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McKee ED, Clement ND. Does an Adductor Canal Block Influence Patient-Reported Outcomes at One Year Following Total Knee Arthroplasty? Cureus 2023; 15:e41123. [PMID: 37519521 PMCID: PMC10382907 DOI: 10.7759/cureus.41123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Total knee arthroplasty (TKA) for osteoarthritis is performed to improve knee function and quality of life. Adductor canal block (ACB) (with posterior capsule local anaesthetic) and periarticular local anaesthetic infiltration (LA) alone are common methods used for post-operative pain control following TKA. The primary aim of this study was to investigate the influence of ACB compared to LA alone on knee function at one year in patients undergoing primary TKA. The secondary aims were to investigate the influence on health-related quality of life (HRQoL), patient satisfaction at one year, and length of stay (LOS) in hospital following TKA. Methods During a three-year period, 1396 patients who underwent TKA at the study centre completed pre-operative and one-year post-operative questionnaires. Data collected included patient demographics, co-morbidities, LOS, Oxford Knee Score (OKS), EuroQol 5-Dimension (EQ-5D) and satisfaction scores. Patients who had a spinal anaesthetic (n=1096) with either ACB (with posterior capsule local anaesthetic) (n=224) and LA infiltration alone (n=872) were compared. Results There was a significant improvement in pre-operative to one-year post-operative knee function as measured by OKS overall (15.1, p<0.001), however there was no significant difference between ACB and LA groups (p=0.37). There was no significant difference in change (p=0.43) or one-year post-operative (p=0.70) HRQoL, as measured by EQ-5D. There was also no significant difference in one-year patient satisfaction between groups (p=0.57). There was no significant difference in median LOS between groups (four days with ACB, four days with LA), although patients younger than 55 years undergoing ACB had a statistically significant median of one day reduced LOS compared with the LA group (p=0.01). Conclusions ACB when compared with LA alone was not associated with a difference in change in knee function, HRQoL, or patient satisfaction at one year following TKA. There was also no difference between groups in length of stay post-operatively. However, ACB was associated with a shorter length of stay in patients younger than 55, and this may be a group that would benefit from this intervention.
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Affiliation(s)
| | - Nick D Clement
- Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, GBR
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Peripheral Nerve Block for Pain Management after Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching. J Clin Med 2022; 11:jcm11185456. [PMID: 36143103 PMCID: PMC9505421 DOI: 10.3390/jcm11185456] [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: 08/13/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided into two groups: the patient-controlled analgesia (PCA) group (n = 217) who received only intravenous (IV) analgesia, and others who received IV PCA and PNB (PCA + PNB group) (n = 136). After propensity score matching for age and sex, 136 patients from each group were included in the study. Primary outcomes were the visual analogue scale (VAS) at rest, activity status at postoperative 6, 24, 48 h. Secondary outcomes were functional scores by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and rescue medications used. The postoperative VAS at 6, 24, 48 h at rest and 6 h at activity were significantly lower in the PCA + PNB group (p = 0.000, 0.001, 0.000, 0.004 in order). There was no significant difference for postoperative 3-month HHS (p = 0.218), except for 3-month WOMAC index (p = 0.001). There were no significant differences for VAS between the PNB methods except femoral nerve block (FNB) and fascia iliaca compartment block (FICB) at postoperative activity 48 h (p = 0.028). There was no significant difference in the total count and amount of rescue medication (p = 0.091, 0.069) and difference in the quadriceps weakness was not noted. Therefore, PNB is beneficial for patients who undergo THA as it provides sufficient postoperative analgesia, especially during immediate postoperative resting pain without quadriceps weakness.
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Phuvachoterojanaphokin N, Watanaboonyongcharoen G, Jinawong S, Munjupong S. Low-dose lidocaine attenuates fentanyl-induced cough: A double-blind randomized controlled trial. Eur J Clin Pharmacol 2022; 78:813-821. [PMID: 35089372 DOI: 10.1007/s00228-022-03282-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The study aimed to determine the efficacy of lidocaine at different low doses to reduce fentanyl-induced cough (FIC). METHODS Three hundred twenty patients aged from 18 to 60 years with ASA I and II scheduled for general anesthesia were randomly assigned to 4 groups to obtain peripheral intravenous 0.9%NaCl (Group I), lidocaine 0.25 mg/kg (Group II), 0.5 mg/kg (Group III) or 1.0 mg/kg (Group IV) 2 min before 3 μg/kg of fentanyl intravenously in a prospective randomized controlled fashion. The primary result was incidence of cough among comparison groups. The secondary results included severity of cough, hemodynamic response and risk factors of FIC. RESULTS Thirty-two, 15, 13 and 11 patients (40, 18.8, 16.3 and 13.8%) presented incidence of cough in Groups I, II, III and IV, respectively (P < 0.05 Group I vs. II, III and IV). No significant difference was observed in the incidence and severity of cough among the lidocaine groups (P > 0.05). Multivariate analysis showed that age ≤ 40 years, nonsmoking and patients not receiving the prior lidocaine injection were risk factors of FIC (P = 0.007, 0.013 and 0.001, respectively). CONCLUSION The study implied intravenous lidocaine 0.25 mg/kg for 2 min before fentanyl injection was the most effective dose to suppress FIC and could be applied in daily practice. Patients aged less than 40 years and nonsmoking were risk factors of FIC, regardless of sex and underlying disease.
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Affiliation(s)
- Nuanwan Phuvachoterojanaphokin
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Grit Watanaboonyongcharoen
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sarita Jinawong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand.
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Cicekci F, Yildirim A, Önal Ö, Celik JB, Kara I. Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial. SAO PAULO MED J 2019; 137:45-53. [PMID: 31116270 PMCID: PMC9721210 DOI: 10.1590/1516-3180.2018.0269101218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING Prospective randomized clinical trial in a university hospital. METHODS Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY ACTRN-12618000438257.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anesthetics, Local/administration & dosage
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Female
- Humans
- Injections, Intramuscular
- Levobupivacaine/administration & dosage
- Male
- Middle Aged
- Muscle, Skeletal/drug effects
- Nerve Block/methods
- Pain Measurement
- Pain, Postoperative/prevention & control
- Postoperative Period
- Prospective Studies
- Range of Motion, Articular/drug effects
- Range of Motion, Articular/physiology
- Reference Values
- Reproducibility of Results
- Time Factors
- Treatment Outcome
- Ultrasonography, Interventional/methods
- Walk Test/methods
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Affiliation(s)
- Faruk Cicekci
- MD. Assistant Professor, Department of Anesthesiology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
| | - Ahmet Yildirim
- MD. Assistant Professor, Department of Orthopedics and Traumatology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
| | - Özkan Önal
- MD. Associate Professor, Department of Anesthesiology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
| | - Jale Bengi Celik
- MD. Professor, Department of Anesthesiology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
| | - Inci Kara
- MD. Associate Professor, Department of Anesthesiology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
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Affiliation(s)
- B. Hennessy
- Acute Pain Service and Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia
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Chatrath V, Khetarpal R, Kumari H, Kaur H, Sharma A. Intermittent Transcutaneous Electrical Nerve Stimulation versus Transversus Abdominis Plane Block for Postoperative Analgesia after Infraumbilical Surgeries. Anesth Essays Res 2018; 12:349-354. [PMID: 29962596 PMCID: PMC6020592 DOI: 10.4103/aer.aer_16_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Multimodal analgesia is currently recommended for effective postoperative analgesia. Aim The aim of this study is to compare the efficacy of transversus abdominis plane (TAP) block with intermittent transcutaneous electrical nerve stimulation (TENS) in postoperative patients after infraumbilical surgeries under spinal anesthesia with respect to postoperative analgesia, rescue analgesia, hemodynamic changes, block characteristics, nausea/vomiting score, sedation score, adverse effects, and patient satisfaction. Settings and Design This was a prospective, observational study randomized controlled trial. Methods A total of 60 American Society of Anesthesiologists physical status Classes I and II patients of 20-60 years scheduled for infraumbilical surgeries were randomized by a computer-generated list into two groups of 30 each, to receive either TAP Block (Group TAP: 15 ml of 0.25% levobupivacaine on each side of abdomen) or TENS (Group TENS: TENS with frequency of 50 Hz and intensity of electrical stimulation 9-12 mA, continued for 30 min every 2 h till 24 h). The primary outcome was to compare the postoperative analgesia as assessed using visual analog scale score. Secondary objectives were to compare rescue analgesia, nausea/vomiting score, sedation score, the block characteristics, adverse effects, hemodynamic changes, and patient satisfaction. Statistical Analysis Used Student's t-test, Chi-square test as applicable and Statistical Package for Social Sciences (version 23.0, 2017, SPSS Inc., Chicago, IL, USA) were used. Results Time to the first analgesic requirement was 12.87 ± 4.72 h in Group TAP and 9.93 ± 3.63 h in Group TENS (P < 0.008), the difference between two groups was significant. Conclusion TAP block is better modality due to ease of application and prolonged analgesia.
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Affiliation(s)
- Veena Chatrath
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Ranjana Khetarpal
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Heena Kumari
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Harjinder Kaur
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Anu Sharma
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
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Enhanced recovery principles applied to revision hip and knee arthroplasty reduces length of stay and blood transfusion. J Orthop 2017; 14:555-560. [PMID: 28878516 DOI: 10.1016/j.jor.2017.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/08/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION This is the first study reporting the application of Enhanced Recovery Principles (ERP) to revision arthroplasty. METHOD Retrospective series of 132 revision hip and knee replacements treated with ERP. RESULTS Infiltration was associated with reduced LOS in knees (6 vs 8.5 days), lower PCA usage and incidence of transfusion in knees (2 vs 3 days) and hips (1 vs 6 days). Revisions for infection had a longer LOS (5.4 vs 11.5 days p = 0.001), a greater use of PCA and a higher incidence of transfusion (5 vs 0) in both knees and hips. DISCUSSION The application of ERPs to revision arthroplasty is safe. Infiltration appears to be an important factor in improving outcome measures.
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Jayakumar P, Di J, Fu J, Craig J, Joughin V, Nadarajah V, Cope J, Bankes M, Earnshaw P, Shah Z. A Patient-Focused Technology-Enabled Program Improves Outcomes in Primary Total Hip and Knee Replacement Surgery. JB JS Open Access 2017; 2:e0023. [PMID: 30229224 PMCID: PMC6133096 DOI: 10.2106/jbjs.oa.16.00023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: A patient-engagement and pathway-management program for patients undergoing primary total hip and knee replacement was evaluated. Health-service and multimedia features supported by technology were integrated with existing enhanced recovery after surgery (ERAS) practices. The primary objective was to demonstrate the impact on length of stay. The secondary objective was to assess the impact on clinical, patient-focused, and financial outcomes. Methods: Two thousand and eighty consecutive patients undergoing primary total hip replacement (n = 1,034) and total knee replacement (n = 1,046) were classified into “pre-program” (retrospectively assessed [n = 1,038]) and “program” (prospectively assessed [n = 1,042]) cohorts. Patients in the program cohort were subdivided according to those who were eligible for criteria-based outreach support (OS) (n = 401) and those who were ineligible for this service (NOS) (n = 641). Clinical outcomes were assessed for all patients, and patient-focused outcomes were assessed for a subset (n = 223). Results: The mean reduction in length of stay ranged from 20% (1.2 days) to 42% (2.5 days) following total hip replacement and from 9% (0.6 day) to 31% (2 days) following total knee replacement (p < 0.001). Clinical outcomes (readmissions, complications, emergency department re-attendance rates) were not significantly negatively impacted. The Oxford Hip Score had numerically larger improvement after total hip replacement in the OS group than in the pre-program group (4.1-point increase), and the Oxford Knee Score had numerically larger improvement after total knee replacement in the NOS group than in the pre-program group (0.8-point increase). The patients in the program cohort (either OS or NOS) rated overall health gain as higher than those in the pre-program cohort (gain in numerical rating scale, 1.4 points for patients managed with total hip replacement, 0.6 points for patients managed with total knee replacement). Older patients and those with higher comorbidity indices benefited most with respect to length of stay and multiple clinical outcomes. Patient experience was significantly improved across domains (p < 0.001 to p = 0.003). Potential savings for patients managed with total hip replacement (£401.64 [$267.76] per patient) exceeded estimated program charges of £50 [$33.33] to £60 [$40] per patient, whereas the potential savings for patients managed with total knee replacement (£76.67 [$51.11] per patient) were sufficient to achieve a reduction of total system costs. Conclusions: Technology-enabled programs may deliver enhanced care at lower costs for patients undergoing lower-limb arthroplasty. Shorter durations of inpatient stay without a negative impact on clinical outcomes and improved patient-focused outcomes and experience can deliver substantial value that can be especially beneficial for older patients and those with greater medical complexity. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Prakash Jayakumar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Jianing Di
- Janssen Healthcare Innovation, a Division of Janssen Cilag Ltd., High Wycombe, United Kingdom
| | - Jiayu Fu
- Janssen Healthcare Innovation, a Division of Janssen Cilag Ltd., High Wycombe, United Kingdom
| | - Joyce Craig
- York Health Economics Consortium, Heslington, York, United Kingdom
| | - Vicki Joughin
- Johnson & Johnson Medical Devices, Beeston, Leeds, United Kingdom
| | - Victoria Nadarajah
- Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Jade Cope
- Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Marcus Bankes
- Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Peter Earnshaw
- Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
| | - Zameer Shah
- Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom
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Choi S, O’Hare T, Gollish J, Paul JE, Kreder H, Thorpe KE, Katz JD, Mamdani M, Moisiuk P, McCartney CJ. Optimizing Pain and Rehabilitation After Knee Arthroplasty. Anesth Analg 2016; 123:1316-1324. [DOI: 10.1213/ane.0000000000001469] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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McCartney CJL, Wong P. How Can We Best Balance Pain Control and Rehabilitation After Knee Replacement? Anesth Analg 2016; 122:1760-2. [PMID: 27195624 DOI: 10.1213/ane.0000000000001311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Colin J L McCartney
- From the Department of Anesthesiology, The Ottawa Hospital and University of Ottawa, Ontario, Canada
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12
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Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham K. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2016; 116:597-609. [DOI: 10.1093/bja/aew099] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/14/2022] Open
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Nagafuchi M, Sato T, Sakuma T, Uematsu A, Hayashi H, Tanikawa H, Okuma K, Hashiuchi A, Oshida J, Morisaki H. Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty: a randomized controlled trial. BMC Anesthesiol 2015; 15:182. [PMID: 26669859 PMCID: PMC4681154 DOI: 10.1186/s12871-015-0160-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. METHODS This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375% ropivacaine, and 5 mL h(-1) of 0.2% ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2% ropivacaine and 0.5 mg epinephrine to the surgical region. In group S, participants received SNB with 20 ml of 0.375% ropivacaine. After TKA, Numeric Rating Scale (NRS) scores for the first 24 h post-operation were compared via repeated-measures analysis of variance (ANOVA) as the primary outcome. Other outcome measures included NRS score changes within groups, area under the curve for the NRS scores, total analgesic dose, change in knee flexion and extension, pain control satisfaction, nausea and vomiting, and hospital stay duration. RESULTS NRS score changes were greater in group L than in group S (P < 0.01, ANOVA) and greater in group L than in group S at three postoperative time points: 3 h (P < 0.01), 6 h (P < 0.01), and 12 h (P = 0.013; Mann-Whitney U test). Changes in the mean NRS score were observed in each group (P < 0.01, Friedman test). No significant differences were detected in the other outcome measures (Mann-Whitney U, Wilcoxon signed-rank, and chi-squared tests). CONCLUSIONS Sciatic nerve block with femoral nerve block is superior to local anesthetic infiltration with femoral nerve block for postoperative pain control within 3-12 h of total knee arthroplasty. TRIAL REGISTRATION UMIN-CTR ID: 000013364 R: 000015591.
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Affiliation(s)
- Mari Nagafuchi
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Tomoyuki Sato
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Takahiro Sakuma
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Akemi Uematsu
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Hiromasa Hayashi
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Hidenori Tanikawa
- Department of Orthopedics, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Kazunari Okuma
- Department of Orthopedics, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Akira Hashiuchi
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Junya Oshida
- Department of Anesthesiology, Saitama City Hospital, Mimuro 2460, Saitama Midori-ku, Saitama, 336-8522, Japan.
| | - Hiroshi Morisaki
- Department of Anesthesiology, School of Medicine, Keio University, Shinanomati 35, Shinjuku-ku, Tokyo, 160-0016, Japan.
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Mei S, Jin S, Chen Z, Ding X, Zhao X, Li Q. Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics (Sao Paulo) 2015; 70:648-53. [PMID: 26375568 PMCID: PMC4557589 DOI: 10.6061/clinics/2015(09)09] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients frequently experience postoperative pain after a total knee arthroplasty; such pain is always challenging to treat and may delay the patient's recovery. It is unclear whether local infiltration or a femoral nerve block offers a better analgesic effect after total knee arthroplasty.We performed a systematic review and meta-analysis of randomized controlled trials to compare local infiltration with a femoral nerve block in patients who underwent a primary unilateral total knee arthroplasty. We searched Pubmed, EMBASE, and the Cochrane Library through December 2014. Two reviewers scanned abstracts and extracted data. The data collected included numeric rating scale values for pain at rest and pain upon movement and opioid consumption in the first 24 hours. Mean differences with 95% confidence intervals were calculated for each end point. A sensitivity analysis was conducted to evaluate potential sources of heterogeneity.While the numeric rating scale values for pain upon movement (MD-0.62; 95%CI: -1.13 to -0.12; p=0.02) in the first 24 hours differed significantly between the patients who received local infiltration and those who received a femoral nerve block, there were no differences in the numeric rating scale results for pain at rest (MD-0.42; 95%CI:-1.32 to 0.47; p=0.35) or opioid consumption (MD 2.92; 95%CI:-1.32 to 7.16; p=0.18) in the first 24 hours.Local infiltration and femoral nerve block showed no significant differences in pain intensity at rest or opioid consumption after total knee arthroplasty, but the femoral nerve block was associated with reduced pain upon movement.
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Affiliation(s)
| | | | | | | | | | - Quan Li
- Corresponding author: E-mail:
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Wang C, Cai XZ, Yan SG. Comparison of Periarticular Multimodal Drug Injection and Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2015; 30:1281-6. [PMID: 25735501 DOI: 10.1016/j.arth.2015.02.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/13/2015] [Accepted: 02/07/2015] [Indexed: 02/01/2023] Open
Abstract
The analgesic efficacy and safety of periarticular multimodal drug injection (PMDI) compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) still remains controversial. We therefore conducted a meta-analysis to quantitatively compare PMDI to FNB in TKA. 10 randomized controlled trials (RCTs) with 744 TKAs in 728 patients were included in this study. The meta-analysis showed that single shot FNB may have better pain relief in the early postoperative period compared with single shot PMDI, and continuous PMDI provided postoperative analgesia comparable to that of continuous FNB. No significant difference was seen in regard to the complications between the two groups. However, due to the variation of the included studies, no firm conclusions can be drawn.
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Affiliation(s)
- Cong Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xun-Zi Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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17
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Zhang X, Shu L, Lin C, Yang P, Zhou Y, Wang Q, Wu Y, Xu X, Cui X, Lin X, Jin L, Li T. Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2015; 29:1550-6. [PMID: 26409920 DOI: 10.1053/j.jvca.2015.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare paravertebral block under thoracoscopy with wound infiltration at an early stage after video-assisted thoracic lobectomy surgery. DESIGN A prospective, randomized, triple-blinded, placebo-controlled trial. SETTING A single-center university hospital. PARTICIPANTS Patients scheduled for video-assisted thoracic lobectomy surgery between February 20, 2014 and June 1, 2014 randomly were allocated into paravertebral block (PVB) (n = 35) and infiltration (n = 35) groups. INTERVENTIONS In the PVB group, 0.5% ropivacaine was injected into the paravertebral space by the surgeon under direct vision with placebo infiltration of saline in the wounds. In the infiltration group, the wounds were infiltrated with 0.5% ropivacaine by the surgeon with a placebo paravertebral block. Subsequently, patient-controlled intravenous morphine analgesia and paracoxib were administered. MEASUREMENTS AND MAIN RESULTS The primary endpoints were visual analog scale (VAS) pain scores at rest and on cough 0, 2, 6, and 24 hours after surgery. The secondary endpoints were the total morphine during postoperative 0 hours to 24 hours, adverse events, and patient satisfaction with the analgesia. Sixty-one patients completed the study. VAS score on cough at each time point was significantly lower (p<0.05) and median (25th, 75th) morphine consumption was lower in the PVB group than in the infiltration group (26 [10, 35] mg and 42 [29, 58] mg, p<0.001, respectively). There was no difference in VAS score at rest. Patients in the PVB group had higher satisfaction with analgesia than in the infiltration group (p = 0.003). CONCLUSIONS As part of the multimodal postoperative analgesia, intraoperative paravertebral block provided better dynamic pain relief and reduced morphine consumption compared with local wound infiltration.
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Affiliation(s)
- Xuezheng Zhang
- Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Luowa Shu
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chaoxi Lin
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pei Yang
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ying Zhou
- Department of Pulmonary Medicine, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Quanguang Wang
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yiquan Wu
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xuzhong Xu
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xu Cui
- Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Lin
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lielie Jin
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Tianzuo Li
- Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital Medical University, Beijing, China
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18
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Yu N, Long X, Lujan-Hernandez JR, Succar J, Xin X, Wang X. Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2014; 14:121. [PMID: 25580086 PMCID: PMC4289539 DOI: 10.1186/1471-2253-14-121] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 12/11/2014] [Indexed: 12/31/2022] Open
Abstract
Background Postoperative pain management is of great importance in perioperative anesthetic care. Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain and morphine consumption after open lower abdominal operations. Meanwhile, local anesthetic infiltration (LAI) is also commonly used as a traditional method. However, the effectiveness of these two methods has not been compared before. Methods A meta-analysis of all relevant randomized controlled trials (RCTs) was conducted to compare the efficacy of single shot TAP block with that of single shot LAI for postoperative analgesia in adults. Major medical databases and trial registries were searched for published and unpublished RCTs. The endpoints include postoperative visual analog scale (VAS) pain score, morphine requirement, and rate of postoperative nausea and vomiting (PONV). For continuous data, weighted mean differences (WMDs) were formulated; for dichotomous data, risk ratios (RR) were calculated. Results were derived using a random-/fixed-effects model with 95% confidence interval (CI). Results Four RCTs, encompassing 96 TAP-block and 100 LAI patients, were included in the final analysis. Patients in the TAP-block group had lower VAS pain scores 24 hours postoperatively compared with the LAI group, both at rest (WMD [95% CI] = -0.67 [p < 0.01] and with movement (WMD = -0.89, p < 0.01). There were no significant between-group differences in 24-hour postoperative morphine requirements, the rates if PONV or VAS pain scores at 2 and 4 h postoperatively. Conclusion TAP block and LAI provide comparable short-term postoperative analgesia, but TAP block has better long-lasting effect. Electronic supplementary material The online version of this article (doi:10.1186/1471-2253-14-121) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nanze Yu
- Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730 China
| | - Xiao Long
- Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730 China
| | - Jorge R Lujan-Hernandez
- Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
| | - Julien Succar
- Department of Surgery, University of Kentucky, Lexington, KY USA
| | - Xin Xin
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Xiaojun Wang
- Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730 China
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19
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Analgesic techniques in hip and knee arthroplasty: from the daily practice to evidence-based medicine. Anesthesiol Res Pract 2014; 2014:569319. [PMID: 25484894 PMCID: PMC4251423 DOI: 10.1155/2014/569319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/14/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022] Open
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice.
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20
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Pain Management for Ambulatory Surgery: What Is New? CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Andersen LØ, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 2014; 113:360-74. [PMID: 24939863 DOI: 10.1093/bja/aeu155] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on with TKA were selected for inclusion in the review. In THA, no additional analgesic effect of LIA compared with placebo was reported in trials with low risk of bias when a multimodal analgesic regimen was administered perioperatively. Compared with intrathecal morphine and epidural analgesia, LIA was reported to have similar or improved analgesic efficacy. In TKA, most trials reported reduced pain and reduced opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal morphine LIA provided similar or improved analgesia in the early postoperative period but most trials had a high risk of bias due to different systemic analgesia between groups. Overall, the use of wound catheters for postoperative administration of local anaesthetic was not supported in the included trials, and LOS was not related to analgesic efficacy. Despite the many studies of LIA, final interpretation is hindered by methodological insufficiencies in most studies, especially because of differences in use of systemic analgesia between groups. However, LIA provides effective analgesia in the initial postoperative period after TKA in most randomized clinical trials even when combined with multimodal systemic analgesia. In contrast, LIA may have limited additional analgesic efficacy in THA when combined with a multimodal analgesic regimen. Postoperative administration of local anaesthetic in wound catheters did not provide additional analgesia when systemic analgesia was similar and LOS was not related to use of LIA with a fast-track set-up.
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Affiliation(s)
- L Ø Andersen
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark Department of Anesthesiology and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - H Kehlet
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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22
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Fiegel MJ. Noteworthy literature in regional anesthesia 2013. Semin Cardiothorac Vasc Anesth 2014; 18:29-35. [PMID: 24623805 DOI: 10.1177/1089253214522327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The regional anesthesia literature was quite active in the calendar year 2013. In typical fashion, the literature was composed of articles representing neuraxial analgesia, peripheral nerve blocks, patient outcomes, regional anesthesia adjuvant medications, and patient safety. The goal of this article is to summarize and present the most relevant articles from each of these arenas.
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23
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Stoneham M, Murray D, Foss N. Emergency surgery: the big three - abdominal aortic aneurysm, laparotomy and hip fracture. Anaesthesia 2013; 69 Suppl 1:70-80. [DOI: 10.1111/anae.12492] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 01/23/2023]
Affiliation(s)
- M. Stoneham
- Nuffield Division of Anaesthetics; Oxford University Hospitals NHS Trust; Oxford UK
| | - D. Murray
- James Cook University Hospital; Middlesbrough UK
| | - N. Foss
- Department of Anaesthesia; Hvidovre University Hospital; Copenhagen Denmark
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