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Monteleone G, Tasso F, De Angelis A, Martorelli F, Simili V, Bovio M, Biamino C, Anzillotti G, Di Matteo B, Marcacci M, Scardino M. Sublingual sufentanil tablet system (SSTS) versus a single shot peri-nervous injection of ropivacaine for the management of postoperative pain after total knee arthroplasty: a single-center randomized trial. Musculoskelet Surg 2024:10.1007/s12306-024-00833-1. [PMID: 38814427 DOI: 10.1007/s12306-024-00833-1] [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: 07/17/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION For several years, ropivacaine has been the standard-of-care for establishing postoperative femoral nerve block in total knee arthroplasty (TKA) setting and is still widely in use but new approaches such as the patient-controlled administration of sublingual sufentanil tablets system (SSTS) seem to offer good clinical results. Our aim is to compare the SSTS to single shot peri-nervous injection of ropivacaine (single shot) after TKA in terms of effectiveness in pain management and of time to recovery. MATERIALS AND METHODS A total of 165 patients undergoing TKA were enrolled. Eighty-four patients were randomly allocated in the SSTS group and 81 patients in the single shot group. The primary objective of the study was to evaluate performance of Timed Up and Go test. Secondary objectives were to measure the length of stay, NRS pain scale, the adherence to the prescribed plan, the joint mobility, the frequency of rescue analgesic use, side effects and patients' satisfaction. RESULTS Of all patients of the single shot group, 64 were withdrawn from the study as they unable to achieve pain control; only one patient was withdrawn from the SSTS group. Times for the "Timed Up and Go" test on the 3rd postoperative day were 8.4 ± 1.6 and 11.8 ± 3.6 in the SSTS group (n = 83) and single shot group (n = 17), respectively (p < .001). CONCLUSIONS SSTS provides better pain management when compared to peri-nervous ropivacaine single shot injection after TKA.
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Affiliation(s)
- G Monteleone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - F Tasso
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A De Angelis
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - F Martorelli
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - V Simili
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Bovio
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - C Biamino
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy.
| | - B Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow, Russia, 119991
| | - M Marcacci
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy
| | - M Scardino
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
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Riehm CD, Zuleger T, Diekfuss JA, Arellano E, Myer GD. The Evolution of Neuroimaging Technologies to Evaluate Neural Activity Related to Knee Pain and Injury Risk. Curr Rev Musculoskelet Med 2024; 17:14-22. [PMID: 38109007 PMCID: PMC10766917 DOI: 10.1007/s12178-023-09877-5] [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] [Accepted: 11/26/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW In this review, we present recent findings and advancements in the use of neuroimaging to evaluate neural activity relative to ACL injury risk and patellofemoral pain. In particular, we describe prior work using fMRI and EEG that demonstrate the value of these techniques as well as the necessity of continued development in this area. Our goal is to support future work by providing guidance for the successful application of neuroimaging techniques that most effectively expose pain and injury mechanisms. RECENT FINDINGS Recent studies that utilized both fMRI and EEG indicate that athletes who are at risk for future ACL injury exhibit divergent brain activity both during active lower extremity movement and at rest. Such activity patterns are likely due to alterations to cognitive, visual, and attentional processes that manifest as coordination deficits during naturalistic movement that may result in higher risk of injury. Similarly, in individuals with PFP altered brain activity in a number of key regions is related to subjective pain judgements as well as measures of fear of movement. Although these findings may begin to allow objective pain assessment and identification, continued refinement is needed. One key limitation across both ACL and PFP related work is the restriction of movement during fMRI and EEG data collection, which drastically limits ecological validity. Given the lack of sufficient research using EEG and fMRI within a naturalistic setting, our recommendation is that researchers target the use of mobile, source localized EEG as a primary methodology for exposing neural mechanisms of ACL injury risk and PFP. Our contention is that this method provides an optimal balance of spatial and temporal resolution with ecological validity via naturalistic movement.
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Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Taylor Zuleger
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Neuroscience Graduate Program, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Emilio Arellano
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, 30542, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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Bogaerts K, Van Den Houte M, Jongen D, Ly HG, Coppens E, Schruers K, Van Diest I, Jan T, Van Wambeke P, Petre B, Kragel PA, Lindquist MA, Wager TD, Van Oudenhove L, Van den Bergh O. Brain mediators of negative affect-induced physical symptom reporting in patients with functional somatic syndromes. Transl Psychiatry 2023; 13:285. [PMID: 37604880 PMCID: PMC10442365 DOI: 10.1038/s41398-023-02567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Functional somatic syndromes (FSS) include fibromyalgia, irritable bowel syndrome (IBS), and others. In FSS patients, merely viewing negative affective pictures can elicit increased physical symptoms. Our aim was to investigate the neural mechanisms underlying such negative affect-induced physical symptoms in FSS patients. Thirty patients with fibromyalgia and/or IBS and 30 healthy controls (all women) watched neutral, positive and negative affective picture blocks during functional MRI scanning and rated negative affect and physical symptoms after every block. We compared brain-wide activation during negative versus neutral picture viewing in FSS patients versus controls using robust general linear model analysis. Further, we compared neurologic pain signature (NPS), stimulus intensity-independent pain signature (SIIPS) and picture-induced negative emotion signature (PINES) responses to the negative versus neutral affect contrast and investigated whether they mediated between-group differences in affective picture-induced physical symptom reporting. More physical symptoms were reported after viewing negative compared to neutral pictures, and this effect was larger in patients than controls (p = 0.025). Accordingly, patients showed stronger activation in somatosensory regions during negative versus neutral picture viewing. NPS, but not SIIPS nor PINES, responses were higher in patients than controls during negative versus neutral pictures (p = 0.026). These differential NPS responses partially mediated between-group differences in physical symptoms. In conclusion, picture-induced negative affect elicits physical symptoms in FSS patients as a result of activation of somatosensory and nociceptive brain patterns, supporting the idea that affect-driven alterations in processing of somatic signals is a critical mechanism underlying FSS.
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Affiliation(s)
- Katleen Bogaerts
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
- Health Psychology, Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - Maaike Van Den Houte
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
- Leuven Brain Institute, University of Leuven, Leuven, Belgium
| | - Daniëlle Jongen
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
- Leuven Brain Institute, University of Leuven, Leuven, Belgium
| | - Huynh Giao Ly
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Eline Coppens
- University Psychiatric Center KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Koen Schruers
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ilse Van Diest
- Health Psychology, Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Tack Jan
- GI motility and sensitivity research group, Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Peter Van Wambeke
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bogdan Petre
- Cognitive & Affective Neuroscience Lab (CANLab), Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Philip A Kragel
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Martin A Lindquist
- Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Tor D Wager
- Cognitive & Affective Neuroscience Lab (CANLab), Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
- Leuven Brain Institute, University of Leuven, Leuven, Belgium
- Cognitive & Affective Neuroscience Lab (CANLab), Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Omer Van den Bergh
- Health Psychology, Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
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Biological Targets of Multimolecular Therapies in Middle-Age Osteoarthritis. Sports Med Arthrosc Rev 2022; 30:141-146. [PMID: 35921596 DOI: 10.1097/jsa.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knee osteoarthritis (OA) is a common condition, prevalent in middle-agedness, associated with chronic pain and impaired quality of life. Two interrelated biological processes fuel early OA progression: inflammation and structural tissues catabolism. Procatabolic and proinflammatory mediators are interconnected and form part of a self-perpetuating loop. They leverage OA research complexity because of the impossibility to discern certain spatiotemporal tissues' changes from others. Both are shared targets of versatile regenerative multimolecular therapies. In particular, platelet-rich plasma can interfere with inflammation and inflammatory pain. The therapeutic approach is to alter the vicious inflammatory loop by modifying the molecular composition of the synovial fluid, thereby paracrine cellular cross talk. Intra-articular injections of platelet-rich plasma can provide key factors balancing proinflammatory and anti-inflammatory factors, targeting macrophage dysfunction and modulating immune mechanisms within the knee.
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