University of Miami, Miami, Florida
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Li C, Peng J, Hu R, Yan J, Sun Y, Zhang L, Liu W, Jiang H. Safety and Efficacy of Ketamine Versus Ketamine-Fentanyl-Dexmedetomidine Combination for Anesthesia and Analgesia in Rats. Dose Response 2019; 17:1559325819825902. [PMID: 30792614 PMCID: PMC6376518 DOI: 10.1177/1559325819825902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 12/16/2022] Open
Abstract
Ketamine (KET), a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is most frequently used as an anesthetic, analgesic, and sedative drug in pediatric clinical practices. However, the adverse effects of KET administration such as psychotic episodes limited the use of KET. The aim of the present study was to evaluate whether the addition of small doses of fentanyl (FENT) and dexmedetomidine would reduce the overall KET consumption without concession on the safety and efficacy of anesthesia and analgesia in rats. We compared the effects of KET (50 mg/kg) administration alone and KET (25 mg/kg) combined with FENT (0.005 mg/kg) and dexmedetomidine (0.05 mg/kg) (KFD) on the times of onset and duration of anesthesia and analgesia. Compared with the KET group, the KFD group provides similar onset time of anesthesia, but longer duration of anesthesia, and better analgesic effect. Unlike the KET group, the KFD group had a lower heart rate and higher respiratory rate. Meanwhile, KFD induced markedly changes in the electroencephalography (EEG) spectral power when compared with control and KET. Furthermore, combination of FENT and dexmedetomidine alleviated the liver toxicity of KET. These results indicated that, when compared with KET alone, the administration of KFD combination offered safer and more efficient anesthesia.
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Affiliation(s)
- Chunzhu Li
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiali Peng
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Hu
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Yan
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Sun
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Liu
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Research Institute of Criminal Science and Technology, Shanghai, China
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Karlsen APH, Wetterslev M, Hansen SE, Hansen MS, Mathiesen O, Dahl JB. Postoperative pain treatment after total knee arthroplasty: A systematic review. PLoS One 2017; 12:e0173107. [PMID: 28273133 PMCID: PMC5342240 DOI: 10.1371/journal.pone.0173107] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/15/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L'Abbe Plots and trial sequential analysis. RESULTS The included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low. CONCLUSION A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.
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Affiliation(s)
- Anders Peder Højer Karlsen
- Department of Anaesthesia, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Anaesthesia, Zealand University Hospital, Koege, Denmark
| | - Mik Wetterslev
- Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Morten Sejer Hansen
- Department of Anaesthesia, 4231, Centre of head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Ole Mathiesen
- Department of Anaesthesia, Zealand University Hospital, Koege, Denmark
| | - Jørgen B. Dahl
- Department of Anaesthesia, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Xu Q, Li QG, Fan GR, Liu QH, Mi FL, Liu B. Protective effects of fentanyl preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion in rats. ACTA ACUST UNITED AC 2017; 50:e5286. [PMID: 28225864 PMCID: PMC5343559 DOI: 10.1590/1414-431x20165286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/29/2016] [Indexed: 01/05/2023]
Abstract
We aimed to study the effect of fentanyl (Fen) preconditioning on cardiomyocyte
apoptosis induced by ischemia-reperfusion (I/R) in rats. A total of 120 Sprague
Dawley male rats (age: 3 months) were randomly divided into: sham operation group (S
group), I/R group, normal saline I/R group (NS group), and fentanyl low, middle, and
high dose groups (Fen1: 2 μg/kg; Fen2: 4 μg/kg; Fen3: 6 μg/kg). Heart rate (HR), mean
arterial pressure (MAP), left ventricular developed pressure (LVDP), ±dp/dtmax,
malondialdehyde (MDA), superoxide dismutase (SOD) activity, creatine phosphokinase-MB
(CK-MB), and cardiac troponin-I (cTnI) were measured. Myocardial ischemic (MI) area,
total apoptotic myocardial cells, and protein and mRNA expressions of B-cell lymphoma
2 (Bcl-2) and Bax were detected. HR and MAP were higher, while LVDP and ±dp/dtmax
were close to the base value in the Fen groups compared to those in the I/R group.
Decreased MDA concentration and CK-MB value and increased SOD activity were found in
the Fen groups compared to the I/R group, while cTnI concentration was significantly
lower in the Fen1 and Fen2 groups (all P<0.05). Myocardial damage
was less in the Fen groups compared to the I/R group and the MI areas and apoptotic
indexes were significantly lower in the Fen1 and Fen2 groups (all
P<0.05). Furthermore, significantly increased protein and mRNA
expressions of Bcl-2, and decreased protein and mRNA expressions of Bax were found in
the Fen groups compared to the I/R group (all P<0.05). Fentanyl preconditioning
may suppress cardiomyocyte apoptosis induced by I/R in rats by regulating Bcl-2 and
Bax.
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Affiliation(s)
- Q Xu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, China
| | - Q-G Li
- Department of Anesthesiology, Linyi Cancer Hospital, Linyi, Shandong, China
| | - G-R Fan
- Operation Room, Linyi People's Hospital, Linyi, Shandong, China
| | - Q-H Liu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, China
| | - F-L Mi
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, China
| | - B Liu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, China
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 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, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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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.
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Periarticular Injection of Liposomal Bupivacaine Offers No Benefit Over Standard Bupivacaine in Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial. J Arthroplasty 2017; 32:628-634. [PMID: 27667533 DOI: 10.1016/j.arth.2016.07.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periarticular injection of liposomal bupivacaine has been adopted as part of multimodal pain management after total knee arthroplasty (TKA). METHODS In this prospective, randomized clinical trial, we enrolled 162 patients undergoing primary TKA in a single institution between January 2014 and May 2015. Eighty-seven patients were randomized to liposomal bupivacaine (experimental group), and 75 patients were randomized to free bupivacaine (control group). All patients received spinal anesthesia and otherwise identical surgical approaches, pain management, and rehabilitation protocols. Outcomes evaluated include the patient-reported visual analog pain scores, narcotic consumption, and narcotic-related side effects (Brief Pain Inventory) within 96 hours after surgery as well as functional outcomes using the Knee Society Score and the Short-Form 12 measured preoperatively and at 4-6 weeks after surgery. RESULTS There were no statistically significant differences between the groups in terms of postoperative daily pain scores, narcotic consumption (by-day and overall), or narcotic-related side effects. There were no statistically significant differences between the groups in terms of surgical (P = .76) and medical complications or length of hospital stay (P = .35). There were no statistically significant differences in satisfaction between the groups (P = .56) or between the groups in postoperative Knee Society Score (P = .53) and the Short-Form 12 at 4-6 weeks (P = .82, P = .66). CONCLUSION As part of multimodal pain management protocol, periarticular injection of liposomal bupivacaine compared with bupivacaine HCl did not result in any clinically or statistically significant improvement of the measured outcomes following TKA.
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Analgesic effect and pharmacological mechanism of fentanyl and butorphanol in a rat model of incisional pain. J Clin Anesth 2016; 28:67-73. [DOI: 10.1016/j.jclinane.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 04/21/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022]
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Matsumoto S, Matsumoto K, Iida H. Transdermal fentanyl patch improves post-operative pain relief and promotes early functional recovery in patients undergoing primary total knee arthroplasty: a prospective, randomised, controlled trial. Arch Orthop Trauma Surg 2015; 135:1291-7. [PMID: 26112273 DOI: 10.1007/s00402-015-2265-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of the present study was to evaluate the efficacy and safety of a 12.5 μg/h transdermal fentanyl patch (TFP). MATERIALS AND METHODS Fifty-two patients scheduled for primary total knee arthroplasty (TKA) were recruited in the study. They were randomly divided into two groups: patients provided with a transdermal fentanyl patch (Group TFP) and those provided with non-steroid anti-inflammatory drugs (Group NSAID). The patients in the TFP and NSAID groups had mean ages of 70.1 years (range 36-86 years) and 73.5 years (range 32-86 years), respectively. Post-operative pain intensity was measured using the visual analogue scale both at rest and during movement (mVAS). We also evaluated lower leg functional recovery and adverse events. RESULTS The mean mVAS scores were not different between the two groups on post-operative day 4, but were significantly smaller in the TFP group than in the NSAID group on post-operative days 7 (p = 0.0026) and 14 (p = 0.007). Muscle strength recovered faster in the TFP group than in the NSAID group, the percentage of pre-operative strength being significantly greater in the former than in the latter on post-operative days 7 (p = 0.027) and 14 (p = 0.047). Furthermore, there were no remarkable adverse events in patients using TFP. CONCLUSION We conclude that a 12.5 μg/h TFP can improve post-operative pain relief and promotes early functional recovery following total knee arthroplasty.
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Affiliation(s)
- Shigemi Matsumoto
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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