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Huang H, Tang K, Song X, Zhao L, Liang Y, Xu H, Xiao L, Chen Y. Effects of contralateral versus ipsilateral electroacupuncture for analgesia and rehabilitation after unilateral total knee arthroplasty: a randomized controlled trial. Acupunct Med 2024; 42:183-193. [PMID: 38149653 DOI: 10.1177/09645284231211601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) is a treatment for advanced knee osteoarthritis. Since postoperative pain affects rehabilitation, this study aimed to determine whether electroacupuncture (EA) contralateral to the surgical site is more effective than ipsilateral EA or sham EA in terms of relieving postoperative pain and promoting post-TKA rehabilitation. METHODS In this parallel, single-blind randomized controlled trial, 114 patients undergoing unilateral TKA were assigned to the contralateral EA (EA on the contralateral side + sham EA on the ipsilateral), ipsilateral EA (EA on the ipsilateral + sham EA on the contralateral side), or sham EA (sham EA on both sides) groups (n = 38 each). Treatment was performed once daily on postoperative days 1-3. The visual analog scale (VAS) scores, additional opioid doses via patient-controlled analgesia (PCA) pump, Hospital for Special Surgery (HSS) knee scores, active/passive range of motion (AROM/PROM), swelling around the knee joint, and Hamilton anxiety scale (HAMA) scores were used for postoperative evaluation. RESULTS At 3 days postoperatively, the VAS scores, HSS scores, AROM/PROM, swelling around the knee, and HAMA scores in the contralateral EA and ipsilateral EA groups were significantly improved compared with baseline. In addition, VAS scores, HSS scores, PROM and swelling around the knee were significantly better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups. Furthermore, PCA additional dose release was significantly higher in the sham EA group than in the two true EA groups (which did not significantly differ). At 10 days postoperatively, the HSS scores, AROM/PROM, and HAMA scores were better in the contralateral and ipsilateral EA groups than in the sham EA group, but similar in the two true EA groups. CONCLUSION Contralateral EA is more effective than sham EA for treating postoperative pain following TKA, but has an analgesic effect similar to that of ipsilateral EA. TRIAL REGISTRATION NUMBER ChiCTR1800020297 (Chinese Clinical Trial Registry).
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Affiliation(s)
- Hai Huang
- Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine
| | - Kangmin Tang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiuling Song
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Zhao
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongying Liang
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Xu
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lianbo Xiao
- Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuelai Chen
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Hadlandsmyth K, Lund BC, Gao Y, Strayer AL, Davila H, Hausmann LRM, Schmidt S, Shireman PK, Jacobs MA, Mader MJ, Tessler RA, Duncan CA, Hall DE, Sarrazin MV. Social Determinants of Long-Term Opioid Use Following Total Knee Arthroplasty. J Knee Surg 2024; 37:742-748. [PMID: 38599604 DOI: 10.1055/s-0044-1786021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Total knee arthroplasty (TKA) risks persistent pain and long-term opioid use (LTO). The role of social determinants of health (SDoH) in LTO is not well established. We hypothesized that SDoH would be associated with postsurgical LTO after controlling for relevant demographic and clinical variables. This study utilized data from the Veterans Affairs Surgical Quality Improvement Program, VA Corporate Data Warehouse, and Centers for Medicare and Medicaid Services, including Veterans aged ≥ 65 who underwent elective TKA between 2013 and 2019 with no postsurgical complications or history of significant opioid use. LTO was defined as > 90 days of opioid use beginning within 90 days postsurgery. SDoH variables included the Area Deprivation Index, rurality, and housing instability in the last 12 months identified via medical record screener or International Classification of Diseases, Tenth Revision codes. Multivariable risk adjustment models controlled for demographic and clinical characteristics. Of the 9,064 Veterans, 97% were male, 84.2% white, mean age was 70.6 years, 46.3% rural, 11.2% living in highly deprived areas, and 0.9% with a history of homelessness/housing instability. Only 3.7% (n = 336) developed LTO following TKA. In a logistic regression model of only SDoH variables, housing instability (odds ratio [OR] = 2.38, 95% confidence interval [CI]: 1.09-5.22) and rurality conferred significant risk for LTO. After adjusting for demographic and clinical variables, LTO was only associated with increasing days of opioid supply in the year prior to surgery (OR = 1.52, 95% CI: 1.43-1.63 per 30 days) and the initial opioid fill (OR = 1.07; 95% CI: 1.06-1.08 per day). Our primary hypothesis was not supported; however, our findings do suggest that patients with housing instability may present unique challenges for postoperative pain management and be at higher risk for LTO.
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Affiliation(s)
- Katherine Hadlandsmyth
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Brian C Lund
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
| | - Yubo Gao
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrea L Strayer
- College of Nursing, University of Iowa, Iowa City, Iowa
- Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations VA Quality Scholars Advanced Fellowship Program, Iowa City, Iowa
| | - Heather Davila
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas
| | - Paula K Shireman
- Department of Primary Care and Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, Texas
| | - Michael A Jacobs
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Michael J Mader
- Research Service, South Texas Veterans Healthcare System, San Antonio, Texas
| | - Robert A Tessler
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carly A Duncan
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Daniel E Hall
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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3
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Ahmed HS, Jayaram PR. Anesthetic considerations for joint replacement surgery in hemophilic arthropathy: a comprehensive review. Anesth Pain Med (Seoul) 2024; 19:194-208. [PMID: 39069647 PMCID: PMC11317322 DOI: 10.17085/apm.24047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024] Open
Abstract
Managing hemophilia in patients undergoing joint replacement surgery requires a comprehensive approach encompassing preoperative assessment, meticulous intraoperative care, and tailored postoperative management. Evaluation of joint integrity, bleeding history, and inhibitor presence guides surgical planning and hemostatic therapy selection to optimize outcomes. During surgery, careful attention to factor replacement, antibiotic prophylaxis, anesthetic techniques, and orthopedic strategies minimizes bleeding risk and enhances surgical success. Postoperatively, effective pain management, continued hemostatic therapy, and individualized rehabilitation programs are vital for facilitating recovery and preventing complications. Close monitoring for potential complications, such as periprosthetic joint infection and recurrent hemarthrosis, allows for prompt intervention when necessary. Overall, a collaborative approach involving hematologists, orthopedic surgeons, anesthesiologists, and rehabilitation specialists ensures comprehensive care tailored to the unique needs of patients with hemophilia undergoing joint replacement surgery, ultimately optimizing outcomes and improving quality of life. This holistic approach addresses the multifaceted challenges posed by hemophilia and joint replacement surgery, providing patients with the best possible chance for successful outcomes and long-term joint function. By integrating specialized expertise from multiple disciplines and implementing evidence-based strategies, healthcare providers can effectively manage hemophilia in the context of joint replacement surgery, mitigating risks and maximizing benefits for patients.
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Affiliation(s)
- H Shafeeq Ahmed
- Bangalore Medical College and Research Institute, Bangalore, India
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Marcus-Aiyeku U, Fake P, Fetzer C, Hessels A, Kilpatrick R, Markiewicz D, McNicholas M, Mills K, Nedumalayil S, Paliwal M, Panten A, Schuld C, Ullero A. Utilization of patient-reported outcomes in joint replacement care design. Nurs Manag (Harrow) 2024; 55:42-50. [PMID: 38314996 DOI: 10.1097/nmg.0000000000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Analysis finds health disparities among the elective surgery population.
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Affiliation(s)
- Ulanda Marcus-Aiyeku
- Ulanda Marcus-Aiyeku is a nurse scientist at the Ann May Center, Hackensack Meridian Health in Edison, N.J. Pamela Fake is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Christine Fetzer is a retired occupational therapist located in N.J. Amanda Hessels is a nurse scientist at the Ann May Center, Hackensack Meridian Health in Edison, N.J. and an assistant professor of nursing at Columbia University in New York, N.Y. Rachel Kilpatrick is the clinical program manager at Riverview Medical Center in Red Bank, N.J. Dorothy Markiewicz is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Miriam McNicholas is the director of professional practice/clinical policy at Hackensack Meridian Health in Edison, N.J. Kimberly Mills is a project manager, Orthopedic-Care Transformation Services, Hackensack Meridian Health in Edison, N.J. Seera Nedumalayil is a staff RN at Hackensack University Medical Center in Hackensack, N.J. Mani Paliwal is a senior biostatistician at the Institute for Evidence Based Care, Hackensack Meridian Health in Edison, N.J. Angie Panten is a clinical program manager at Ocean University Medical Center in Brick Township, N.J. Clare Schuld is a clinical nurse navigator for Orthopedics at Old Bridge Medical Center in Old Bridge, N.J., and Raritan Bay Medical Center in Raritan, N.J. Amarlyn Ullero is a staff RN at Hackensack University Medical Center in Hackensack, N.J
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McNaughton MA, Quinlan-Colwell A, Lyons MT, Arkin LC. Acute Perioperative Pain Management of the Orthopaedic Patient: Guidance for Operationalizing Evidence Into Practice. Orthop Nurs 2024; 43:10-22. [PMID: 38266259 DOI: 10.1097/nor.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.
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Affiliation(s)
- Molly A McNaughton
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Ann Quinlan-Colwell
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Mary T Lyons
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Laura C Arkin
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
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Hawkins K, Coffey M, Cooper M, Markwell A, Boyd P, Zuk K, Thompson E. The Use of Lavender Aromatherapy for Pain After Total Hip and Total Knee Arthroplasty: A Randomized Trial. Orthop Nurs 2023; 42:230-242. [PMID: 37494903 DOI: 10.1097/nor.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
A randomized clinical trial was conducted over a threemonth period with 102 participants undergoing a total hip arthroplasty (THA) or total knee arthroplasty (TKA). The study purpose was to assess whether there was a reduction in the use of opioids in the postoperative period for THA or TKA participants that utilized lavender aromatherapy as an adjunct to pain medication. The participants in the control and intervention group were administered nonopioid pain medication around the clock and opioids as needed after surgery. However, the intervention group also received a pre-packaged lavender essential oil inhaler. Total oral morphine equivalents (OME) were calculated for each participant to determine opioid usage. Although the total OME was similar for the groups overall, the total OME was slightly lower for THA patients that were enrolled in the intervention group (median 22.5) compared to THA patients that were enrolled in the control group (median 31.2). In the intervention group, 58% of participants reported that the lavender inhaler was a useful tool for pain management and 76% indicated they would continue to use the lavender inhaler after discharge.
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Affiliation(s)
- Kelley Hawkins
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Mary Coffey
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Maureen Cooper
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Ashley Markwell
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Pamela Boyd
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Kathy Zuk
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
| | - Elizabeth Thompson
- Kelley Hawkins, BSN, RN, HN-BC, Nurse Professional Development Generalist, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Mary Coffey, PhD, Senior Biostatistician, Research Institute, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Maureen Cooper, MSN, RN, ACNS-BC, ONC, HN-BC, Clinical Nurse Manager, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Wound Care Clinical Nurse Specialist, Corewell Health Dearborn Hospital, Dearborn, MI
- Pamela Boyd, MSN, RN, ACNPC-AG, HN-BC, Orthopaedic Nurse Practitioner, Corewell Health William Beaumont University Hospital, Royal Oak, MI
- Kathy Zuk, BSN, RN, HN-BC, Postoperative Nurse, Michigan Orthopaedic Surgeons
- Elizabeth Thompson, BSN, RN, HN-BC, Clinical Nurse Instructor, Oakland Community College, Auburn Hills, MI
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Watson MB, Wood BA, Tubog TD. Utilization of Ketamine in Total Knee and Hip Joint Arthroplasty: An Evidence-Based Review. J Perianesth Nurs 2023; 38:139-147. [PMID: 35985972 DOI: 10.1016/j.jopan.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the efficacy of ketamine in total knee and hip arthroplasty. DESIGN Evidence-based review. METHODS Following the guidelines outlined in the PRISMA statement, a comprehensive search was conducted using Google Scholar, PubMed, CINAHL, Cochrane Collaboration, and other grey literature. Only randomized controlled studies and pre-appraised evidence such as systematic review and meta-analysis examining the effects of ketamine in total knee and hip arthroplasty were included. The quality appraisal of the literature was conducted using the proposed algorithm described in the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. FINDINGS Three systematic reviews and meta-analyses and 2 randomized controlled trials involving 1284 patients were included in this review. The use of ketamine reduced pain scores within the 24 hours after surgery. In addition, evidence suggests that patients who were treated with ketamine consumed fewer opioids 24 and 48 hours after surgery. Furthermore, ketamine reduced the incidence of postoperative nausea and vomiting with no effects on the incidence of hallucinations and central nervous system side effects. All studies included in the review were categorized as Level I and rated Grade A implying strong confidence in the true effects of ketamine in all outcome measures in the review. CONCLUSIONS The current evidence demonstrates the viability of ketamine as a safe and effective alternative to opioids in the perioperative setting with major total joint arthroplasty surgery. Decreased pain scores and opioid consumption up to 48 hours into the postoperative period were observed in a number of the appraised articles.
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Affiliation(s)
- Matthew B Watson
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Blake A Wood
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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8
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Kamel EZ, Fathy GM, Talaat M, Bakri MH, Soliman OM, Abd El-Salam MAER, Ismail EA. Ultrasound guided suprascapular and costoclavicular nerve block versus interscalene nerve block for postoperative analgesia in arthroscopic shoulder surgery: A randomized non-inferiority clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2108050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Emad Zarief Kamel
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Golnar M Fathy
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Talaat
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed H. Bakri
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar M. Soliman
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Eman A. Ismail
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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9
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Gabapentin for Pain Management in Total Joint Arthroplasty. Orthop Nurs 2022; 41:406-411. [DOI: 10.1097/nor.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Hampton H, Torre M, Satalich J, Pershad P, Gammon L, O’Connell R, Brusilovsky I, Vap A. Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery. Orthop J Sports Med 2022; 10:23259671221133412. [PMID: 36452342 PMCID: PMC9703544 DOI: 10.1177/23259671221133412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols in orthopaedic surgery have garnered significant focus due to their ability to control pain adequately in the immediate postoperative window, allowing for earlier mobilization, shorter hospital stays, and fewer complications. Virginia Commonwealth University created a multimodal pain management approach in which patients receive a preoperative femoral nerve block followed by periarticular intraoperative local injection anesthesia consisting of bupivacaine, ketamine, and ketorolac. HYPOTHESIS We hypothesized that implementation of the ERAS protocol will decrease postoperative pain scores, decrease recovery time in the postanesthesia care unit (PACU), and decrease opioid use in anterior cruciate ligament (ACL) reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Two patient cohorts were involved: before ERAS implementation (pre-ERAS) and after (post-ERAS). Patients with ACL reconstruction only and patients with ACL reconstruction with meniscal repair were analyzed separately. Post-ERAS patients received an intraoperative periarticular injection of bupivacaine, ketamine, and ketorolac and a postoperative multimodal pain regimen. Outcomes included time spent in the PACU, short-term and long-term opioid consumption, and pain score at discharge from the PACU. RESULTS Compared with pre-ERAS patients, post-ERAS patients had decreased pain (2.1 vs 0.84 out of 10, respectively), spent less time in the PACU (79.4 vs 62.8 minutes, respectively), and had less opioid consumption in the immediate postoperative period (4.55 vs 2.26 total morphine milligram equivalents [MMEs], respectively) (P < .001 for all). After ERAS implementation, long-term MME use decreased from 410 to 321 between 0 and 2 weeks postoperatively, 92.6 to 1.69 between 2 and 6 weeks, and 494.5 to 323 between 0 and 6 weeks (P < .001 for all). All domains showed significant improvements for both the ACL and the ACL plus meniscal repair cohorts, with the exception of pain at discharge in the ACL plus meniscal repair group. CONCLUSION The study findings suggest that an enhanced recovery pathways protocol that includes a standardized intraoperative periarticular bupivacaine, ketamine, and ketorolac injection improves pain scores in the immediate postoperative window, decreases opioid consumption, and reduces recovery time in the PACU for patients undergoing ACL reconstruction.
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Affiliation(s)
- Hailey Hampton
- Virginia Commonwealth University Medical School, Richmond, Virginia, USA
| | - Matthew Torre
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - James Satalich
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Prayag Pershad
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Lee Gammon
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Robert O’Connell
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Ilia Brusilovsky
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Alexander Vap
- Department of Orthopedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Multimodal analgesia is superior to opiates alone after tibial fracture in patients with substance abuse history. OTA Int 2022; 5:e214. [PMID: 36569103 PMCID: PMC9782319 DOI: 10.1097/oi9.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 05/08/2022] [Indexed: 12/27/2022]
Abstract
Objectives: To evaluate the effectiveness of multimodal analgesia in patients with a tibial shaft fracture. Design: Retrospective review. Setting: Large, urban, academic center. Patients: One hundred thirty-eight patients were evaluated before implementation of multimodal analgesia. Thirty-four patients were evaluated after implementation. All patients were treated operatively with internal fixation for their tibial shaft fracture. Patients with polytrauma were excluded. Intervention: Multimodal analgesia. Main Outcome Measures: Pain levels at rest and with movement were assessed. Morphine milligram equivalents (MMEs) dosed per patient were calculated each day. Length of stay was also documented. Results: After implementation of a multimodal analgesic program, there was a statistically significant decrease in pain score at rest (4.7-4.0, P = 0.034) and with movement (5.8-4.8, P = 0.007). MMEs dosed in the multimodal analgesic program correlated with pain score (R2 = 0.5), whereas before implementation of the program, MMEs dosed were not dependent on pain score (R2 = 0.007). Patients with a history of substance abuse had the most profound effect from this paradigm change. For those with a history of substance abuse, treatment of pain using a multimodal approach reduces MMEs dosed and length of stay (5.7-3.1 days, P = 0.016). Conclusions: Multimodal analgesia improves patient pain scores both at rest and during movement. In patients with a history of substance abuse, multimodal analgesia not only decreases pain but also decreases length of stay and MMEs dosed to levels consistent with someone who does not have a substance abuse history. Level of Evidence: Therapeutic Level III.
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Berardino K, Carroll AH, Popovsky D, Ricotti R, Civilette MD, Sherman WF, Kaye AD. Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties. Orthop Rev (Pavia) 2022; 14:35318. [DOI: 10.52965/001c.35318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022] Open
Abstract
Over the last several decades, rates of opioid use and associated problems have dramatically increased in the United States leading to laws limiting prescription duration for acute pain management. As a result, orthopedic surgeons who perform total hip arthroplasty (THA), a procedure that often leads to significant postoperative pain, have been faced with substantial challenges to adequately mitigate patient pain while also reducing opioid intake. Current strategies include identifying and correcting modifiable risk factors associated with postoperative opioid use such as preoperative opioid use, alcohol and tobacco abuse, and untreated psychiatric illness. Additionally, recent evidence has emerged in the form of Enhanced Recovery After Surgery (ERAS) protocols suggesting that a multidisciplinary focus on patient factors perioperatively can lead to reduced postoperative opioid administration and decreased hospital stays. A cornerstone of ERAS protocols includes multimodal pain regimens with opioid rescue only as needed, which often includes multiple systemic pain therapies such as acetaminophen, gabapentin, non-steroidal anti-inflammatory drugs, as well as targeted pain therapies that include epidural catheters and ultrasound-guided nerve blocks. Many hospital systems and states have also implemented opioid prescribing limitations with mixed success. As the opioid epidemic continues in the United States, while contributing to poor outcomes following elective surgeries, further research is warranted to identify multidisciplinary strategies that mitigate opioid use while also allowing for adequate pain control and rehabilitation.
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Position Statement: Acute Perioperative Pain Management Among Patients Undergoing Orthopedic Surgery by the American Society for Pain Management Nursing and The National Association of Orthopaedic Nurses. Pain Manag Nurs 2022; 23:251-253. [DOI: 10.1016/j.pmn.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022]
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Hattrup SJ, Chung AS, Rosenfeld DM, Misra L, Koyyalamudi V, Ritz ML, Tokish JM. Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: a double-blinded prospective randomized control trial. J Shoulder Elbow Surg 2021; 30:587-598. [PMID: 33045330 DOI: 10.1016/j.jse.2020.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Interscalene brachial plexus blocks are a common modality used to provide adjunctive pain relief with shoulder replacement surgery. In 2018, the Federal Drug Administration approved the use of liposomal bupivacaine (LB) for such nerve blocks. We sought to evaluate whether this formulation of bupivacaine would provide superior pain relief for shoulder replacement patients over standard bupivacaine alone. Our hypotheses were that in the LB cohort the average postoperative pain score over the first 72 hours would be significantly lower, time to block cessation would be longer, total opioid consumption would be lower, and the average patient satisfaction score regarding their pain management would be higher. MATERIALS AND METHODS A randomized, double-blinded study was designed comparing primary shoulder replacement surgery after an interscalene block with 25 mL of 0.5% plain bupivacaine vs. 133 mg of LB with 7.5 mL of 0.5% and 7.5 mL of 0.25% plain bupivacaine. A total of 104 patients were included in the study, with an equal number in each study arm. Patients' visual analog pain scores (VAPS) were followed for their inpatient stay, first 3 full outpatient days, and at a 3-week follow-up. Use of opioid medication was recorded for the same intervals and converted to morphine milligram equivalents. The time to first opioid rescue was documented, as well as the patients' satisfaction with their pain management at both the 3-day and 3-week intervals. RESULTS No clinically relevant advantage to the use of LB over plain bupivacaine was found. During the second postoperative day, the mean VAPS was 2.4 with LB vs. 3.3 in the standard cohort (P = .0409). The only other statistically significant finding was a higher VAPS with LB during the third full day home compared with standard bupivacaine (4.0 vs. 2.8, respectively, P = .0197). Both of these differences were less than the minimal clinically important difference of 2 for the VAPS. Analysis of the VAPS for the first and third postoperative days, the first and second full days home, and at 3 weeks revealed no significant difference. Similarly, there was no significant difference in time to first opioid rescue, total morphine milligram equivalent use, and patient satisfaction with pain management. CONCLUSION When used for an interscalene block to provide adjunctive pain relief in shoulder replacement surgery, the addition of LB to plain bupivacaine provides no additional clinically important benefit to the patient's pain experience over standard bupivacaine.
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Affiliation(s)
- Steven J Hattrup
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - Andrew S Chung
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Lopa Misra
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Matthew L Ritz
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Abstract
Total joint replacement (TJR) is one of the most commonly performed and painful surgeries in the United States. Over the past few decades, regulatory changes increased the use of oral narcotics as a first-line treatment of this population. In the current opioid crisis, new pain management techniques and therapies have emerged. Research of current therapies, their effectiveness, and emerging best practices are discussed. Clear, thoughtful, and thorough education is an essential next step for closing the gap of the pain experience. Specifically, education of the frontline nurses, patients, and their caregivers on pain reduction techniques is essential.
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