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Shah M, Desai S, Thakkar P, Jain A, Shah N. Adductor Catheter Insertion Through The Knee Arthrotomy: Can This Technique Be As Safe And Effective As Ultrasound-Guided Insertion? J Arthroplasty 2024:S0883-5403(24)00940-9. [PMID: 39332600 DOI: 10.1016/j.arth.2024.09.003] [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] [Received: 04/18/2024] [Revised: 08/29/2024] [Accepted: 09/10/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Early postoperative pain following total knee arthroplasty (TKA) remains challenging. We devised a technique for inserting a continuous catheter intra-operatively in the adductor canal and aimed to compare its efficacy and safety with that of an ultrasound-guided (USG) anesthetist-administered continuous catheter. METHODS This single-center, single-surgeon, prospective, interventional, randomized controlled trial included 330 patients, who were randomized into two groups with similar pre-operative status and demographics. There were 18 patients who met exclusion criteria. Group A (n=152) received the block from an anesthetist, while Group B (n=160) received the block from the surgeon. Patients had Visual Analogue Scale (VAS) scores, range of motion (ROM), maximum ambulation distance, time to straight leg raise (SLR), length of stay, and results from a 10-meter walk test, Timed Up and Go (TUG) test, and a 30-second chair test measured pre-operatively and at 6, 12, and 24 hours post-operatively by a physiotherapist and pain nurse blinded to the group assignment. RESULTS The VAS scores at 12 hours post-surgery were significantly lower in Group B (0.66) compared to Group A (0.77, P = 0.04). ROM (supine flexion 43.22 vs. 43.08, P = 0.72; sitting flexion 90.02 vs. 89.93, P = 0.17), TUG test (126.1 vs. 136.9, P = 0.9), 10-meter walk test (163.50 vs. 165.35, P = 0.7), 30-second chair test (3.74 vs. 3.75, P = 0.7), time to active SLR (4.02 vs. 4.05, P = 0.3), time to ambulation with walker (4.02 vs. 4.05, P = 0.3), and length of stay (1.44 vs. 1.39, P = 0.49) showed no significant differences between the groups. No serious complications were reported in either group. CONCLUSION We concluded that this technique was as at least as safe and effective as the USG-guided, anesthetist-administered adductor canal catheter.
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Affiliation(s)
- Manan Shah
- Department of Orthopaedics, Sir H.N Reliance Foundation Hospital.
| | - Sameer Desai
- Department of Orthopaedics, Sir H.N Reliance Foundation Hospital
| | - Parna Thakkar
- Department of Anaesthesia, Sir H.N Reliance Foundation Hospital
| | - Aanchal Jain
- Department of Physiotherapy, Sir H.N Reliance Foundation Hospital
| | - Nilen Shah
- Department of Orthopaedics, Sir H.N Reliance Foundation Hospital
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Dobson SW, Stouffer ND, Weller RS, Shields JS, Edwards CJ, Henshaw DS. Comparison of Femoral Nerve Catheter, Adductor Canal Catheter, and Periarticular Liposomal Bupivacaine Infiltration for Postoperative Analgesia After Primary Total Knee Arthroplasty. J Arthroplasty 2022; 38:824-830. [PMID: 36470364 DOI: 10.1016/j.arth.2022.11.015] [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] [Received: 07/05/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Peripheral nerve catheters are used to provide analgesia after total knee arthroplasty (TKA) and have been shown to decrease pain and opioid use, to facilitate participation with physical therapy (PT), and to hasten discharge. More recently, pericapsular infiltration using liposomal bupivacaine (LB) has been employed as an alternative analgesic approach. METHODS This retrospective study compared outcomes for three analgesic approaches: femoral nerve catheter (FNC), adductor canal catheter (ACC), and intraoperative LB infiltration. The primary outcome was numeric rating scale (NRS) pain scores at 24 hours. Secondary outcomes included pain scores at 12, 36, and 48 hours, time-to-first opioid, cumulative opioid use, distance walked, and time-to-discharge. RESULTS Pain scores at 24 hours were significantly lower in both the ACC and FNC cohorts when compared to the LB cohort (3.1 versus 4.6 [P = .017] and 2.4 versus 4.6 [P < .0001]). The ACC and FNC groups did not differ significantly at that timepoint (P = .27). Similar comparisons were found at 12 and 36 hours, while at 48 hours the FNC group was superior. Time to first opioid and opioid consumption favored the ACC and FNC groups. Walking distance favored the ACC group. Both the ACC and LB groups had a faster time-to-discharge than the FNC group. CONCLUSION Both ACCs and FNCs provided superior analgesia at 24 hours compared to LB, while being equivalent to each other. Pain scores at 12 hours and 36 hours as well as opioid consumption through 48 hours mirrored this finding. Although various differences were found between groups in terms of time-to-first analgesic, walking distance and time-to-discharge, the ACC approach appeared to optimally balance analgesia, ambulation, and time-to-discharge.
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Affiliation(s)
- Sean W Dobson
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nathan D Stouffer
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert S Weller
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John S Shields
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher J Edwards
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daryl S Henshaw
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Freccero DM, Van Steyn P, Joslin PM, Robbins CE, Li X, Efremov K, Shukla P, Talmo CT, Bono JV. Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty. JB JS Open Access 2022; 7:JBJSOA-D-21-00155. [PMID: 35935602 PMCID: PMC9354944 DOI: 10.2106/jbjs.oa.21.00155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
- Email for corresponding author:
| | | | - Pinak Shukla
- New England Baptist Hospital, Boston, Massachusetts
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Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, Mariano ER, Johnson RL, Go G, Hargett MJ, Lee BH, Wendel P, Brouillette M, Kim SJ, Baaklini L, Wetmore DS, Hong G, Goto R, Jivanelli B, Athanassoglou V, Argyra E, Barrington MJ, Borgeat A, De Andres J, El-Boghdadly K, Elkassabany NM, Gautier P, Gerner P, Gonzalez Della Valle A, Goytizolo E, Guo Z, Hogg R, Kehlet H, Kessler P, Kopp S, Lavand'homme P, Macfarlane A, MacLean C, Mantilla C, McIsaac D, McLawhorn A, Neal JM, Parks M, Parvizi J, Peng P, Pichler L, Poeran J, Poultsides L, Schwenk ES, Sites BD, Stundner O, Sun EC, Viscusi E, Votta-Velis EG, Wu CL, YaDeau J, Sharrock NE. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021; 46:971-985. [PMID: 34433647 DOI: 10.1136/rapm-2021-102750] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
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Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Janis Bekeris
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Dace Bekere
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - George Go
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Mary J Hargett
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bradley H Lee
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Pamela Wendel
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Mark Brouillette
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Sang Jo Kim
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Lila Baaklini
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Douglas S Wetmore
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Genewoo Hong
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Rie Goto
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bridget Jivanelli
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Vassilis Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eriphili Argyra
- Faculty of Medicine, Aretaieion University Hospital, Athens, Greece
| | - Michael John Barrington
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Alain Borgeat
- Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Jose De Andres
- Anesthesia, Critical Care and Multidisciplinary Pain Management Department, Valencia University General Hospital, Valencia, Spain.,Anesthesia Unit, Surgical Specialties Department, School of Medicine, University of Valencia, Valencia, Spain
| | | | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University Of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Gautier
- Department of Anesthesiology and Resuscitation, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| | - Peter Gerner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Enrique Goytizolo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Zhenggang Guo
- Department of Anesthesiology, Peking Universtiy Shougang Hospital, Beijing, China
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Henrik Kehlet
- Department of Clinical Medicine, Rigshosp, Copenhagen, Denmark
| | - Paul Kessler
- Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alan Macfarlane
- School of Medicine, Dentistry & Nursing, Glasgow Royal Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK
| | - Catherine MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, New York, USA.,Center for the Advancement of Value in Musculoskeletal Care, Weill Cornell Medical College, New York, New York, USA
| | - Carlos Mantilla
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexander McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Joseph M Neal
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.,Benaroya Research Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Parks
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Javad Parvizi
- Orthopedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jashvant Poeran
- Orthopaedics/Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, New York Langone Orthopaedic Hospital, New York, New York, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian D Sites
- Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Ottokar Stundner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria.,Department of Anesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eugene Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Effrossyni Gina Votta-Velis
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Jacques YaDeau
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Nigel E Sharrock
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
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5
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Qin L, You D, Zhao G, Li L, Zhao S. A comparison of analgesic techniques for total knee arthroplasty: A network meta-analysis. J Clin Anesth 2021; 71:110257. [PMID: 33823459 DOI: 10.1016/j.jclinane.2021.110257] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVE There is no established analgesic method for postoperative total knee arthroplasty. We comprehensively compared the analgesic methods for postoperative total knee arthroplasty. DESIGN A network meta-analysis of randomised controlled trials was used to compare 18 interventions, which were ranked by six outcome indices, to select the best modality. SETTING Postoperative recovery room and inpatient ward. PATIENTS 98 randomised controlled trials involving 7452 patients (ASA I-III) were included in the final analysis. INTERVENTIONS Studies that included the use of at least one of the following 12 nerve block(fascia iliaca compartment block (FIB), FNB, cFNB, single femoral nerve block (sFNB), adductor canal block (ACB), sciatic nerve block (SNB), obturator nerve block (ONB), continuous posterior lumbar plexus block (PSOAS), FNB + SNB, ACB + LIA, FNB + LIA, PCA + FNB). MEASUREMENTS Pain intensity was compared using Visual Analogue Scale (VAS). Also, postoperative complications, function score, hospital length of stay, morphine consumption and patient satisfaction were measured. MAIN RESULTS For visual analogue scale scores, continuous femoral nerve block (FNB) and FNB + sciatic nerve block (SNB) were the the most effective interventions. For reducing postoperative complications, fascia iliaca compartment block, FNB, SNB, and obturator nerve block showed the best results. For reducing postoperative morphine consumption, adductor canal block (ACB) + local infiltration analgesia (LIA) and FNB + SNB were preferred. For function scores (range of motion, Timed-Up-and-Go test), ACB and LIA were optimal choices. For reducing hospital length of stay and patient satisfaction, ACB + LIA and FNB + LIA were best, respectively. CONCLUSIONS Peripheral nerve block, especially FNB and ACB, is a better option than other analgesic methods, and its combination with other methods can be beneficial. Peripheral nerve block is a safe and effective postoperative analgesia method. However, our findings can only provide objective evidence. Clinicians should choose the treatment course based on the individual patient's condition and clinical situation.
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Affiliation(s)
- Lu Qin
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China.
| | - Di You
- China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Guoqing Zhao
- China-Japan Union Hospital of Jilin University, Changchun, China; Jilin University, Changchun, China.
| | - Longyun Li
- China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Shishun Zhao
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China.
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Yun SH, Choi YS, Kim SR. Low concentration continuous femoral nerve block improves analgesia and functional outcomes after total knee arthroplasty in spinal anesthesia. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.4.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- So Hui Yun
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Rim Kim
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, Korea
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7
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Sankineani SR, Reddy ARC, Ajith Kumar KS, Eachempati KK, Reddy AVG. Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study. Musculoskelet Surg 2018; 102:173-177. [PMID: 29086337 DOI: 10.1007/s12306-017-0519-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Pain management after total knee arthroplasty has seen many recent advances such as peripheral nerve blocks in order to improve the functional outcome and reduce morbidity after surgery. Adductor canal block (ACB) and multimodal periarticular infiltration (MPI) are two techniques that have been proven to be efficacious individually. We hypothesized that the combination of ACB with MPI would reduce pain and improve knee range of movement (ROM) compared to ACB alone. METHODS A prospective non-randomized study was conducted from July 2015 to December 2015 in our institution in a total of 200 consecutive patients undergoing unilateral total knee arthroplasty who were either given ACB alone (Group 1, n = 100 patients) or ACB + MPI (Group 2, n = 100 patients). All the patients were assessed for severity of pain by Visual Analogue Scale (VAS) at 8, 24, 48 h postoperatively and knee ROM after 48 h. RESULTS Patients in ACB + MPI group had significantly better VAS scores at 8 h postoperatively but showed no significant difference at 24 and 48 h compared to ACB group. Patients in ACB + MPI group showed significantly better knee ROM after 48 h. CONCLUSIONS Our study concludes that patients receiving ACB + MPI have demonstrated better VAS scores in the immediate postoperative period but have no significant difference at the time of discharge.
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Affiliation(s)
- S R Sankineani
- Department of Orthopaedics, Sunshine Hospital, P.G. Road, Secunderabad, Telangana, India.
| | - A R C Reddy
- Department of Anaesthesia, Mediciti Institute of Medical Sciences, Medchal, Hyderabad, India
| | - K S Ajith Kumar
- Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - K K Eachempati
- Department of Orthopaedics, Maxcure Hospital, Madhapur, Hyderabad, Telangana, India
| | - A V G Reddy
- Department of Orthopaedics, Sunshine Hospital, P.G. Road, Secunderabad, Telangana, India
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8
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Intraoperative Adductor Canal Block for Augmentation of Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study. J Arthroplasty 2016; 31:2072-6. [PMID: 26996675 DOI: 10.1016/j.arth.2016.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/24/2016] [Accepted: 02/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Function is often sacrificed for pain control after total knee arthroplasty. Motor-sparing blocks, including adductor canal block (ACB) and periarticular injection (PAI), have gained interest to address this compromise. Our study evaluates the anatomic feasibility, accuracy, and safety of intraoperative ACB as an adjunct to PAI by analyzing 3 different injection orientations and needle configurations. METHODS Eleven cadaveric knees underwent a standard medial parapatellar arthrotomy. Blunt dissection through the suprapatellar recess was performed. Using a 10-mL syringe, various colors of dyed liquid gelatin were injected toward the proximal and distal adductor canal (AC) using 3 needle configurations. Medial dissection of the knee for each specimen was performed. The position of each needle and location of injected dye was identified and described relative to the AC. RESULTS Accuracy of each injection orientation and/or needle configuration was different: 86% for a blunt needle in the distal AC, 57% for blunt needle in the proximal AC, and 14% for a spinal needle in the proximal AC. Puncture of the femoral artery was observed with the spinal needle 43% of the time and had the closest average proximity to the femoral artery with a distance of 5.9 mm. There were no vascular punctures using blunt needles, and the average distance from the femoral artery with proximal and distal orientation was 10.2 mm and 15.4 mm, respectively. CONCLUSION Intraoperative ACB augmentation of PAI appears to be anatomically feasible and safe. There was decreased accuracy and increased risk of vascular puncture using a 3.5-inch spinal needle. A blunt 1.5-inch needle directed toward the distal AC had the highest accuracy while minimizing vascular injury.
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9
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Fan L, Yu X, Zan P, Liu J, Ji T, Li G. Comparison of Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: A Prospective, Randomized Clinical Trial. J Arthroplasty 2016; 31:1361-1365. [PMID: 26810604 DOI: 10.1016/j.arth.2015.12.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is usually associated with severe postoperative pain, which can prevent rehabilitation of patients' knee function and influence the satisfaction of surgery. Local infiltration analgesia (LIA) as a new method to managing postoperative pain has been applied in clinical practice recently. However, the safety and efficacy of LIA compared with femoral nerve block (FNB) in postoperative pain management of TKA still remains controversial. Thus, we conducted an original clinical trial to compare LIA and FNB. METHOD One hundred fifty-seven patients undergoing TKA were enrolled in a randomized, double-blind, single-center study. The patients received either FNB (group A) or periarticular infiltration of local anesthetic (group B). The morphine consumption used in patient-controlled analgesia after surgery, postoperative Visual Analogue Scale (VAS), Knee Society Score, and range of motion before and after surgery in both groups were analyzed, as well as the adverse effects. RESULTS Group A consisted 78 patients, and group B contained 79 patients. The patients' characteristics including age and body mass index had no significant difference (P > .05). Morphine consumption, VAS at rest, range of motion, and Knee Society Score were similar between the 2 groups. Our study showed group B, the local anesthetic group had less VAS with movement on postoperative day 1 (P = .01) than that of group A, which means a better pain control. Because of the study design, the surgery time showed no significant difference. Eighteen patients in group A and 21 patients in group B experienced mild-to-medium nausea or vomiting. One patient in group B had dizziness and one patient in group A suffered a neuropraxic injury to the femoral nerve. No urinary retention case was seen during inpatient days. There were no significant differences between the 2 groups about side effects. CONCLUSIONS Our research showed that no significant differences were observed between the 2 treatment groups. LIA could provide a similar analgesic effect to FNBs with a low incidence of complications.
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Affiliation(s)
- Lin Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiao Yu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Nan Jing Medical University, Nangjing, People's Republic of China
| | - Pengfei Zan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jin Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Nan Jing Medical University, Nangjing, People's Republic of China
| | - Tongxiang Ji
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Guodong Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Ishida K, Shibanuma N, Matsumoto T, Tei K, Kuroda R, Kurosaka M. Periarticular multimodal drug injection improves post-operative pain and functional recovery after total knee arthroplasty. J Orthop Sci 2016; 21:178-83. [PMID: 26723225 DOI: 10.1016/j.jos.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/10/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study retrospectively compared the clinical benefits of periarticular multimodal drug injection (PMDI) and continuous femoral nerve block (CFNB) after total knee arthroplasty (TKA). METHODS From 2010 to 2012, 520 primary TKAs were performed, and patients were treated with CFNB or PMDI after surgery. Patients who underwent simultaneous bilateral TKA were excluded, leaving 185 and 166 patients in the CFNB and PMDI groups, respectively. Numeric rating scale for pain (NRS) scores and analgesic consumption were evaluated to compare the effectiveness of pain control between the groups. Further, range of motion (ROM), extension lag, the time to recovery of functions, and postoperative C-reactive protein (CRP) levels were monitored. Complications such as deep infection were assessed. RESULTS The PMDI group displayed a significantly smaller NRS score on postoperative day (POD) 1 and lower analgesic consumption on PODs 0 and 1. The times to functional recovery were significantly shorter and the extension lag was smaller in the PMDI group. Furthermore, CRP levels were lower in the PMDI group by POD 7. No obvious deep infections were noted. CONCLUSION Our results indicate that PMDI induced earlier functional recovery after TKA than CFNB, partially via its analgesic effect.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe 657-0068, Japan.
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe 657-0068, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumasa Tei
- Department of Orthopaedic Surgery, Chibune General Hospital, Osaka, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Pereira LC, Jolles BM. The effect of end-of-range grade A+ knee mobilisation following acute primary total knee arthroplasty: A randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.12.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background/Aims: Although the number of total knee arthroplasty procedures being performed is increasing worldwide, the rehabilitation protocols following surgery are poorly studied in the literature. Research suggests that exercise therapy and joint mobilisation are recommended in the later stages of osteoarthritis. However, best practice for rehabilitation in the immediate postoperative period is yet to be determined. This prospective randomised controlled trial examined whether adding grade A+ joint mobilisation to the standard in-hospital rehabilitative approach would increase pain (based on recordings of pain intensity on the visual analogue scale) and improve range of motion in the knee. Methods: Participants (n=32; mean±SD age: 71.1± 8.9 years) undergoing primary total knee arthroplasty at a university hospital were randomly assigned to two equal groups. Measurements were recorded before surgery and on the first, third and seventh days following total knee arthroplasty. All participants received standard care postoperatively, with participants in the experimental group receiving additional grade A+ joint mobilisation for knee flexion and extension twice a day for 20 minutes using the JAS Knee system (Joint Active Systems®, Effingham, Illinois). Results: There were no statistically significant differences in visual analogue scale scores or range of motion in all measurements (p > 0.05). Increased range of motion at a faster pace was observed in the obese subgroup of patients (p = 0.016). Other factors such as age, body mass index, type of anaesthesia and implant model did not influence the final outcome. Conclusions: Early grade A+ joint mobilisation combined with the standard in-hospital rehabilitative approach is safe to be used during the post-acute phase of rehabilitation after total knee arthroplasty. Despite increasing trends in the obese subgroup of patients, adding grade A+ joint mobilisation to the standard protocol did not significantly improve overall range of motion. The results of this study and heterogeneities in the literature identify the need for further research and development in this area.
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Affiliation(s)
- Luis C Pereira
- Physiotherapist, University Hospital of Lausanne, Swiizerland
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De Pinto M, Dagal A, O'Donnell B, Stogicza A, Chiu S, Edwards WT. Regional anesthesia for management of acute pain in the intensive care unit. Int J Crit Illn Inj Sci 2015; 5:138-43. [PMID: 26557482 PMCID: PMC4613411 DOI: 10.4103/2229-5151.164917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects.
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Affiliation(s)
- Mario De Pinto
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Armagan Dagal
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Brendan O'Donnell
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Agnes Stogicza
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Sheila Chiu
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - William Thomas Edwards
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
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Kim HY, Byeon GJ, Cho HJ, Baek SH, Shin SW, Cho HJ. A comparison of ultrasound alone vs ultrasound with nerve stimulation guidance for continuous femoral nerve block in patients undergoing total knee arthroplasty. J Clin Anesth 2015; 32:274-80. [PMID: 26427307 DOI: 10.1016/j.jclinane.2015.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/01/2015] [Accepted: 08/13/2015] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare analgesic efficacy of ultrasound (US) guidance alone and US guidance combined with nerve stimulation (NS) for continuous femoral nerve block (CFNB) in patients undergoing total knee arthroplasty (TKA). DESIGN Prospective, randomized double-blind trial. SETTING Postanesthesia care unit and general ward. PATIENTS Fifty American Society of Anesthesiologist physical status I to II patients undergoing TKA under spinal anesthesia. INTERVENTIONS In group A (n = 25), an 18-gauge Tuohy needle was directed at the lower mid-part of the femoral nerve, and a nonstimulating catheter was inserted through the needle under US guidance. In group B (n = 25), an 18-gauge Tuohy needle and stimulating catheter were directed to the lower part of femoral nerve under US guidance, and quadriceps muscle contraction was checked using NS. All patients received a 20-mL loading dose of 0.2% ropivacaine, a continuous infusion of 4 mL/h, and a 4-mL bolus of 0.2% ropivacaine with a lockout time of 60 minutes for patient-controlled analgesia. MEASUREMENTS The primary outcome was resting and exercising pain quality assessed by numeric rating scale. Other outcomes included procedure time for correct catheter placement, block failure rate, patient satisfaction for postoperative pain control, total dose of local anesthetic, additional opioid requirement, and adverse effects postoperatively. MAIN RESULTS There were no significant differences between groups in resting and exercising numeric rating scale. Procedure times were longer in group B than group A (P < .05). There were no significant differences between groups in block failure rate or other outcomes. CONCLUSIONS US-guided CFNB was associated with similar analgesic efficacy and block failure rate and reduced procedure time compared to US with NS guidance for CFNB in patients undergoing TKA.
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Affiliation(s)
- Hee-Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea; Research Institute for Convergence of biomedical science and technology Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea; Research Institute for Convergence of biomedical science and technology Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea.
| | - Hyun-Jun Cho
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Seung-Hoon Baek
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea; Research Institute for Convergence of biomedical science and technology Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea
| | - Sang-Wook Shin
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea; Research Institute for Convergence of biomedical science and technology Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea
| | - Hyung-Jun Cho
- Research Institute for Convergence of biomedical science and technology Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea; Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea
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Clothier V, Morphet J. Femoral nerve blocks for fractured neck of femur patients: A ‘feel good solution’ but a ‘short-term fix'? Emerg Med Australas 2015; 27:512-515. [DOI: 10.1111/1742-6723.12479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/23/2023]
Affiliation(s)
| | - Julia Morphet
- Monash Health; Dandenong Hospital; Melbourne Victoria Australia
- School of Nursing and Midwifery; Monash University; Melbourne Victoria Australia
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Fan L, Zhu C, Zan P, Yu X, Liu J, Sun Q, Li G. The Comparison of Local Infiltration Analgesia with Peripheral Nerve Block following Total Knee Arthroplasty (TKA): A Systematic Review with Meta-Analysis. J Arthroplasty 2015; 30:1664-71. [PMID: 25922311 DOI: 10.1016/j.arth.2015.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty (TKA) is usually associated with severe post-operative pain, which can prevent rehabilitation of patients' knee function and influence the satisfaction of surgery. Local infiltration analgesia (LIA) is a method that has been applied in clinical practice recently. However, the clinical use of this method is still under discussion. In this paper, we systematically reviewed randomized clinical trails (RCTs) comparing LIA with peripheral nerve block (PNB) to verify the efficacy and safety of LIA. During the analysis, we strictly filtered papers and chose ones that had fewer disturbance variables. We also analyzed the heterogeneity. We conclude that when compared with PNB, pain control with LIA is at least comparable.
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Affiliation(s)
- Lin Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
| | - Chunyan Zhu
- Department of Operating Room, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Pengfei Zan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
| | - Xiao Yu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
| | - Jin Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
| | - Qi Sun
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
| | - Guodong Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China
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Shah NA, Jain NP, Panchal KA. Adductor Canal Blockade Following Total Knee Arthroplasty-Continuous or Single Shot Technique? Role in Postoperative Analgesia, Ambulation Ability and Early Functional Recovery: A Randomized Controlled Trial. J Arthroplasty 2015; 30:1476-81. [PMID: 25824025 DOI: 10.1016/j.arth.2015.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/24/2015] [Accepted: 03/10/2015] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED Total knee arthroplasty (TKA) can be associated with severe pain in early postoperative period. Adductor canal block may provide optimal analgesia following TKA. However, ideal regimen for administration whether continuous or single shot is yet undefined. We prospectively randomized 90 patients in continuous and single shot adductor canal blockade groups. Postoperative VAS (visual analog scale for pain) score was significantly better at all times in continuous than single shot technique (P<0.001). However, ambulation ability (Timed Up & Go, 10m walk, 30s chair) and early functional recovery (active SLR, ambulation with walker, staircase competency, ambulation distance and maximal flexion at discharge) showed no statistical significant difference. Continuous adductor canal blockade was superior to single shot block in terms of pain control but was similar for early functional recovery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Nilen A Shah
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India
| | - Nimesh P Jain
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India; Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, South Korea
| | - Karnav A Panchal
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India; Rajasthan Hospital, Shahibaug, Ahmedabad, Gujrat, India
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Yu B, Hu X, Zou T, He M, Cai G. Effects of Postoperative Continuous Femoral Nerve Block Analgesia with Braun Continuous Peripheral Nerve Block Catheter Set versus Novel Needle-Over-Cannula after Total Knee Arthroplasty. Med Sci Monit 2015; 21:1843-9. [PMID: 26111971 PMCID: PMC4494567 DOI: 10.12659/msm.893617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the novel needle-over-cannula vs. the Braun continuous peripheral nerve block catheter set (Contiplex A) in postoperative analgesics after total knee arthroplasty (TKA). MATERIAL AND METHODS Sixty patients undergoing total knee arthroplasty were randomly assigned to Braun continuous peripheral nerve block catheter set group (Braun Group, n=30) or the novel needle-over-cannula group (Cannula Group, n=30). All the patients in the 2 groups received continuous femoral nerve block (CFNB) for postoperative analgesics. RESULTS We found no significant difference in analgesic effect between the 2 groups. The time of catheter or cannula insertion was shorter in the Cannula Group than in the Braun Group. Four (13.32%) out of 30 patients had failed catheter insertions in the Braun Group compared to none in the Cannula Group. Twelve (46%) out of 26 patients in the Braun Group had serious local anesthetic leakage at puncture sites during 12 h compared to none in the Cannula Group. CONCLUSIONS The novel needle-over-cannula is effective, convenient, and safe in CFNB after TKA.
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Affiliation(s)
- Bin Yu
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Xiaoxue Hu
- Department of Anesthesiology, Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China (mainland)
| | - Tianxiao Zou
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Miao He
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Guangyu Cai
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
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Kessler J, Marhofer P, Hopkins P, Hollmann M. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth 2015; 114:728-45. [DOI: 10.1093/bja/aeu559] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty 2014; 29:2224-9. [PMID: 25041873 DOI: 10.1016/j.arth.2014.06.010] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/10/2014] [Accepted: 06/15/2014] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED Total knee arthroplasty is associated with intense, early post-operative pain. Femoral nerve block is known to provide optimal pain relief but reduces the strength of the quadriceps muscle and associated with the risk of falling. Adductor canal block is almost pure sensory blockade with minimal effect on quadriceps muscle strength. We prospectively randomized 100 patients in two groups' continuous adductor and femoral block group. Ambulation ability (Timed up go, 10-m walk, 30 s chair test), time to active SLR, quadsticks, staircase competency, ambulation distance was significantly better (P value < 0.001) in adductor canal group whereas pain scores, opioid consumption showed no significant difference. Adductor canal block provided better ambulation and early functional recovery but without superior analgesia than femoral nerve block post TKA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Nilen A Shah
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India
| | - Nimesh P Jain
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India; Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, South Korea
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Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty. Clin Orthop Relat Res 2014; 472:1394-9. [PMID: 23857316 PMCID: PMC3971238 DOI: 10.1007/s11999-013-3164-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period. QUESTIONS/PURPOSES This study sought to determine whether continuous femoral nerve block with a single-shot sciatic block prevented early ambulation after total knee arthroplasty (TKA) and whether the technique was associated with adverse effects. METHODS Between January 2011 and January 2013, 77 consecutive patients undergoing primary TKAs at an orthopaedic specialty hospital received a continuous femoral nerve block for perioperative analgesia. The femoral block was placed preoperatively with an initial bolus and 76 (99%) patients received a single-shot sciatic nerve block performed at the same time. Fifty-eight percent (n = 45) received an initial bolus of 0.125% bupivacaine and 42% (n = 32) received 0.25% bupivacaine. All 77 patients received 0.125% bupivacaine infusion postoperatively with the continuous femoral nerve block. All patients were provided a knee immobilizer that was worn while they were out of bed and was used until 24 hours after removal of the block. All patients also used a front-wheeled walker to assist with ambulation. All 77 patients had complete records for assessing the end points of interest in this retrospective case series, including distance ambulated each day and whether in-hospital complications could be attributed to the patients' nerve blocks. RESULTS Thirty-five patients (45%) ambulated for a mean distance of 19 ± 22 feet on the day of surgery. On postoperative Days 1 and 2, all 77 patients successfully ambulated a mean of 160 ± 112 and 205 ± 123 feet, respectively. Forty-eight patients (62%) had documentation of ascending/descending stairs during their hospital stay. No patient fell during the postoperative period, required return to the operating room, or readmission within 90 days of surgery. One patient experienced a transient foot drop related to the sciatic nerve block, which resolved by postoperative Day 1. CONCLUSIONS Continuous femoral nerve block with dilute bupivacaine (0.125%) can be successfully used after TKA without preventing early ambulation. By taking active steps to prevent in-hospital falls, including the use of a knee immobilizer for ambulation while the block is in effect, patients can benefit from the analgesia provided by the block and still ambulate early after TKA. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Factors influencing decision making on therapeutic interventions. Int J Technol Assess Health Care 2014; 29:331-5. [PMID: 23863190 DOI: 10.1017/s0266462313000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to explore factors that influenced decision making in the assessment of new health technology in Korea. METHODS We analyzed the decision-making results of the Committee for New Health Technology Assessment (CnHTA) on fifty-three new nondrug health technologies in Korea from July 2007 to December 2010. The scope of the committee was mainly limited to safety and efficacy/effectiveness, and every decision was based on a systematic review of the literature. The committee was composed of healthcare professionals, policy makers, lawyers, and representatives from nongovernmental organizations. Decisions made on therapeutic interventions were included, while those on diagnostic procedures were excluded. RESULTS Factors that positively influenced decisions were lower complication rate than existing technology, similar or greater effectiveness compared with existing technology, ability to save critical organs, absence of alternative intervention, decreased invasiveness, expansion of patient's set of choices, and similarity to the mechanism of existing technology. Factors that negatively influenced decisions were higher complication rates than existing technology, lower effectiveness than comparable technology, low levels of evidence, unknown mechanisms of intervention, inconsistency, lack of long-term outcomes, lack of comparative data, nonstandardized technology, heterogeneity between control and treatment, excessively diverse indications, and nongeneralizability. CONCLUSIONS This qualitative analysis of past decision-making results provided us with clues on the values that decision makers on the Korean CnHTA considered in terms of safety and effectiveness. These findings will help us develop appraisal guidelines and enhance the objectivity of decision-making processes in Korea.
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Anderson BM, Donnelly MJ, Groose M, Chambers T, Schroeder KM. Changing from epidurals to femoral nerve catheters for postoperative analgesia following total knee arthroplasty: Analysis of efficacy versus nurse perception. Int J Orthop Trauma Nurs 2014. [DOI: 10.1016/j.ijotn.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brueilly KE, Pabian PS, Straut LC, Freve LA, Kolber MJ. Factors contributing to rehabilitation outcomes following hip arthroplasty. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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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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Postoperative Pain Control for Total Knee Arthroplasty: Continuous Femoral Nerve Block Versus Intravenous Patient Controlled Analgesia. Anesth Pain Med 2012. [DOI: 10.5812/anesthpain.3404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Complications of femoral nerve blockade in total knee arthroplasty and strategies to reduce patient risk. J Arthroplasty 2012; 27:564-8. [PMID: 21908171 DOI: 10.1016/j.arth.2011.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 06/30/2011] [Indexed: 02/01/2023] Open
Abstract
Femoral nerve catheters are widely used for analgesia in total knee arthroplasty. Although evidence suggests that catheters improve pain control and may facilitate short-term rehabilitation, few reports exist regarding their complications. This case series explores the experience of femoral nerve catheter use at high-volume orthopedic specialty hospitals. Serious complications including compartment syndrome, periprosthetic fracture, and vascular injury are reported. The authors support femoral nerve catheter use with appropriate precautions taken to reduce risk of patient falls, vascular injury, and wrong-site surgery.
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Lee RM, Lim Tey JB, Chua NHL. Postoperative pain control for total knee arthroplasty: continuous femoral nerve block versus intravenous patient controlled analgesia. Anesth Pain Med 2012; 1:239-42. [PMID: 24904807 PMCID: PMC4018706 DOI: 10.5812/aapm.3404] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 11/25/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022] Open
Abstract
Background: Pain after total knee arthroplasty is severe and impacts functional recovery. Objectives: We performed a retrospective study, comparing conventional patient control analgesia (PCA) modalities versus continuous femoral nerve blockade (CFNB) for 1582 post-TKA (total knee arthroplasty) patients. Patients and Methods: Using our electronic acute pain service (APS) database, we reviewed the data of 579 patients who had received CFNBs compared with 1003 patients with intravenous PCA over 4 years. Results: Our results show that the incidence of a severe pain episode was higher in the PCA compared with the CFNB group. Lower pain scores were observed in the CFNB group compared with the PCA group from postoperative day (POD) 1 to 3, primarily due to lower rest pain scores in the CFNB group. Conclusions: Our study shows that there is improvement in pain scores, at rest and on movement, as well as a reduction in incidence of severe pain, in patients who receive CFNB versus those who receive intravenous PCA.
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Affiliation(s)
- Rui Min Lee
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
- Corresponding author: Rui Min Lee, Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, BLK 501 Ang Mo Kio Ave 5 #06-3704 S (560501), Singapore. Tel: +65-097237392. E-mail:
| | - John Boon Lim Tey
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Nicholas Hai Liang Chua
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
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Acute Care Outcomes Status Post Total Knee Arthroplasty with Continuous Femoral Nerve Block. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2012. [DOI: 10.1097/01592394-201203010-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Two continuous femoral nerve block strategies after TKA. Knee Surg Sports Traumatol Arthrosc 2011; 19:1901-8. [PMID: 21484386 DOI: 10.1007/s00167-011-1510-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 04/04/2011] [Indexed: 01/06/2023]
Abstract
PURPOSE The purposes of this study were to compare the pain score, systemic opioid consumption, and range of motion (ROM) between the group where the use of continuous femoral nerve block (CFNB) was discontinued on postoperative day 3 (POD 3) and the group where it was discontinued on POD 7 within an established clinical pathway for postoperative recovery after total knee arthroplasty (TKA) and to assess the treatment-related side effects and complications, as well as the functional status of these two groups of patients at 2 years after surgery. METHODS This prospective, randomized, double-blinded trial compared the analgesic efficacy and the functional outcomes between group A (n = 30) where continuous femoral nerve block was performed until POD 3 (discontinued prior to the initiation of range of motion (ROM) exercises) and group B (n = 33), where the continuous femoral nerve block was performed until POD 7 (discontinued during the ROM exercise) after TKA. RESULTS The resting pain scores of group B were lower than those of group A but there was no significant difference between the two groups (n.s., P = 0.387). However, the peak pain scores during ROM exercise, beginning on POD3 through to POD14, were significantly lower in group B than in group A (P = 0.001). The cumulative morphine IV-PCA requirements through the POD 2 were similar in the two groups (n.s., P = 0.811). However, the cumulative oral oxycodone consumption during hospitalization was significantly lower in group B than in group A, P < 0.0001. Group B showed significantly greater satisfaction with their method of analgesia than group A (P = 0.001). Group A scored 2.0 (2.0-3.0), whereas group B scored 1.0 (1.0-2.0). At 2 years, there was no significant difference in the functional outcomes (the knee flexion and extension angle, the Knee Society Score, and WOMAC pain, stiffness, and function scale). CONCLUSION The study group who received 7-day continuous femoral nerve block after TKA showed superior analgesia and higher patient satisfaction during the hospital stay than those given 3-day continuous femoral nerve block. Despite the additional time, effort and cost to place and manage continuous femoral nerve catheters, the 7-day continuous femoral nerve block can be recommended as an effective and safe regional component of a multimodal analgesia strategy after TKA.
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Zhang S, Wang F, Lu ZD, Li YP, Zhang L, Jin QH. Effect of Single-Injection versus Continuous Local Infiltration Analgesia after Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Study. J Int Med Res 2011; 39:1369-80. [PMID: 21986137 DOI: 10.1177/147323001103900423] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this randomized, double-blind, placebo-controlled, single-centre study, 80 patients (American Society of Anesthesiologists physical status I — III) received postoperative single-injection local infiltration analgesia (SLIA), continuous local infiltration analgesia (CLIA) or placebo (control group). Intravenous patient-controlled morphine was used as rescue analgesia. The CLIA group showed lower postoperative visual analogue scale (VAS) pain scores from 8 to 48 h at rest and from 16 to 48 h during activity compared with the SLIA group. The CLIA group also had significantly lower consumption of morphine from 24 to 48 h postoperatively versus the SLIA group. Patient satisfaction was higher, and maximum flexion of the knee on postoperative days 7 and 90 was greater, in the CLIA group compared with the SLIA group. CLIA provided prolonged superior analgesia and was associated with more favourable functional recovery and patient satisfaction compared with SLIA.
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Affiliation(s)
- S Zhang
- Postgraduate Education College, Ningxia Medical University, Yinchuan, China
| | - F Wang
- Department of Anaesthesiology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
| | - ZD Lu
- Department of Orthopaedics, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
| | - YP Li
- Department of Orthopaedics, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
| | - L Zhang
- Department of Orthopaedics, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
| | - QH Jin
- Department of Orthopaedics, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
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Fetherston CM, Ward S. Relationships between post operative pain management and short term functional mobility in total knee arthroplasty patients with a femoral nerve catheter: a preliminary study. J Orthop Surg Res 2011; 6:7. [PMID: 21294923 PMCID: PMC3238227 DOI: 10.1186/1749-799x-6-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 02/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective pain management following total knee arthroplasty (TKA) is fundamental in achieving positive rehabilitation outcomes. The purpose of our study was to investigate post operative pain management in relation to short term functional mobility in an intervention group receiving concomitant use of an IV narcotic PCA and a continuous infusion of local anaesthetic via a femoral nerve catheter (CFNC), compared to a group receiving narcotic PCA alone. This was a preliminary study conducted to establish an appropriate design for a larger investigative study. METHODS A prospective design was used to measure the effect of a CFNC on post operative pain management and functional mobility prior to hospital discharge. The amount of fentanyl used, pain and nausea scores, timed up and go (TUG) tests and active range of knee movement (AROM) were used to compare a CFNC and supplemental narcotic patient controlled analgesia (PCA) group (n = 27) with a PCA only group (n = 25). RESULTS The CFNC group used significantly less fentanyl than the PCA only group (p < .001) but there was no significant difference in TUG times between the two groups. There was however a significantly lower AROM reported for both extension (p < .04) and flexion (p < .006,) in the FNC group. Women had significantly slower TUG times (p < .005,) and there were moderate to strong positive correlations between post operative TUG times and the preoperative TUG time (r(s) = .505 p < .001), the time since oral analgesia (r(s) = .529 p < .014), and pain scores (r(s) = .328, p = .034) CONCLUSIONS In this small preliminary study improved TUG performance at Day 4 post op was not influenced by the use of a CFNC but was positively correlated with male gender, preoperative performance, time elapsed since last oral analgesia and pain score. However AROM was decreased in the CFNC group suggesting further research on the relationship between CFNCs, local anaesthetic concentration and quadriceps strength should be incorporated in the follow up study's design.
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Affiliation(s)
- Catherine M Fetherston
- School of Nursing and Midwifery, Murdoch University, Education Drive, Mandurah 6210, Western Australia
| | - Sarah Ward
- Peel Health Campus, Lakes Road, Mandurah 6210, Western Australia
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Carli F, Clemente A, Asenjo J, Kim D, Mistraletti G, Gomarasca M, Morabito A, Tanzer M. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 2010; 105:185-95. [DOI: 10.1093/bja/aeq112] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Pulley SC, Spofford CM, Brennan TJ. Continuous cervical paravertebral catheter knot. J Clin Anesth 2010; 22:135-8. [DOI: 10.1016/j.jclinane.2009.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 02/17/2009] [Accepted: 02/24/2009] [Indexed: 10/19/2022]
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Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty 2009; 24:132-7. [PMID: 19553071 DOI: 10.1016/j.arth.2009.04.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 04/03/2009] [Indexed: 02/01/2023] Open
Abstract
One thousand one hundred ninety patients underwent knee arthroplasty between January 2004 and July 1, 2007, and received an indwelling continuous infusion femoral catheter for postoperative ropivicaine pump infusion. Catheters were placed using electrical stimulation guidance. For the initial 469 patients (group 1), the continuous infusion ran for 2 to 3 days. In 721 patients, the infusion was discontinued 12 hours after surgery. There were 9 femoral nerve palsies (2 in group 1, 7 in group 2) and 8 major falls (0.7%). The overall complication rate was 1.5%, and the risk of permanent nerve injury was 0.2%. Patients should be made aware of these complications as part of the usual informed consent process before using this technique for postoperative pain control after knee arthroplasty. We did not observe fewer falls when the continuous infusion was stopped 12 hours after surgery.
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Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study. J Arthroplasty 2009; 24:138-43. [PMID: 19520544 DOI: 10.1016/j.arth.2009.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 03/20/2009] [Indexed: 02/01/2023] Open
Abstract
We investigated the hypothesis that a posterior capsular injection of ropivacaine would improve pain and accelerate functional recovery after total knee arthroplasty in a randomized, double-blind, placebo-controlled study design. Sixty-six patients received a standardized multimodal anesthesia protocol that included a femoral nerve block. Twenty milliliters of either saline (control) or ropivacaine (study group) was injected into the posterior capsule. Pain and function outcomes were recorded prospectively at 4, 8, 12, and 24 hours postinjection. Significantly more patients in the study group were able to perform a straight-leg raise at 8 and 12 hours. In addition, significantly more patients in the control group had a numeric pain score higher than 7/10 (severe pain) at the 12-hour evaluation. Other parameters of pain or functional recovery were not significantly different between the 2 groups. Posterior capsular injection did not improve the pain or accelerate the functional recovery after 12 hours in patients also receiving a femoral nerve block for pain control after total knee arthroplasty.
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Kandasami M, Kinninmonth AW, Sarungi M, Baines J, Scott NB. Femoral nerve block for total knee replacement - a word of caution. Knee 2009; 16:98-100. [PMID: 19046884 DOI: 10.1016/j.knee.2008.10.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 10/23/2008] [Accepted: 10/26/2008] [Indexed: 02/02/2023]
Abstract
Femoral nerve block (FNB) is a well documented option for post-operative analgesia following major knee surgery. However, motor blockade may be prolonged preventing early mobilisation thereby increasing the length of stay. In addition, as a consequence of persistent quadriceps weakness, patients have an increased risk of falling. We present a series of five patients who underwent total knee replacement with spinal anaesthesia and FNB who fell, sustaining complete wound disruption - including a patient with peri-prosthetic fracture requiring further surgery and prolonged hospital stay. The literature, which is largely in anaesthetic journals, reflects the high quality of analgesia of FNB but makes little or no mention of the delays or dangers in early mobilization. We believe that the potential risks to orthopaedic patients are underestimated.
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Abstract
PURPOSE OF REVIEW The present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks. RECENT FINDINGS Continuous peripheral nerve blocks consistently provide better analgesia than traditional systemic opioid-based analgesia. The literature shows that continuous peripheral nerve blocks prolong site-specific local anesthetic delivery in the outpatient setting, allow optimal analgesia, have minimal side effects, and avoid premature regression of an analgesic block. Furthermore, an improvement in patients' health-related quality of life or outcome benefits has been demonstrated. It appears that continuous peripheral nerve blocks are generally superior to intraarticular local anesthetic infusion for immediate postoperative pain, but new data demonstrate that, apart from a multimodal analgesia regimen, periarticular and intraarticular application of local anesthetics can improve early postoperative analgesia and mobilization. Finally, it seems that, only for interscalene and popliteal sciatic nerve blocks, the use of stimulating catheters slightly decreases visual analog scale scores for postoperative pain and intravenous opioid rescue analgesia. Ultrasound guidance offers the potential advantage to confirm catheter tip location. SUMMARY Continuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.
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Elmawgoud MAA, Badawy A, Abu Elkass S, Rashwan D. Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.395.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Heid F, Müller N, Piepho T, Bäres M, Giesa M, Drees P, Rümelin A, Werner C. Postoperative Analgesic Efficacy of Peripheral Levobupivacaine and Ropivacaine: A Prospective, Randomized Double-Blind Trial in Patients After Total Knee Arthroplasty. Anesth Analg 2008; 106:1559-61, table of contents. [DOI: 10.1213/ane.0b013e318168b493] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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