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Sivco C, Townsend D, Leslie MP, Li J. Periarticular Injection Versus Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty. Cureus 2023; 15:e39503. [PMID: 37366446 PMCID: PMC10290567 DOI: 10.7759/cureus.39503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Pain control after total hip arthroplasty is associated with patient satisfaction, early discharge, and improved surgical outcomes. Two commonly utilized opioid-reducing analgesic modalities are periarticular injection (PAI) by surgeons and motor-sparing peripheral nerve block (PNB) by anesthesiologists. We present a case contrasting PAI and PNB in a single patient undergoing bilateral total hip arthroplasty. For the left hip, the patient received preoperative transmuscular quadratus lumborum, femoral nerve, and lateral femoral cutaneous nerve blocks using a combination of low-concentration local anesthetic and glucocorticoids. For the right hip, the patient received an intraoperative PAI with liposomal bupivacaine. The patient's pain scores and recovery were evaluated for three months postoperatively. The patient's pain scores on postoperative day (POD) zero to five were consistently lower in the left hip than in the right hip. For this patient undergoing bilateral hip replacement, preoperative PNBs were superior to PAI for postoperative pain control.
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Affiliation(s)
- Carolyn Sivco
- Anesthesiology, Yale School of Medicine, New Haven, USA
| | - Dahlia Townsend
- Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Michael P Leslie
- Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, USA
| | - Jinlei Li
- Anesthesiology, Yale School of Medicine, New Haven, USA
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Del Toro-Pagán NM, Dai F, Banack T, Berlin J, Makadia SA, Rubin LE, Zhou B, Huynh P, Li J. Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty. J Pain Res 2022; 15:2537-2546. [PMID: 36061486 PMCID: PMC9432382 DOI: 10.2147/jpr.s378243] [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: 06/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption. Methods A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay. Results Cumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = -45.3 (-80.5 to -10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = -1.3 (-2.3 to -0.4), P = 0.005 and -0.9 (-1.8 to -0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = -22.5 (-36 to -8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups. Conclusion Compared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC. Level of Evidence III.
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Affiliation(s)
- Nicole M Del Toro-Pagán
- Department of Pharmacy, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA,Applied Precision Pharmacotherapy Institute, Tabula Rasa HealthCare, Moorestown, NJ, USA
| | - Feng Dai
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Trevor Banack
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Jill Berlin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Satya A Makadia
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Lee E Rubin
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Bin Zhou
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Phu Huynh
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Jinlei Li
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA,Correspondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT, 06520-8051, USA, Tel + 1 475 434 4038, Email
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Jin Y, Zhao S, Cai J, Blessing M, Zhao X, Tan H, Li J. Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial. J Pain Res 2021; 14:2717-2727. [PMID: 34512011 PMCID: PMC8423490 DOI: 10.2147/jpr.s321514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty. METHODS In this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS). RESULTS Significant differences in pain scores over time were found between the two groups (P=0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours (P=0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively (P=0.000) and postoperatively (P=0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients. CONCLUSION ESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.
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Affiliation(s)
- Yanwu Jin
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Shanshan Zhao
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Jiahui Cai
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Marcelle Blessing
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Xin Zhao
- Department of Anesthesiology, Second Hospital of Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Haizhu Tan
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
- Correspondence: Jinlei Li; Haizhu Tan Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT, 06520-8051, USATel +1 203 785-2802Fax +1 203 785-6664 Email ;
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