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Sieber F, McIsaac DI, Deiner S, Azefor T, Berger M, Hughes C, Leung JM, Maldon J, McSwain JR, Neuman MD, Russell MM, Tang V, Whitlock E, Whittington R, Marbella AM, Agarkar M, Ramirez S, Dyer A, Friel Blanck J, Uhl S, Grant MD, Domino KB. 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery. Anesthesiology 2025; 142:22-51. [PMID: 39655991 DOI: 10.1097/aln.0000000000005172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Affiliation(s)
- Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Stacie Deiner
- Department of Anesthesiology, Geisel School of Medicine and Dartmouth Health, Hanover, New Hampshire
| | - Tangwan Azefor
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Christopher Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacqueline M Leung
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California
| | - John Maldon
- Washington Medical Commission, Seattle, Washington
| | - Julie R McSwain
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mark D Neuman
- Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Victoria Tang
- Division of Geriatric Medicine, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Elizabeth Whitlock
- Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California
| | - Robert Whittington
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | | | | | | | - Alexandre Dyer
- American Society of Anesthesiologists, Schaumburg, Illinois
| | | | - Stacey Uhl
- American Society of Anesthesiologists, Schaumburg, Illinois
| | - Mark D Grant
- Division of Epidemiology and Biostatistics, University of Chicago, Chicago, Illinois
| | - Karen B Domino
- Committee on Practice Parameters, American Society of Anesthesiologists, Schaumburg, Illinois; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
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Zhao R, Ren H, Li P, Fan M, Zhao R, Liu T, Wang Y, Ji Q, Zhang G. Research trends and frontiers in rehabilitation after total knee arthroplasty: based on bibliometric and visualization analysis. J Orthop Surg Res 2024; 19:897. [PMID: 39741262 DOI: 10.1186/s13018-024-05377-5] [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: 11/13/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis, and postoperative rehabilitation is crucial. However, a comprehensive bibliometric analysis of this area has yet to emerge. This study aims to visualize the research trends in postoperative rehabilitation after TKA through bibliometric analysis and explore current research frontiers and hotspots. METHODS Publications related to postoperative rehabilitation following TKA were identified and extracted from the Web of Science Core Collection (WoSCC) database. CiteSpace and VOSviewer were used for bibliometric and visualization analysis. RESULTS From January 1, 2000, to December 31, 2022, a total of 1,422 articles on TKA postoperative rehabilitation were identified from the database. The number of publications and citations showed steady growth during this period. The United States was the major contributor in this field, with the University of Colorado being the most active institution domestically. J Arthroplasty ranked first in both publication volume and total citations among all journals. Stevens-Lapsley, JE, and Mizner, RL were the two most influential authors. Reference and keyword analyses suggest that remote or home-based rehabilitation, the development of novel prehabilitation techniques, and pain management hold significant research potential, constituting current research hotspots. CONCLUSION This study quantitatively identified and assessed the current research status and trends in perioperative rehabilitation management for TKA through bibliometric and visualization analyses. It provides essential information for scholars in the field of TKA postoperative rehabilitation research, highlighting key research frontiers and trends.
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Affiliation(s)
- Runkai Zhao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Haichao Ren
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Pengcheng Li
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Menglin Fan
- Department of the Third Hospital of Harbin Medical University, Harbin, 150081, China
| | - Runzhi Zhao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Te Liu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Yan Wang
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China
- Medical School of Chinese PLA, Beijing, China
| | - Quanbo Ji
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China.
- Medical School of Chinese PLA, Beijing, China.
| | - Guoqiang Zhang
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 050051, China.
- Medical School of Chinese PLA, Beijing, China.
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Yu D, Wu Y, Han S, Wang X, Jiang L. Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta-analysis. Int Wound J 2024; 21:e14766. [PMID: 38351465 PMCID: PMC10864686 DOI: 10.1111/iwj.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
Total knee arthroplasty (TKA) often involves significant postoperative pain, necessitating effective analgesia. This meta-analysis compares the analgesic efficacy of local infiltration anaesthesia (LIA) and femoral nerve block (FNB) in managing postoperative wound pain following TKA. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was structured around the PICO framework, assessing studies that directly compared LIA and FNB in TKA patients. A comprehensive search across PubMed, Embase, Web of Science and the Cochrane Library was conducted without time restrictions. Studies were included based on specific criteria such as participant demographics, study design and outcomes like pain scores and opioid consumption. Quality assessment utilized the Cochrane Collaboration's risk of bias tool. The statistical approach was determined based on heterogeneity, with the choice of fixed- or random-effects models guided by the I2 statistic. Sensitivity analysis and evaluation of publication bias using funnel plots and Egger's linear regression test were also conducted. From an initial pool of 1275 articles, eight studies met the inclusion criteria. These studies conducted in various countries from 2007 to 2016. The meta-analysis showed no significant difference in resting and movement-related Visual Analogue Scale scores post-TKA between the LIA and FNB groups. However, LIA was associated with significantly lower opioid consumption. The quality assessment revealed a low risk of bias in most studies, and the sensitivity analysis confirmed the stability of these findings. There was no significant publication bias detected. Both LIA and FNB are effective in controlling postoperative pain in TKA patients, but LIA offers the advantage of lower opioid consumption. Its simplicity, cost-effectiveness and opioid-sparing nature make LIA the recommended choice for postoperative analgesia in knee replacement surgeries.
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Affiliation(s)
- Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Yajing Wu
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Shuang Han
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Xiaoyu Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
| | - Li Jiang
- Department of AnesthesiologyHebei General HospitalShijiazhuangHebei ProvinceChina
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Hao C, Xu H, Du J, Zhang T, Zhang X, Zhao Z, Luan H. Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy-A Randomized Controlled Trial. Drug Des Devel Ther 2023; 17:3539-3547. [PMID: 38046284 PMCID: PMC10693280 DOI: 10.2147/dddt.s439674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Opioid analgesics may delay discharge and affect postoperative quality of recovery because of their significant adverse effects, such as hyperalgesia, postoperative nausea and vomiting (PONV), shivering and urine retention. We aimed to compare the quality of postoperative recovery (QoR) between patients undergoing laparoscopic cholecystectomy surgeries with opioid-free anesthesia (OFA) and those with opioid-based anesthesia (OA). Patients and Methods 80 adult patients undergoing laparoscopic cholecystectomy were randomly allocated to an opioid-free anesthesia group (Group OFA) or an opioid-based anesthesia group (Group OA). The primary outcome was the quality of postoperative recovery using QoR-15 scale on postoperative day 1 (POD 1) and 2 (POD 2). The secondary outcomes included the incidence of opioid-related adverse symptoms, perioperative hemodynamic data, duration of post-anesthesia care unit (PACU) stay and duration of extubation, and the incidences of hypotension and bradycardia. Results A statistically significant difference in total QoR-15 was observed between the two groups on POD 1 and POD 2 (91.00 (90.00, 92.00) vs 113.00 (108.25, 115.00), 106.00 (104.00, 112.00) vs 133.00 (130.00, 135.00), P < 0.001). The incidence of opioid-related symptoms was significantly different between the two groups on POD 1 (P < 0.05). There were between-group differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T3 (P < 0.001). There was also a significant difference in the incidence of hypotension between the two groups (P = 0.001). However, there were no significant differences in the duration of PACU stay, duration of extubation and the incidence of bradycardia (P > 0.05). There was no difference in heart rate between the two groups at all observed time points, either (P > 0.05). Conclusion We concluded that the quality of recovery of patients receiving OFA was superior to those receiving OA after laparoscopic cholecystectomy.
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Affiliation(s)
- Conghui Hao
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Hai Xu
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Jingjing Du
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Tianyu Zhang
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Xiaobao Zhang
- Department of anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, People’s Republic of China
| | - Zhibin Zhao
- Department of anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, People’s Republic of China
| | - Hengfei Luan
- Department of anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, People’s Republic of China
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Thawkar VN, Taksande K. Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block. Cureus 2023; 15:e48827. [PMID: 38106768 PMCID: PMC10722345 DOI: 10.7759/cureus.48827] [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: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Surgical procedures on the shoulder pose distinctive challenges in managing pain during the perioperative period, underscoring the importance of exploring innovative anesthesia techniques. This comprehensive review article delves into integrating dexmedetomidine, an alpha-2 adrenergic agonist, within interscalene brachial plexus blocks for shoulder surgery. The review initiates by underscoring the pivotal role of effective anesthesia in shoulder surgery and elucidates the rationale behind investigating dexmedetomidine as an adjunct. It meticulously examines the anatomy and physiology of the brachial plexus, emphasizing its critical significance in shoulder surgery. Furthermore, the article expounds on dexmedetomidine's mechanisms of action and pharmacokinetics, encompassing its safety profile and potential side effects. The conventional interscalene brachial plexus block techniques, along with their limitations and challenges, are discussed, laying the foundation for the integration of dexmedetomidine. The review subsequently delves into exploring the role of dexmedetomidine in regional anesthesia, covering previous studies, mechanisms of action, and the potential advantages of incorporating it into nerve blocks. The review's core concentrates on the practical application of dexmedetomidine-enhanced interscalene brachial plexus blocks. This includes discussions on administration techniques, dosage guidelines, and compelling evidence supporting its utilization. Clinical scenarios where this approach proves most advantageous are thoroughly explored, comparing its effectiveness with traditional techniques in terms of pain control and patient outcomes. A comprehensive examination of relevant clinical trials and case studies highlights the evidence supporting its efficacy. The review also underscores safety considerations associated with dexmedetomidine. It proposes strategies for mitigating risks to ensure patient safety. Insights into future directions and research are provided, encompassing ongoing studies, areas necessitating further investigation, and potential refinements in technique. Finally, the article summarizes key findings, emphasizing the practicality of dexmedetomidine-enhanced interscalene brachial plexus blocks in shoulder surgery and its far-reaching implications for clinical practice and patient care.
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Affiliation(s)
- Varun N Thawkar
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Karuna Taksande
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Marinova M, Sundaram A, Holtham K, Ebert JR, Wysocki D, Meyerkort D, Radic R. The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:4422-4429. [PMID: 37464101 PMCID: PMC10471706 DOI: 10.1007/s00167-023-07455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The study sought to investigate the effectiveness of a cryocompression Game Ready™ (GR) versus usual care protocol (UC) on early post-operative recovery following total knee arthroplasty. METHODS This study prospectively randomised 72 total knee arthroplasties to a 2-week (from day 0) intervention of GR treatment (n = 36, 63.9% females) or UC of ice with static compression (n = 36, 45.7% females). Knee flexion and extension range of motion (ROM), a visual analogue pain scale and limb circumference were documented at day 1, 2 and 14, as well as 6 weeks post-surgery. Medication usage and length of hospital stay were documented. Patient-reported outcome measures (PROMs) included the Knee Injury and Osteoarthritis Outcome Score and a Patient Satisfaction Questionnaire. Statistical analysis using linear mixed modelling and analysis of variance table with Satterthwaite's method were used along with two-tailed t-tests. RESULTS There were no significant group-by-time interactions regarding any of the outcomes. The GR group had 19% lost to follow-up at 2 weeks, while the UC group had 8%. The GR group demonstrated significantly better knee extension ROM at day 1 (p = 0.048) and day 14 (p = 0.007) compared with the UC group. There were no group differences (n.s.) observed in pain, flexion ROM, limb circumference, opioid use or PROMs. Overall, higher pain levels resulted in increased opioid intake (p = 0.002), older patients used significantly less opioids (p < 0.001) and males reported significantly less pain than females (p = 0.048). No adverse effects were observed due to either protocol. CONCLUSION Despite patients gaining significantly more knee extension during the initial two-week intervention period when using GR compared to UC, this effect was likely due to chance. No further significant differences were observed between the groups during or after cession of the intervention. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Mira Marinova
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia.
- Department of Orthopaedics, Royal Perth Hospital, Perth, WA, Australia.
| | - Abayasankar Sundaram
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
| | - Katie Holtham
- Sports Physiotherapist, Beatty Park Physiotherapy, North Perth, Australia
| | - Jay R Ebert
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA, Australia
| | - David Wysocki
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
| | - Daniel Meyerkort
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
| | - Ross Radic
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, WA, Australia
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Zhu B, Zhang D, Sang M, Zhao L, Wang C, Xu Y. Establishment and evaluation of a predictive model for length of hospital stay after total knee arthroplasty: A single-center retrospective study in China. Front Surg 2023; 10:1102371. [PMID: 37091271 PMCID: PMC10118006 DOI: 10.3389/fsurg.2023.1102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundTotal knee arthroplasty (TKA) is the ultimate option for end-stage osteoarthritis, and the demand of this procedure are increasing every year. The length of hospital stay (LOS) greatly affects the overall cost of joint arthroplasty. The purpose of this study was to develop and validate a predictive model using perioperative data to estimate the risk of prolonged LOS in patients undergoing TKA.MethodsData for 694 patients after TKA collected retrospectively in our department were analyzed by logistic regression models. Multi-variable logistic regression modeling with forward stepwise elimination was used to determine reduced parameters and establish a prediction model. The discrimination efficacy, calibration efficacy, and clinical utility of the prediction model were evaluated.ResultsEight independent predictors were identified: non-medical insurance payment, Charlson Comorbidity Index (CCI) ≥ 3, body mass index (BMI) > 25.2, surgery on Monday, age > 67.5, postoperative complications, blood transfusion, and operation time > 120.5 min had a higher probability of hospitalization for ≥6 days. The model had good discrimination [area under the curve (AUC), 0.802 95% CI, 0.754–0.850]] and good calibration (p = 0.929). A decision curve analysis proved that the nomogram was clinically effective.ConclusionThis study identified risk factors for prolonged hospital stay in patients after TKA. It is important to recognize all the factors that affect hospital LOS to try to maximize the use of medical resources, optimize hospital LOS and ultimately optimize the care of our patients.
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