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Jiangping W, Xiaolin Q, Han S, Zhou X, Mao N, Zhibo D, Ting G, Shidong H, Xiangwei L, Xin Y, Guoyin S. Network Meta-Analysis of Perioperative Analgesic Effects of Different Interventions on Postoperative Pain After Arthroscopic Shoulder Surgery Based on Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:921016. [PMID: 35872801 PMCID: PMC9304654 DOI: 10.3389/fmed.2022.921016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundShoulder arthroscopic surgery is a common surgical method used in orthopedics. However, severe postoperative pain can significantly limit the early joint movement of patients and adversely affect the impact of the surgery. At present, there is no consistent and effective analgesic scheme for the management of postoperative pain after arthroscopic surgery of the shoulder.PurposeThe aim of this study was to search for the most effective analgesic scheme to control pain in the perioperative period of arthroscopic surgery of the shoulder.Study DesignNetwork meta-analysis.MethodsWe searched 5 different databases (i.e., Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from January 2011 to January 2021 for English literature. Thereafter, we sifted out randomized controlled trials (RCTs), which compared different intervention schemes for pain management after shoulder arthroscopy and selected only 12 h, 24 h, or 48 h after the patient leaves the operating room as an optimal period for administration of analgesic intervention schemes. Only patients with shoulder disease who have undergone arthroscopic shoulder surgery were included in this study. The Cochrane “risk of bias” was used for the quality assessment. Moreover, some additional tests were performed to enhance the credibility of the results.ResultsTwenty-nine RCTs involving 1,885 patients were included in this frequentist network meta-analysis (NMA). These articles mainly were divided into two distinct groups, namely, the nerve block group and the non-nerve block group. Regarding the nerve block group, at postoperative 12 h, the intervention suprascapular nerve block + interscalene nerve block (SSNB + INB) was ranked first, whereas INB + intra-articular injection (INB + IAI) was ranked first at 24 h and 48 h postoperation. In the non-nerve block group, external application (EA) was ranked first at postoperative 12 h, but oral administration (OA) exhibited a better analgesic effect at postoperative 24 h and postoperative 48 h.ConclusionWe conclude that the analgesic effect of SSNB+INB was the best at postoperative 12 h, and INB+IAI was the best at postoperative 24 h and 48 h in the nerve block group. For the non-nerve block group, the effect of EA was the best at postoperative 12 h, and the analgesic effect of OA at postoperative 24 h and 48 h was significantly better than any other interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021286777.
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Affiliation(s)
- Wu Jiangping
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Quan Xiaolin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Han
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
- *Correspondence: Shu Han
| | - Xiaolan Zhou
- Medical Record Statistics Section, The Second Hospital of Chongqing Medical University, Chongqing, China
- Xiaolan Zhou
| | - Nie Mao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Deng Zhibo
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Gong Ting
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Hu Shidong
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Li Xiangwei
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Yuan Xin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Guoyin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
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Kim H, Park HJ, Lee SY, Kim JN, Moon J, Kim MS, Kim E. Ultrasound evaluation of postsurgical shoulder after rotator cuff repair: comparison of clinical results. Acta Radiol 2021; 62:1025-1034. [PMID: 32799556 DOI: 10.1177/0284185120948494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between the imaging parameters on postoperative ultrasound (US) other than repaired tendon integrity with clinical outcome such as postoperative residual pain has not been well defined. PURPOSE To investigate whether the repaired tendon thickness and subdeltoid fluid collection after rotator cuff repair are correlated with early postoperative clinical outcome. MATERIAL AND METHODS This retrospective study included 54 patients who underwent repair of the arthroscopic rotator cuff either by suture-bridge or single-row technique and postoperative US. We assessed the relationship between the sonographic parameters, including repaired supraspinatus tendon thickness and subdeltoid fluid collection, with the clinical outcome represented by the Korean Shoulder Scoring system (KSS) score using correlation coefficients (R). Also, the subgroup analysis was done to assess the differences by surgical technique and patients' age. RESULTS There was a significant inverse relationship between the amount of subdeltoid fluid collection and degree of self-assessed pain improvement of the patients (P < 0.05), although every KSS category showed statistically insignificant tendency of inverse relationship with the fluid thickness. However, there was no statistically significant relationship between the thickness of repaired supraspinatus tendon and KSS scores. In patients aged >60 years, a statistically significant inverse relationship between thickness of subdeltoid fluid collection and difference value of the KSS scores in category of function was observed with both interpreters (P = 0.015 and P = 0.04, respectively). CONCLUSION Subdeltoid fluid collection measured on US after repair of the arthroscopic rotator cuff in the early postoperative period has significant association with the patients' subjective clinical outcome.
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Affiliation(s)
- Haejung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Moon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Post-operative pain control following arthroscopic rotator cuff repair: Intravenous acetaminophen versus interscalene brachial plexus block; A prospective randomized study. J Orthop 2021; 25:6-9. [PMID: 33897133 DOI: 10.1016/j.jor.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background With the increasing number of patients undergoing arthroscopic rotator cuff repair (ARCR), postoperative pain control in these patients has become an important issue. We investigated and compared post-operative pain relief with intravenous acetaminophen (IA) and interscalene brachial plexus block (IBPB) after ARCR. Methods This prospective study involved 66 consecutive patients who underwent ARCR in 2019-2020 at our hospital. Overall, 23 and 43 shoulders were assigned to the IA and IBPB groups, respectively. We evaluated the visual analog scale (VAS) pain scores at rest, during activity, and at night for the first 72 h postoperatively. We compared the results statistically between the groups. A p-value <0.05 was considered statistically significant. Results VAS scores for night pain in the IBPB group were significantly lower than those in the IA group for the first 24 h postoperatively (p = 0.017). In contrast, the same scores were significantly lower in the IA group than in the IBPB group at 72 h postoperatively (p = 0.024). Other scores were not significantly different between the groups. Conclusions IBPB provides superior night pain control during the first 24 h postoperatively, and IA provides superior night pain control at 72 h postoperatively. However, there were no significant differences in other pain scores between the two groups.
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Affiliation(s)
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Jensen AR, Sharma AK, Formanek B, Wang C, Buser Z, Wang JC, Petrigliano FA. Continuous Peripheral Nerve Blocks Are Associated With Increased Rates of Emergency Department Visits After Arthroscopic Rotator Cuff Repair Surgery. Orthopedics 2020; 43:127-131. [PMID: 31841606 DOI: 10.3928/01477447-20191212-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/14/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess trends in the use of perioperative single and continuous peripheral nerve blocks (PNBs) and their associations with emergency department (ED) visits after arthroscopic rotator cuff repair (RCR) surgery. The authors used a large database from a private insurer to identify patients who received perioperative PNBs for arthroscopic RCR surgeries from 2007 to 2015. They analyzed patient demographics as well as trends in perioperative PNB use. They also assessed rates of single shot vs continuous PNB use and compared rates of postoperative ED visits according to PNB type. The rate of perioperative PNB for arthroscopic RCR was higher than previously reported (65.9%) and increased over time (52.8% in 2007 to 64.6% in 2015; P=.029). Single shot PNBs were more common than continuous, catheter-mediated PNBs (60.0% vs 6.6%; P<.001), although the use of continuous blocks increased at a greater rate during the study period. Patients who received a perioperative continuous PNB were significantly more likely to visit an ED within 7 days of their surgery than those who received a single shot PNB or no PNB (6.71% vs 4.78% vs 4.74%; P<.02). The rates of ED visits within each group did not change significantly over time. Continuous PNBs are increasingly common for patients undergoing arthroscopic RCR surgery but are associated with increased rates of postoperative ED visits. Studies are needed to identify the reasons for this increased rate of ED visits and strategies to decrease ED use. [Orthopedics. 2020; 43(2): 127-131.].
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Lee W, Kim SJ, Choi CH, Choi YR, Chun YM. Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3912-3919. [PMID: 30980117 DOI: 10.1007/s00167-019-05486-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes and structural integrity following arthroscopic rotator cuff repair, either with intra-articular injection of corticosteroids in the early postoperative period using ultrasound guidance or without it. METHODS This study included 318 patients who underwent arthroscopic repair for either a partial-thickness or small-to-medium-sized full-thickness rotator cuff tear from 2012 to 2015. Patients were divided into two groups based on the administration of an intra-articular corticosteroids injection at 3 months after the surgery: group A (with corticosteroid injection, n = 56) and group B (without corticosteroid injection, n = 262). Functional outcomes were evaluated using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity. RESULTS At the 2-year follow-up, both groups showed no significant differences in VAS pain score (group A/B, 1.1 ± 0.9/1.1 ± 1.1), functional scores including SSV (88.5 ± 10.8/88.3 ± 10.0), ASES (90.8 ± 6.6/90.4 ± 6.9), and UCLA scores (30.2 ± 5.6/30.7 ± 5.2), and active ROM including forward flexion (151° ± 8°/153° ± 7°), external rotation (54° ± 5°/55° ± 7°), and internal rotation (10 ± 1/10 ± 2). Follow-up MRA imaging collected 6 months after surgery showed no significant difference in the re-tear rate (n.s.) between group A and B (n = 10/56, 17.9% and 45/262, 17.2%, respectively). CONCLUSIONS Intra-articular corticosteroids injection in the early postoperative period after arthroscopic rotator cuff repair provided satisfactory pain relief and ROM improvement without increasing the re-tear rate or deteriorating clinical outcomes at the 2-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wonyong Lee
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Sung-Jae Kim
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Chong-Hyuk Choi
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Yun-Rak Choi
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Yong-Min Chun
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea.
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Abstract
Objectives To determine the prevalence of sleep disturbances in orthopaedic trauma patients 3 months following surgery and to identify any subset(s) of patients at high risk for prolonged sleep disturbance. Design Prospective cohort. Setting Level 1 Trauma Center. Patient/Participants All patients at an orthopaedic trauma clinic from May 3, 2016 to Feb 23, 2017. Main outcome measurements Baseline patient Pittsburgh Sleep Questionnaire (PSQI) and Insomnia Severity Index (ISI) scores compared to PSQI and ISI scores 3-months postoperatively. Both gender and age stratified data analyses were performed. Results Sixty-six patients met our inclusion criteria and completed both baseline and 3-month surveys. There were 44 males and 22 females. There was a significant increase in PSQI and ISI scores from baseline to 3 months across all patients. Further analysis revealed significant increases from baseline to 3 months in both PSQI and ISI scores for female patients but not male patients. There was a significant difference from baseline to 3 months in patients 50 years old and under but not for patients above 50 years old. No patients required revision surgery in the first 3 months. Conclusions More than half of all patients reported continued sleep disturbance 3 months postoperatively. Females are at particularly increased risk for sleep disturbance. These findings demonstrate that sleep disturbances merit attention in the early stages of the postoperative recovery process. Level of evidence Therapeutic Level II.
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Effect of pregabalin on postoperative pain after shoulder arthroscopy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The effectiveness of prolotherapy on failed rotator cuff repair surgery. Turk J Phys Med Rehabil 2019; 65:394-401. [PMID: 31893277 DOI: 10.5606/tftrd.2019.3222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/30/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The aim of the present study was to investigate the effectiveness of prolotherapy injections in the treatment of failed rotator cuff repair surgery. Patients and methods Between May 2014 and March 2016, a total of 15 patients (5 males, 10 females; mean age 49.4±10.7 years; range, 33 to 71 years) with failed rotator cuff repair surgery who had at least six months of complaints and were refractory to at least of three months of conservative methods were included. Ultrasound-guided prolotherapy injections were performed under aseptic conditions, and the patients were instructed to carry out a home-based exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotator Cuff (WORC) Index, patient satisfaction and shoulder range of motion. All patients were examined at baseline, at Week 3, 6, and 12 and at the final follow-up visit. Results The intra-group comparison showed that the patients achieved significant improvements at all time points, compared to baseline as measured by VAS, SPADI, WORC index, and shoulder range of motion (p<0.001). Twelve patients (80%) reported excellent or good outcomes. Conclusion Our study results show that prolotherapy is effective in the treatment of patients with failed rotator cuff repair surgery with significant improvements in the shoulder functions and pain relief.
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Jung HS, Seo KH, Kang JH, Jeong JY, Kim YS, Han NR. Optimal dose of perineural dexmedetomidine for interscalene brachial plexus block to control postoperative pain in patients undergoing arthroscopic shoulder surgery: A prospective, double-blind, randomized controlled study. Medicine (Baltimore) 2018; 97:e0440. [PMID: 29668608 PMCID: PMC5916649 DOI: 10.1097/md.0000000000010440] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adjuvant perineural dexmedetomidine can be used to prolong the analgesic effect of interscalene brachial plexus block (ISB). We investigated the optimal dose of dexmedetomidine in ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. METHODS One hundred patients scheduled for elective shoulder arthroscopic surgery were enrolled in this randomized, double-blind study. Ultrasound-guided ISB was performed before general anesthesia using 22 mL of ropivacaine 0.5% combined with 1, 1.5, or 2 μg/kg of dexmedetomidine (group D1, D2, and D3, respectively) or with normal saline as a control (group R, n = 25 per group). The primary outcome was the duration of analgesia (DOA), numeric pain rating scale (NRS), and consumption of additional analgesics during 36 h after ISB. Secondary outcome included durations of motor and sensory block (DOM and DOS), hemodynamic variables and sedation and dyspnea scores. RESULTS Ninety-seven patients completed the study. The DOS, DOM, and DOA were significantly longer in the dexmedetomidine groups than in group R. The DOA was significantly longer in group D3 than in groups D1 (P = .026) and D2 (P = .039). The DOA was 808.13 ± 179.97, 1032.60 ± 288.14, 1042.04 ± 188.13, and 1223.96 ± 238.06 min in groups R, D1, D2, and D3, respectively. The NRS score was significantly higher in group R than in the dexmedetomidine groups 12 h after ISB (P < .001) and significantly lower in group D3 than in the other groups 18 h after ISB (P = .02). The incidence of hypotension was higher in groups D2 and D3 than in group R during surgery (P = .008 and P = .011, respectively). There were no significant differences in consumption of rescue analgesics, sedation, and dyspnea scores between the study groups. CONCLUSION Perineural dexmedetomidine 2 μg/kg could be the optimal dose in ISB for arthroscopic shoulder surgery in that it provides an adequate DOA. However, this dose was associated with increased risk of hypotension.
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Affiliation(s)
- Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Jae Hyuk Kang
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Jin-Young Jeong
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Yong-Shin Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Na-Re Han
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
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Predictors of Nurses' Intentions to Administer As-Needed Opioid Analgesics for Pain Relief to Postoperative Orthopaedic Patients in the Acute Care Setting. Orthop Nurs 2017; 36:392-399. [PMID: 29189621 DOI: 10.1097/nor.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients undergoing orthopaedic surgery experience severe postoperative pain that is frequently undertreated. No study was found that examined the predictors of nurses' intentions to administer as needed (PRN) opioid analgesics for postoperative pain relief. PURPOSE The purpose of this study was to determine what constructs from the Integrated Behavioral Model (IBM) can predict nurses' intentions to administer PRN opioid analgesics for pain relief to hospitalized postoperative orthopaedic patients. METHODS A nonexperimental, cross-sectional quantitative format was used. The sample consisted of 800 nurses. Data collection was done by survey. RESULTS Path analysis revealed the significant predictors of nurses' intention to administer opioid analgesics to be self-efficacy (β= 0.15), normative beliefs (β= 0.21), and salience (importance) of the behavior (β= 0.25). CONCLUSION The study showed that the IBM constructs are useful for predicting intentions toward performance of a professional behavior. The inclusion of self-efficacy, underlying beliefs, and salience of the behavior was new and unique contributions to the existing body of knowledge.
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Abdel Hamid MHE. Intravenous Dexmedetomidine Infusion Compared with that of Fentanyl in Patients Undergoing Arthroscopic Shoulder Surgery under General Anesthesia. Anesth Essays Res 2017; 11:1070-1074. [PMID: 29284877 PMCID: PMC5735452 DOI: 10.4103/aer.aer_148_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile. Aim The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. Patients and Methods A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h. Measurements Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU, MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU. Results This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction. Conclusion Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.
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Mardani-Kivi M, Karimi Mobarakeh M, Keyhani S, Haghighi M, Hashemi-Motlagh K, Saheb-Ekhtiari K. Arthroscopic bankart surgery: Does gabapentin reduce postoperative pain and opioid consumption? A triple-blinded randomized clinical trial. Orthop Traumatol Surg Res 2016; 102:549-53. [PMID: 27178738 DOI: 10.1016/j.otsr.2016.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/27/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of gabapentin as preemptive analgesia in managing acute pain following shoulder bankart arthroscopy is controversial and the studies addressing this issue are limited. HYPOTHESIS The present study was undertaken to examine the effects of preemptive single dose of gabapentin on pain management and opioid consumption in patients undergoing arthroscopic bankart surgery. PATIENTS AND METHODS In the current triple-blinded randomized clinical trial, 76 eligible patients were randomly divided into two groups either taking gabapentin 600mg (G group) or placebo (P group). The primary outcomes were pain intensity assessed based on Visual Analogue Scale (VAS) and secondary outcomes were opioid consumption and side effects, dizziness, sedation, nausea and vomiting at 6h and 24h follow-up visits. RESULTS The pain intensity were not significantly different between the G and P groups (P>0.05). The opioid consumption, however, was significantly reduced in G group at both 6h and 24h follow-up visits (P<0.001). Dizziness and sedation were similar in both groups. Nausea and vomiting were significantly lower in G group only at 6h visit but similar at 24h follow-up visit (P<0.001). DISCUSSION The preemptive single dose of gabapentin 600mg administered prior to arthroscopic bankart surgery does not decrease post-operation pain, but reduces opioid consumption. Gabapentin restrained postoperative nausea and vomiting for a short while (less than 6h). LEVEL OF EVIDENCE Level I, treatment study.
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Affiliation(s)
- M Mardani-Kivi
- Orthopedic Department, Guilan Road Trauma Center, Guilan University of Medical Sciences, Poursina Hospital, Rasht, Iran.
| | - M Karimi Mobarakeh
- Orthopedic Department, Kerman University of Medical Sciences, Kerman, Iran
| | - S Keyhani
- Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Akhtar Orthopedic Hospital, Tehran, Iran
| | - M Haghighi
- Anesthesiology Department, Guilan University Of Medical Sciences, Rasht, Iran
| | - K Hashemi-Motlagh
- Orthopedic Research Center, Guilan University of medical sciences, Rasht, Iran
| | - K Saheb-Ekhtiari
- Orthopedic Research Center, Guilan University of medical sciences, Rasht, Iran
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Shin SJ, Do NH, Lee J, Ko YW. Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2016; 44:2231-6. [PMID: 27268240 DOI: 10.1177/0363546516648326] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Corticosteroid injections have been widely used for reducing shoulder pain. However, catastrophic complications induced by corticosteroid such as infections and tendon degeneration have made surgeons hesitant to use a corticosteroid injection as a pain control modality, especially during the postoperative recovery phase. PURPOSE To determine the effectiveness and safety of a subacromial corticosteroid injection for persistent pain control during the recovery period and to analyze the factors causing persistent pain after arthroscopic rotator cuff repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 458 patients who underwent arthroscopic rotator cuff repair were included in this study. Patient-specific parameters, tear size and pattern, and pain intensity were reviewed. Seventy-two patients were administered a postoperative subacromial corticosteroid injection under ultrasound guidance. The corticosteroid injection was administered to patients who awakened overnight because of constant severe shoulder pain or whose pain was exacerbated at the time of rehabilitation exercises within 8 weeks after surgery. Pain intensity, patient satisfaction, and functional outcomes using the American Shoulder and Elbow Surgeons (ASES) and Constant scores were compared between the patients with and without a subacromial corticosteroid injection. The retear rate was evaluated with magnetic resonance imaging at 6 months postoperatively. RESULTS In patients with an injection, the mean (±SD) visual analog scale for pain (pVAS) score was 7.7 ± 1.2 at the time of the injection. This significantly decreased to 2.3 ± 1.4 at the end of the first month after the injection, demonstrating a 70.2% reduction in pain (P < .01). At 3 months after the injection, the mean pVAS score was 1.2 ± 1.8. Functional outcomes at final follow-up showed no significant differences between patients with and without an injection (ASES score: 90.1 ± 14.6 with injection, 91.9 ± 8.2 without injection [P = .91]; Constant score: 89.1 ± 12.9 with injection, 84.5 ± 13.0 without injection [P = .17]). Patients with an injection showed no significant increase in the retear rate (6.8% with injection, 18.4% without injection; P = .06). According to the tear pattern, L-shaped rotator cuff tears (41.8%) showed a higher occurrence of severe postoperative persistent pain. Preoperative shoulder stiffness was revealed as a predisposing factor for persistent pain (odds ratio, 0.2; P = .04). CONCLUSION A subacromial corticosteroid injection can be considered as a useful and safe modality for the treatment of patients having severe persistent pain during the recovery phase after arthroscopic rotator cuff repair.
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Affiliation(s)
- Sang-Jin Shin
- Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Nam-Hoon Do
- Joint Center, Department of Orthopedic Surgery, Baro Hospital, Incheon, Korea
| | - Juyeob Lee
- Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Young-Won Ko
- Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea
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Abstract
PURPOSE The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1±2.0 in the zolpidem group and 3.3±2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
| | - Si-Wook Lee
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea.
| | - Young-Kuk Lee
- Department of Orthopedic Surgery, Hanmi Hospital, Daegu, Korea
| | - Hong-Kwan Shin
- Department of Orthopedic Surgery, Hanmi Hospital, Daegu, Korea
| | - Ilseon Hwang
- Department of Pathology, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
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Shulman BS, Liporace FA, Davidovitch RI, Karia R, Egol KA. Sleep disturbance after fracture is related to emotional well-being rather than functional result. J Orthop Trauma 2015; 29:e146-50. [PMID: 25072285 DOI: 10.1097/bot.0000000000000217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of sleep disturbance after 4 common orthopaedic traumatic conditions. METHODS The functional status of 1095 patients was prospectively assessed using validated questionnaires for patients with acute proximal humerus (n = 111), distal radius (n = 440), tibial plateau (n = 109), and ankle fractures (n = 435). Patient reported sleep difficulty was compared with the overall functional and emotional status of each patient at 3, 6, and 12 months after treatment. RESULTS Sleep difficulty at 3-month follow-up was reported in 41% of patients with proximal humerus fracture, 25% of patients with distal radius fracture, 36% of patients with tibial plateau, and 19% of patients with ankle fracture. By 12-month follow-up, less than 20% of patients with all fracture types reported sleep difficulty. At 12-month follow-up, the SF-36 Mental Health category for patients with distal radius fractures (P = 0.001) and the Short Musculoskeletal Function Assessment Emotional category for patients with tibial plateau fractures (P = 0.024) and ankle fractures (P ≤ 0.001) were independent predictors of poor sleep, whereas the respective functional status categories were not. CONCLUSIONS At 12-month follow-up, poor sleep was independently associated with poor emotional status but not associated with poor functional status. The mental health status of patients with sleep difficulty in the latter stages of fracture healing should be carefully assessed to provide the highest level of care. The results of this study should allow orthopaedic trauma surgeons to counsel patients regarding expectations of difficulty sleeping after acute fractures. LEVEL OF EVIDENCE Prognostic level II. See Instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- Brandon S Shulman
- *NYU Department of Orthopaedic Surgery, Jamaica Hospital for Joint Diseases, New York, NY; and †Department of Orthoapedic Surgery Jamaica Hospital Medical Center, Jamaica, NY
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Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2015; 23:542-7. [PMID: 23108685 DOI: 10.1007/s00167-012-2272-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/19/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study reported here was to compare the efficacy and safety of postoperative analgesia provided by interscalene block with multimodal pain control (IB-MPC) versus that provided by multimodal pain control (MPC) alone after arthroscopic rotator cuff repair. METHODS Sixty consecutive patients were assigned to either the IB-MPC group (30 patients) or the MPC group (30 patients). Visual analogue scale (VAS) pain scores before surgery and through day 5 after surgery, consumption of rescue analgesic, adverse effects and complications were evaluated. RESULTS Mean VAS pain scores immediately after surgery and on days 1 through 5 after surgery were 3.9 ± 2.6, 4.4 ± 1.5, 3.4 ± 1.3, 2.7 ± 1.3, 2.4 ± 1.2, and 2.0 ± 1.0, respectively, in the IB-MPC group and 6.2 ± 1.8, 4.1 ± 1.7, 3.2 ± 1.9, 2.7 ± 1.4, 2.5 ± 1.3, and 2.0 ± 1.2, respectively, in the MPC group. The IB-MPC group had significantly lower VAS pain score immediately after surgery than the MPC group did (P < 0.001). There were no statistically significant differences regarding consumption of rescue analgesic or adverse effects between the two groups (n.s.). In the IB-MPC group, complications related to interscalene block included tingling of the hand in three patients and numbness of the neck and ear in two. However, these symptoms resolved spontaneously within a few days. No patients had major complications related to interscalene block. CONCLUSIONS IB-MPC achieved better pain control immediately after surgery than MPC alone, without major complications related to interscalene block. It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Prospective Comparative Study, Prognosis Study, Level II.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Korea,
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INTRARTICULAR ANALGESICS FOLLOWING SHOULDER ARTHROSCOPY: COMPARISON OF ROPIVACAINE/DEXAMETHASONE WITH ROPIVACAINE. ACTA ACUST UNITED AC 2015. [DOI: 10.14260/jemds/2015/135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lindberg MF, Grov EK, Gay CL, Rustøen T, Granheim TI, Amlie E, Lerdal A. Pain characteristics and self-rated health after elective orthopaedic surgery - a cross-sectional survey. J Clin Nurs 2013; 22:1242-53. [DOI: 10.1111/jocn.12149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Maren F Lindberg
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Ellen K Grov
- Department of Nursing Science; Faculty of Medicine; University of Oslo; Blindern Oslo Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing; University of California; San Francisco CA USA
- Department of Research and Development; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care; Department of Research and Development; Oslo University Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
| | - Tove I Granheim
- Postoperative Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Einar Amlie
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Anners Lerdal
- Department of Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
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A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression. Arthroscopy 2011; 27:1323-8. [PMID: 21868190 DOI: 10.1016/j.arthro.2011.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 05/23/2011] [Accepted: 05/31/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficiency of the suprascapular nerve (SSN) block in pain reduction after arthroscopic subacromial decompression operations and its influence on patient satisfaction. Furthermore, we wanted to evaluate whether better perioperative pain management could positively influence postoperative shoulder function. METHODS In this prospective, randomized, double-blinded clinical trial, 3 groups of patients--each with 15 participants--were treated with SSN block (10 mL of 1% ropivacaine), placebo, or a subacromial infiltration of local anesthesia (20 mL of 1% ropivacaine). Preoperative and postoperative pain was evaluated with a visual analog scale. Functional outcome was measured by the Constant-Murley score, and patient satisfaction was measured anecdotally by interview 2 days, 2 weeks, and 6 weeks after surgery. RESULTS The SSN group reported significantly lower levels of postoperative pain, required significantly less analgesia, had better range of motion, and had higher levels of postoperative satisfaction in comparison to the subacromial infiltration group and placebo group. CONCLUSIONS Patients treated with SSN blocks had less pain overall, which led to a decreased need for analgesics in comparison to the subacromial infiltration and placebo groups. Furthermore, patients in the SSN-blocked group achieved better postoperative ROM and were significantly more satisfied after surgery.
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Cho CH, Song KS, Min BW, Lee KJ, Ha E, Lee YC, Lee YK. Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2011; 19:1744-8. [PMID: 20957469 DOI: 10.1007/s00167-010-1294-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 09/30/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE This prospective study was undertaken to compare the effectiveness and safety of a multimodal pain control protocol with those of intravenous patient-controlled analgesia in rotator cuff repair. METHODS Seventy patients scheduled for rotator cuff repair were randomized to either a multimodal pain control group (group 1, 40 patients) or an intravenous patient-controlled analgesia group (group 2, 30 patients). We compared these two groups with respect to level of pain before surgery to the fifth postoperative day, duration of postoperative rehabilitation, consumption of additional analgesics, and adverse effects. RESULTS Mean visual analogue scale scores immediately after surgery (day 0) and on postoperative days 1-5 were 6.9, 5.5, 4.3, 3.3, 3.0, and 2.6 in group 1 and 7.8, 5.9, 4.4, 4.7, 4.3, and 3.7 in group 2. Pain relief was significantly better in group 1 on days 0, 3, 4, and 5 (P = 0.026, 0.006, 0.010, and 0.009, respectively). Furthermore, functional recovery occurred earlier in group 1. No significant differences were observed between the two groups with respect to nausea, vomiting, urinary retention, and headache (n.s.), but group 1 was found to be significantly less likely to experience dizziness or urticaria (P = 0.007, 0.017, respectively). One other significant difference was observed: 1 patient (2.5%) in group 1 and 6 patients (20%) in group 2 discontinued regimen because of medication-related adverse effects (P = 0.016). CONCLUSION The multimodal pain control protocol was found to offer more effective postoperative pain control with fewer adverse effects than intravenous patient-controlled analgesia. However, achieving adequate pain control within the first 48 h of surgery remains challenging, and thus, the developments of more effective and safer multimodal pain control protocols are required.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 194 Dongsan-Dong, Joong-Gu, Daegu, 700-712, Korea.
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Cho CH. Gender-related Difference in Intravenous Patient-controlled Analgesia for Postoperative Pain Control in Rotator Cuff Repair. ACTA ACUST UNITED AC 2010. [DOI: 10.4055/jkoa.2010.45.1.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chul Hyun Cho
- Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea
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