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Zhang W, Ji H, Wu Y, Sun K, Li J, Xu Z, Wang C, Zhao F, Sun Q. Patient Self-Management Scale After Total Knee Arthroplasty (PSMS-TKA): Instrument Development and Cross-Sectional Validation Study. J Arthroplasty 2024:S0883-5403(24)00554-0. [PMID: 38830430 DOI: 10.1016/j.arth.2024.05.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Effective self-management after total knee arthroplasty (TKA) not only improves patients' knee pain and physical function but also improves quality of life. However, there is no assessment tool that can be targeted to evaluate the self-management level of patients after TKA. This study aimed to develop and validate a scale to specifically assess the level of self-management in patients after TKA. METHODS The study was conducted in 2 steps: (1) instrument development and (2) psychological tests (n = 428). For the instrument development portion, scale items were generated through a literature review and semi-structured interviews, then reviewed and revised by a panel of experts, and assessed for content validity and pilot testing. For the psychometric tests component, items were analyzed using corrected item-total scale correlations, the critical ratio method, and Cronbach's α. Construct validity was evaluated using exploratory factor analysis and validation factor analysis. Criterion correlation validity was checked by calculating Pearson's correlation coefficient using the Arthritis Self-Efficacy Scale-8 and the scale developed in this study. Internal consistency reliability was evaluated using Cronbach's α and fold-half reliability, and retest reliability was assessed using intragroup correlation coefficients. RESULTS The Patient Self-Management Scale after Total Knee Arthroplasty (PSMS-TKA) comprises 4 factors and 23 items that assess daily behavior management, disease information management, psychosocial management, and exercise rehabilitation management. Exploratory factor analysis and validation factor analysis yielded a stable 4-factor model for the 23 items. The PSMS-TKA demonstrated good criterion-related validity when using the Arthritis Self-Efficacy-8 as a criterion. The Cronbach's α of the PSMS-TKA was 0.903, the split-half reliability was 0.934, and the test-retest reliability correlation coefficient was 0.887 (P < .01); thus, the reliability of the scale is good. CONCLUSIONS The PSMS-TKA developed in this study has good validity and reliability and can be used to assess the level of self-management in patients after TKA. The scale helps healthcare professionals understand the level of self-management of patients undergoing TKA.
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Affiliation(s)
- Wenzhong Zhang
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
| | - Hong Ji
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yan Wu
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Kangming Sun
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jing Li
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
| | - Zhenzhen Xu
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
| | - Chunlei Wang
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
| | - Fengyi Zhao
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
| | - Qingxiang Sun
- Shandong University of Traditional Chinese Medicine School of Nursing, Jinan, China
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Pryce R, Langan E, Tector K, Raggett L, Flynn R, Smart KM. Patients' experiences following total knee arthroplasty: a qualitative evidence synthesis. Disabil Rehabil 2024; 46:214-231. [PMID: 36617965 DOI: 10.1080/09638288.2022.2159548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) is a common surgical intervention for patients with advanced arthritis. The aim of this qualitative evidence synthesis was to systematically review the qualitative literature on patients' experiences following primary TKA. MATERIALS AND METHODS Four electronic databases (PubMed, CINAHL, Cochrane and Embase) were searched from inception until October 2021. Pairs of reviewers independently screened search results for eligibility, analysed the quality of included studies and extracted data. We undertook a thematic synthesis and used an interpretive approach to identify recurring themes and draw a conclusion. Data were synthesised using thematic analysis and an interpretive approach was used to identify themes. RESULTS Twenty-three studies exploring patients' experiences following TKA were included. Five main themes emerged: (i) Experience of healthcare staff, (ii) Pain/Medications, (iii) Was it worth it? (iv) Social Support (v) Follow up. CONCLUSIONS This review highlights the variability in patients' experiences following TKA. Whether this experience detailed their pain, function, or encounter with healthcare staff or systems, patients reported a variety of both positive and negative sentiments. Each theme invites attention to an area in which healthcare can improve to enhance patients' experiences. The importance of patient support, individualised rehabilitation and appropriate follow-up are highlighted.
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Affiliation(s)
- Robert Pryce
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Emma Langan
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Katie Tector
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Leah Raggett
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Roisin Flynn
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Keith M Smart
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
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Chalmers BP, Puri S, Chiu YF, Lebowitz J, Sideris A, Westrich GH, Jerabek SA, Gonzalez Della Valle A. Patients Undergoing Primary, Cementless TKA had Similar Pain, Opioid Utilization, and Functional Outcomes Compared to Matched Patients With Cemented Fixation. J Arthroplasty 2023; 38:2131-2136. [PMID: 37142071 DOI: 10.1016/j.arth.2023.04.058] [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: 10/15/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Despite renewed interest in cementless fixation of total knee implants, many surgeons have anecdotal concerns about slower recovery and higher early pain scores. We sought to analyze 90-day opioid utilizations, inhospital pain scores, and patient-reported outcome measures (PROMs) in patients undergoing primary cemented versus cementless total knee arthroplasty (TKA). METHODS We retrospectively identified a cohort of opioid naïve patients undergoing primary TKA for osteoarthritis. There were 186 patients who had cementless TKAs matched 1:6 with 1,116 who received a cemented TKAs based on age (±6 years), body mass index (BMI) (±5), and sex. We compared inhospital pain scores, 90-day opioid utilizations in morphine milligram equivalents (MMEs), and early postoperative PROMs. RESULTS The cemented and cementless cohorts had similar lowest (0.09 versus 0.08), highest (7.36 versus 7.34), and average (3.26 versus 3.27) pain scores using numeric rating scale (P > .05). They received similar inhospital (90 versus 102, P = .176), discharge (315 versus 315, P = .483), and total (687 versus 720, P = .547) MMEs. They had similar average inpatient hourly opioid consumption (2.5 versus 2.5 MMEs/hour, P = .965). Average refills 90 days postoperatively were similar in both cohorts (1.5 versus 1.4 refills, P = .893). Also, preoperative, 6-week, 3-month, delta 6-week, and delta 3-month PROMs scores were similar between cemented and cementless cohorts (P > .05) CONCLUSION: This matched study demonstrated similar in-hospital pain scores and opioid utilization, total MMEs prescribed within 90 days, and PROMs at 6 weeks and 3 months postoperatively between cemented and cementless TKAs. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, New York
| | - Juliana Lebowitz
- Operational Excellence, Hospital for Special Surgery, New York, New York
| | - Alexandra Sideris
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Rubin L, Avraham Y, Sharabi-Nov A, Shebly T, Ben Natan M, Rothem DE. Acupuncture Effect on Analgesic Consumption and Cortisol Levels Following Total Knee Arthroplasty: A Randomized Controlled Trial. Med Acupunct 2023; 35:230-235. [PMID: 37920858 PMCID: PMC10618810 DOI: 10.1089/acu.2023.0024] [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: 11/04/2023] Open
Abstract
Objective Pain following total knee arthroplasty (TKA) is common. Various modalities of treating orthopedic postoperative pain (POP) exist; however, the optimal management of POP remains unclear. The purpose of this study was to examine acupuncture's effect on postoperative analgesic consumption and cortisol levels in patients undergoing TKA. Materials and Methods In this randomized controlled trial, 80 patients scheduled for elective TKA surgery were recruited and randomly assigned to 2 groups: (1) an intervention group, receiving acupuncture treatment on days 1 and 2 in addition to standard POP management (n = 40) and a control group, who received standard POP management only (n = 40). Results There was no statistical difference between the groups in analgesic consumption on days 1 and 3 postoperatively. On day 5 postoperatively, lower analgesic consumption was seen in the intervention group, compared to the control group. However, this difference was not statistically significant (1.4 versus 2.3, respectively; P = 0.215). There was no statistical difference between the groups in cortisol levels on day 1 postoperatively. In contrast, on day 2 postoperatively, cortisol level was significantly lower in the intervention group, compared to the control group (296 nmol/L versus 400 nmol/L, respectively; P < 0.05). Conclusions The findings suggest that acupuncture may have some effect on patients' analgesic consumption short-term after TKA. Further studies with larger samples are required for establishing these results.This trial was registered at ClinicalTrials.gov (Registration #: NCT03415204).
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Affiliation(s)
- Littal Rubin
- Orthopedics Surgery Department, Ziv Medical Center, Safed, Israel
| | - Yaniv Avraham
- Orthopedics Surgery Department, Ziv Medical Center, Safed, Israel
| | - Adi Sharabi-Nov
- Orthopedics Surgery Department, Ziv Medical Center, Safed, Israel
- Tel-Hai Academic College, Kiryat Shemona, Israel
| | - Tanous Shebly
- Orthopedics Surgery Department, Ziv Medical Center, Safed, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - David E. Rothem
- Orthopedics Surgery Department, Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar -Ilan University, Safed, Israel
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Kefeli Çelik H, Tulgar S, Güler S, Koç K, Küçükordulu BB, Ferli RB, Kehribar L, Genç AS, Süren M. Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study. J Clin Med 2023; 12:6076. [PMID: 37763016 PMCID: PMC10531897 DOI: 10.3390/jcm12186076] [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: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. METHODS This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. RESULTS the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. CONCLUSIONS In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group.
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Affiliation(s)
- Hale Kefeli Çelik
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Serkan Güler
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Kadem Koç
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Büşra Burcu Küçükordulu
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Ramazan Burak Ferli
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Lokman Kehribar
- Department of Orthopedics and Traumatology, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (L.K.); (A.S.G.)
| | - Ahmet Serhat Genç
- Department of Orthopedics and Traumatology, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (L.K.); (A.S.G.)
| | - Mustafa Süren
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
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Motififard M, Hatami S, Feizi A, Toghyani A, Parhamfar M. Comparison of the effects of preoperative celecoxib and gabapentin on pain, functional recovery, and quality of life after total knee arthroplasty: A randomized controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:50. [PMID: 37496639 PMCID: PMC10366981 DOI: 10.4103/jrms.jrms_416_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/18/2022] [Accepted: 03/22/2023] [Indexed: 07/28/2023]
Abstract
Background Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of preoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery. Materials and Methods This randomized, double-blind controlled clinical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was administered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients' pain score and knee and its functional score were recoded. Results The mean of reduction pain in gabapentin and celecoxib groups was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P < 0.001); however, two groups were not significantly different from each other (P > 0.05). Furthermore, the two medication groups were not significantly different in this regard (P > 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P < 0.001). Conclusion According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.
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Affiliation(s)
- Mehdi Motififard
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, School of Health, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Toghyani
- Department Faculty of Health, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Parhamfar
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Barton MF, Groves J, Guevel B, Saint K, Barton BL, Hamza M, Papatheodorou SI. Mindfulness-Based Interventions for the Reduction of Postoperative Pain in Hip and Knee Arthroplasty Patients: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e40102. [PMID: 37425587 PMCID: PMC10328720 DOI: 10.7759/cureus.40102] [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: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE The aim of this systematic review and meta-analysis is to evaluate the effect of mindfulness-based interventions (MBIs) on post-surgical pain in patients undergoing a total hip replacement (THR) or total knee replacement (TKR). METHODS We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A search of multiple databases, including PubMed and EMBASE, was performed for studies from database inception through March 2nd, 2022. Data were extracted, and pooled estimates of standardized mean differences in pain scores were calculated using a random effects model and inverse probability weighting. RESULTS Two randomized control trials were eligible for inclusion (299 patients). The average ages of participants in each study were similar at 65.5 and 64.8 years, and both studies were predominantly female at 72.4% and 61.9%. The mindfulness intervention ranged from an eight-week program to a 20-minute session. Both individual studies reported statistically significant reductions in postoperative pain for MBI groups. The pooled standardized mean difference in pain scores for the MBI groups compared to the control groups was -1.94 (-3.39; -0.48). CONCLUSIONS There exists preliminary evidence for the beneficial effect of MBIs on reducing the postoperative pain experience in this patient population. Given the significant consequences of postoperative pain and the necessity for non-opioid forms of analgesia, this topic represents a promising area of research that warrants future randomized control trials to better understand the role of MBIs for postoperative analgesia.
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Affiliation(s)
| | - James Groves
- Health and Social Behavior, Harvard School of Public Health, Boston, USA
| | - Borna Guevel
- Quantitative Methods, Harvard School of Public Health, Boston, USA
| | - Kirin Saint
- Internal Medicine, University of Michigan Medical School, Ann Arbor, USA
| | - Brenna L Barton
- Emergency Medicine, Tufts University School of Medicine, Boston, USA
| | - Mahmoud Hamza
- Quantitative Methods, Harvard School of Public Health, Boston, USA
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Matthews DE, Rella RT. Retrospective Analysis of Surgeon-Placed Nerve Block and Indwelling Catheter in the Adductor Canal in Total Knee Arthroplasty. Cureus 2023; 15:e39833. [PMID: 37397678 PMCID: PMC10314755 DOI: 10.7759/cureus.39833] [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: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is now being performed in the outpatient setting, and often the postoperative pain is managed with opioid analgesics. Non-opioid pain management modalities are in crucial demand, and we propose a surgical technique that can potentially result in less pain and the decrease in the use of opioid analgesia following TKA. The purpose of this study was to investigate the safety and efficacy of a novel peripheral nerve block (PNB) that includes a single injection and catheter placement for a continuous regional nerve block in total knee arthroplasty. METHODS Fifty-six patients underwent TKA by a single surgeon utilizing the novel method. Patient-reported outcomes were entered into an outcomes database and compared to an aggregate of over 3,500 comparative TKA patients. A visual analog scale (VAS) evaluated perioperative pain. Patient perioperative opioid usage, expectations of pain control, the incidence of common side effects, and the average hospital length of stay (LOS) were collected. RESULTS Compared to the aggregate of patients in the database, the patients who received the novel surgeon-placed adductor canal block (ACB) and catheter placement reported findings that suggest this technique can possibly lead to a decrease in the severity of pain in addition to a reduction in side effects and the need for opioid analgesia. LOS for these patients was short, and patient satisfaction scores were excellent for the surgeon performing this technique. CONCLUSIONS Using the placement technique described, surgeons can reproducibly perform a single injection of PNB and place an indwelling catheter in the adductor canal through direct visualization of the muscles that make up the borders of the adductor canal. This technique offers potential advantages over pain management modalities that can be elucidated in further studies. The power of this study is limited due to these findings having not been analyzed for statistical significance.
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Affiliation(s)
- Daniel E Matthews
- Orthopedic Surgery, University of South Alabama College of Medicine, Mobile, USA
- Orthopedic Surgery, Alabama Orthopedic Sports Medicine, Daphne, USA
| | - Robert T Rella
- Orthopedic Surgery, University of South Alabama College of Medicine, Mobile, USA
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Xiong FJ, Zhao W, Jia SJ, Huang XR, Luo XF, Pu HJ, Song K, Li YM. Effect of oral pre-emptive analgesia on pain management after total knee arthroplasty: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e070998. [PMID: 36927594 PMCID: PMC10030931 DOI: 10.1136/bmjopen-2022-070998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is currently regarded as an effective treatment for knee osteoarthritis, relieving patients' pain and significantly enhancing their quality of life and activity levels, allowing them to return to work and daily life after surgery. However, some TKA patients suffer from varying degrees of postoperative residual pain and opioid abuse, which negatively impacts their recovery and quality of life. It has been reported that preoperative treatment with multimodal analgesics improves postoperative pain and reduces opioid consumption. However, there is no conclusive evidence that pre-emptive analgesia provides the same benefits in TKA. In order to inform future research, this protocol focuses on the efficacy and safety of oral analgesics used in TKA pre-emptive analgesia. METHODS AND ANALYSIS We will search the literature on the involvement of pre-emptive analgesia in the management of pain in TKA from the PubMed, EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, from their inception to 1 February 2023. Additionally, clinical registry platforms will be investigated to collect data for ongoing studies. Using the Cochrane Risk of Bias Tool, the quality assessment will be conducted. RevMan V.5.4 will be used for the meta-analysis. The statistic I 2 will be used to measure the percentage of total variability due to heterogeneity between studies. Where appropriate, subgroup and sensitivity analyses, assessment of evidence quality and publication bias will be conducted. ETHICS AND DISSEMINATION No ethical approval and consent is required for this systematic review. Moreover, the results of this systematic review will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022380782.
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Affiliation(s)
- Fan-Jie Xiong
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Wei Zhao
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shi-Jian Jia
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiao-Rong Huang
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiang-Fei Luo
- The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
| | | | - Kai Song
- Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Yan-Ming Li
- Department of Acupuncture, The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, Sichuan, China
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Quality indicators in primary elective total hip and knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:647-658. [PMID: 36640180 DOI: 10.1007/s00264-022-05665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent a significant portion of healthcare spending and are high-priority for quality improvement initiatives. This study aims to develop quality indicators (QIs) in the care of primary elective THA and TKA patients. These QIs serve a number of purposes including documentation of the quality of care, objective comparisons of institutions/providers, facilitating pay-for-performance initiatives, and supporting accountability, regulation, and accreditation. METHODS A guideline-based approach, initially described by Kötter et al., was utilized. Eight clinical practice guidelines (CPGs) were evaluated for candidate indicators (CIs). CIs with high-quality evidence and consensus statements were extracted. Eighteen additional CIs were included from previous work that evaluated quality improvement databases. Each CI and supporting evidence was submitted for independent review by an expert panel. The RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology was utilized and items were rated based on validity, reliability, and feasibility of measurement. After two rounds of ratings and ranking, a final ranked list of QIs was obtained. RESULTS Fifty-six CIs were identified from the literature and CPGs or proposed by the expert panel. Two rounds of voting resulted in 12 total QIs that were deemed appropriate measures of high-quality care. The final 12 QIs were ranked by order of importance: use of peri-operative tranexamic acid, infusion of prophylactic antibiotics prior to inflation of tourniquet, appropriate post-operative venous thromboembolic prophylaxis, complication rate, rate of secondary procedure, readmission rate, early mobilization, average change of pre- to one year post-operative functional status, use of multimodal analgesia, use of neuraxial anesthesia, use of peri-articular injection in TKA, and use of pre-operative PO analgesia. CONCLUSION This study is an expert opinion based on parameters observed in modern and high-quality academic settings. Twelve QIs are proposed to assess the quality of care in the peri-operative management of primary elective THA and TKA patients.
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Bagheri Fard A, Jabalameli M, Khorrami AM, Ghaderi MT, Mohammadpour M, Gharanizadeh K. The Effect of Adding Corticosteroid to the Periarticular Injection Cocktail for Pain Control after Total Hip and Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:1049-1055. [PMID: 36721657 PMCID: PMC9846724 DOI: 10.22038/abjs.2022.50610.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/15/2022] [Indexed: 02/02/2023]
Abstract
Background The impact of periarticular corticosteroid injection for pain control after total joint arthroplasty (TJA) is controversial. The present study aimed to investigate this controversy in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A total of 42 THA and 42 TKA patients were included in this study. The patients of each group were randomly allocated into group A (cocktail+Depo-Medrol) and group B (cocktail alone). The outcome measures were a Visual Analog Scale (VAS) for pain at five different time points for both THA and TKA, as well as the knee range of motion (ROM) and straight leg raise (SLR) for the TKA group only. Patients were followed for three months to observe infection, wound complications, and any venous thromboembolic event. Results In the THA group, the preoperative VAS, 12, 24, 48, and 72h postoperative VAS were not statistically different between groups A and B (P=0.49, P=0.5, P=0.96, P=0.15, and P=0.11, respectively). In the TKA group, the preoperative VAS, 12, 24 48h, and 72h postoperative VAS were not statistically different between groups A and B (P=1.0, P=0.47, P=0.82, P=0.92, P=0.5, respectively). The mean scores of knee range of motion and ability to perform SLR were not significantly different between TKA patients in the steroid and non-steroid groups (P=0.18 and P=0.58, respectively). The only observed complication was one surgical site infection in the non-steroid group of the TKA. Conclusion The obtained results did not support the benefit of including a steroid (Depo-Medrol) in the periarticular injection cocktail for pain control after the THA and TKA.
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Affiliation(s)
- Abolfazl Bagheri Fard
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabalameli
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mohsen Khorrami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher Ghaderi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadpour
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Gharanizadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Shaygan M, Hosseini FA. Comparison of the effect of psychosocial skills training on acute and chronic musculoskeletal pain intensity: The effectiveness of early intervention in the reduction of acute musculoskeletal pain. Musculoskeletal Care 2022; 20:839-847. [PMID: 35332994 DOI: 10.1002/msc.1635] [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: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pain, as a psychological experience, is caused by complex interactions among sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. METHODS In this quasi-experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8-10 people over six 1-h sessions. The data were collected at baseline, after the intervention, and 3 months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. RESULTS In this study, the mean age of the participants was 50.10 ± 10.63 years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p < 0.001), but the effect of group on pain intensity was not statistically significant (p = 0.07). The group × time effect on pain intensity was also statistically significant (p < 0.001). CONCLUSION Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh A Hosseini
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Combined application of adductor canal block and local infiltration anesthesia in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2022; 142:913-926. [PMID: 33417022 DOI: 10.1007/s00402-020-03706-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Perioperative pain after total knee arthroplasty (TKA) may seriously affect the rapid recovery of patients. The purpose of this study was to assess whether the combined use of adductor canal block (ACB) and local infiltration anesthesia (LIA) can further reduce postoperative pain and improve early functional recovery. MATERIALS AND METHODS PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) comparing ACB + LIA and LIA alone in primary TKA. The primary outcomes were visual analog scale (VAS) scores at rest and walking, morphine consumption, range of motion (ROM) at 24 and 48 h postoperatively and distance walked. The secondary outcomes were the length of stay, the incidence of nausea and vomiting, and the total complications. Subgroup analyses were performed on the VAS at rest and walking, morphine consumption, and distance walked at 24, 48, and 72 h postoperatively. RESULTS A total of 10 RCTs involving 797 patients were enrolled in this meta-analysis. The results demonstrated that the combined application of ACB + LIA had a lower resting VAS at 24 h postoperatively (p = 0.02) and the walking score at 24 (p = 0.0002) and 48 h (p = 0.02) postoperatively compared with LIA alone. Similarly, the combined ACB + LIA group also had less morphine consumption at 48 h postoperatively (p = 0.0005) and had a higher ROM score at 24 h (p = 0.01) postoperatively compared to the LIA group. There were no statistical differences in length of stay, distance walked, and incidence of nausea and vomiting. CONCLUSION The current meta-analysis showed that ACB + LIA significantly reduced postoperative walking pain and morphine consumption and promoted rapid recovery in the early postoperative period. There is no statistical difference in the length of stay and ROM after 72 h in the two groups.
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Li X, Wang Y, Chen Y, Qian J, Li S, Chen S, Fu P. Comparison of Femoral Triangle Block in Combination with IPACK to Local Periarticular Injection in Total Knee Arthroplasty. J Knee Surg 2022; 36:605-612. [PMID: 35144303 DOI: 10.1055/s-0041-1741395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article studied the efficacy of two different analgesic methods after unilateral primary total knee arthroplasty (TKA) to find an effective analgesic method. METHODS A randomized, double-blind, placebo, parallel, and controlled study was performed to evaluate the benefits of combining the femoral triangle block (FTB) and the interspace between the popliteal artery and the capsule of the posterior knee (IPACK). Forty patients diagnosed with knee osteoarthritis and underwent unilateral primary TKA with FTB and IPACK were divided grouped into the experimental group, and 40 patients undergoing TKA with intra-articular cocktail analgesic mixture local injection were grouped into the control group. All patients received the patient-controlled anesthesia pump for analgesia at postoperative 48 hours. The main indexes were postoperative knee joint rest and activity pain (visual analog scale) and muscle strength of the affected limb; secondary indexes were anesthetic consumption, total morphine consumption, range of motion, and complications (such as postoperative nausea and vomiting [PONV]). RESULTS There was no significant difference in the general data of each treatment group. Compared with the conventional group, the quadriceps muscle strength of the combined FTB and IPACK group was higher with significant statistical differences after surgery (p < 0.05). At postoperative 2, 6, 12, 24, 48, and 72 hours, active pain was better than in the conventional group (p < 0.05). Resting pain was significantly smaller than the traditional group only at postoperative 2, 6, 12, and 48 hours (p < 0.05). Morphine consumption, anesthetics consumption, and hospitalization time were lower than the conventional group, the difference being statistically significant. There were no significant differences between the two groups in postoperative wound healing, infection incidence, blood pressure, heart rate, rash, respiratory depression, deep vein thrombosis, and urinary retention. There were also no significant differences in PONV (p > 0.05). CONCLUSION Combining FTB and IPACK significantly increased the quadriceps muscle in patients, together with relieving early pain and reducing the amount of anesthetic consumption at different postoperative intervals.
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Affiliation(s)
- Xiang Li
- Department of Orthopedics, Naval Medical University, Changzheng Hospital, Shanghai, China
| | - Yuanyuan Wang
- School of Life Sciences, Bengbu Medical College, Bengbu, Anhui, China
| | - Yancheng Chen
- Department of Orthopedics, Naval Medical University, Changzheng Hospital, Shanghai, China
| | - Jiatian Qian
- Department of Orthopedics, Naval Medical University, Changzheng Hospital, Shanghai, China
| | - Shiao Li
- Department of Orthopedics, Naval Medical University, Changzheng Hospital, Shanghai, China
| | - Song Chen
- Department of Orthopedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Peiliang Fu
- Department of Orthopedics, Naval Medical University, Changzheng Hospital, Shanghai, China
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Rowe S, Zagales I, Fanfan D, Gargano T, Meneses E, Awan M, Zagales R, McKenney M, Elkbuli A. Postoperative opioid prescribing practices in US adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:456-463. [PMID: 34238859 DOI: 10.1097/ta.0000000000003341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioids have been proven effective in pain management, but overprescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study was to examine opioid prescribing practices for US adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age. METHODS PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MMEs) prescribed to trauma patients. Significance was defined as p < 0.05. RESULTS Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than nonorthopedic surgeons. CONCLUSION Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population. LEVEL OF EVIDENCE Systematic review, level III.
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Affiliation(s)
- Scott Rowe
- From the Department of Surgery, Division of Trauma and Surgical Critical Care (S.R., I.Z., D.F., T.G., E.M., M.A., R.Z., M.M., A.E.), Kendall Regional Medical Center; and Department of Surgery (M.M.), University of South Florida, Tampa, Florida
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GÜMÜŞKANAT TABUR Z, YILMAZ C, KARASU D, BAYTAR Ç. Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.977400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kukreja P, Venter A, Mason L, Kofskey AM, Northern T, Naranje S, Ghanem E, Lawson PA, Kalagara H. Comparison of Genicular Nerve Block in Combination With Adductor Canal Block in Both Primary and Revision Total Knee Arthroplasty: A Retrospective Case Series. Cureus 2021; 13:e16712. [PMID: 34471571 PMCID: PMC8399964 DOI: 10.7759/cureus.16712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. The genicular nerve block has recently been demonstrated to provide effective analgesia to the anterior and posterior knee capsule in recent studies. In this retrospective case series, we compare the efficacy of combined genicular nerve block (GNB) and adductor canal block (ACB) to only ACB in both primary and revision TKA patients. This combined novel approach for TKA patients can be utilized to improve patient pain scores and early ambulation, limiting the use of opioids and early discharge.
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Affiliation(s)
- Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Alana Venter
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Lauren Mason
- Medicine, Edward Via College of Osteopathic Medicine, Birmingham, USA
| | - Alexander M Kofskey
- Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Theresa Northern
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Sameer Naranje
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Elie Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Prentiss A Lawson
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Hari Kalagara
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
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Pietrantoni P, Cuñat T, Nuevo-Gayoso M, Martín N, Tió M, Basora M, Sastre S, Sala-Blanch X. Ultrasound-guided genicular nerves block: an analgesic alternative to local infiltration analgesia for total knee arthroplasty: A noninferiority, matched cohort study. Eur J Anaesthesiol 2021; 38:S130-S137. [PMID: 34038916 DOI: 10.1097/eja.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis. OBJECTIVE To test the noninferiority of the analgesic effect of genicular nerves block in comparison with local infiltration analgesia after 24 h of total knee arthroplasty. DESIGN Prospective cohort study. SETTING Perioperative setting. PATIENTS Thirty-five patients scheduled for total knee arthroplasty were prospectively included in the study and compared with 35 patients in a retrospective cohort. INTERVENTION Genicular nerve blocks in the prospective cohort were compared with local infiltration analgesia in the retrospective cohort. MAIN OUTCOME MEASURES The pain numeric rating scale and the cumulative opioid consumption in oral morphine equivalents during the first 24 h. RESULTS We conducted propensity score-matched analyses of patients using acute postoperative pain-related risk covariates. After one-to-one propensity score matching, 21 patients were included in the local infiltration analgesia group and 21 in the genicular nerve block group. The median difference in numeric rating score at rest at 24 h was -0.99 [95% confidence interval (CI), -1.99 to 0.5, P = 0.012] on the unmatched cohort and -1.9 (95% CI, -2 to 0, P = 0.002) on the matched cohort (meeting the noninferiority criteria, Δ=1). The median difference in cumulative opioid consumption was 2.5 mg (95% CI, -13.5 to 2.5, P < 0.001) for the unmatched cohort and 4.99 mg (95% CI, -11.5 to 2.5, P < 0.001) on the matched group (meeting the noninferiority criteria, Δ = 21 mg). CONCLUSION Local infiltration analgesia and genicular nerve block are comparable in terms of analgesic results. Therefore, genicular nerves block is an alternative to local infiltration analgesia in patients undergoing total knee arthroplasty. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04024319.
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Affiliation(s)
- Pierangela Pietrantoni
- From the School of Medicine, Universitat of Barcelona (PP, TC), Department of Anesthesiology, Hospital Clínic de Barcelona (TC, NM, MT, MB, XSB), Knee Unit, Hospital CLINIC de Barcelona (MNG), Department of Orthopaedic Surgery and Traumatology, Hospital CLINIC de Barcelona (SS) and Anatomy and Embryology Department. School of Medicine. Universitat of Barcelona. Spain (XSB)
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Inkk Trial .Çô Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:78-84. [PMID: 34332009 PMCID: PMC9801218 DOI: 10.1016/j.bjane.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 06/24/2021] [Accepted: 07/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72.áhours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72.áhours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. METHODS After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5.ámg.kg-1 before the incision followed by 10.á..g.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72.áhours. The TUG tests and range of motion were assessed by the physiotherapists until 72.áhours. RESULTS Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. CONCLUSION In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.
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Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-Blind Controlled Trial. Pain Res Manag 2021; 2021:5595095. [PMID: 34113408 PMCID: PMC8154299 DOI: 10.1155/2021/5595095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
Multimodal cocktail periarticular injections comprising corticosteroids are the most suggested therapy for postoperative discomfort and swelling following total knee arthroplasty (TKA). Nevertheless, previous findings cannot be applied to instances of unilateral total knee arthroplasty on bilateral knees. This randomized, prospective, double-blind, controlled clinical study examines the efficacy as well as safety of periarticular multimodal cocktail injection along or sans corticosteroids in certain situations. The 60 patients (120 knees) that experienced concurrent bilateral total knee arthroplasty were provided periarticular injections along additional betamethasone (7 mg) in the randomized knee, as well as the other knee, where corticosteroid was not administered. Key results were “pain scores at rest as well as in action” on a visual analogue scale of 11 pt. Other results included motion range, swelling of the thigh, Hospital for Special Surgery score (HSS score), and adverse effects were measured between the two sides. No statistically promising variations were found in the visual analogue scale ranking, motion range, girth of the thigh, and HSS score, as well as complications between the two sides. The impact on treatment outcomes was maintained between the knees on postoperative day 3 or at 3 months of follow-up. Multimodal periarticular injection without corticosteroid will alleviate postoperative swelling and pain. More studies are needed for the use of betamethasone as a corticosteroid in periarticular multimodal cocktail injections. This Chinese Clinical Trial Registry is registered with ChiCTR-OPC-17013503, dated 2017-11-23, available from http://www.chictr.org.cn/showproj.aspxproj=23146.
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D'Souza RS, Langford BJ, Olsen DA, Johnson RL. Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. Local Reg Anesth 2021; 14:85-98. [PMID: 34012290 PMCID: PMC8126972 DOI: 10.2147/lra.s303827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Posterior knee pain after total knee arthroplasty (TKA) is common despite multimodal analgesia and regional anesthesia use. This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020. Eligible studies evaluated iPACK use on primary outcomes: opioid consumption and pain scores with movement. Secondary outcomes included rest pain, patient satisfaction, length of stay (LOS), gait distance, knee range of motion (ROM), and complications. Bias and quality were appraised using the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Eight RCTs (777 patients) were included. iPACK block use demonstrated similar opioid consumption in the PACU (4/7 RCTs) and 24 hours after TKA (5/7 RCTs) compared to without iPACK (moderate-quality GRADE evidence). Additionally, iPACK block use demonstrated lower movement pain scores in PACU (3/5 RCTs) but similar or higher pain scores after 24 hours (5/7 RCTs; low-quality GRADE evidence). Studies consistently reported no difference in gait distance (4/4 RCTs) or complications (7/7 RCTs) between treatment arms (high-quality GRADE evidence), although differing effect estimates were observed with resting pain, satisfaction, LOS, and knee ROM. This review provides a foundation of knowledge on iPACK efficacy. While evidence does not currently support widespread inclusion of iPACK within enhanced recovery pathways for TKA, limitations suggest further study is warranted.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Brendan J Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - David A Olsen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data. ACTA ACUST UNITED AC 2021; 57:medicina57050451. [PMID: 34066351 PMCID: PMC8148133 DOI: 10.3390/medicina57050451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was “NSAIDs + opioids” (55.92%), followed by “NSAIDs only” (17.85%), and “NSAIDs + Opioids + Non-opioid central analgesics” (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method.
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Parelkar K, Butala R, Pandey A. A comparative retrospective analysis of indoor patients between 50 to 85 years of age suffering from osteoarthritis to determine the effectiveness of epidural and intravenous tramadol in pain relief and functional recovery after total knee replacement surgery. JOURNAL OF ORTHOPAEDICS AND SPINE 2021. [DOI: 10.4103/joasp.joasp_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meier M, Sommer S, Huth J, Benignus C, Thienpont E, Beckmann J. Local infiltration analgesia with additional intraarticular catheter provide better pain relief compared to single-shot local infiltration analgesia in TKA. Arch Orthop Trauma Surg 2021; 141:105-111. [PMID: 32949268 DOI: 10.1007/s00402-020-03606-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Local infiltration analgesia (LIA) has been proven to be efficient in total knee arthroplasty (TKA). However, the effect of single-shot LIA is temporarily limited. The objective of this prospective trial was to investigate if the potential benefits resulting from LIA can be prolonged by a continuous intra-articular perfusion of LIA. The hypothesis of the present study was that the use of an additional continuous intra-articular perfusion delivering LIA would result in less pain and better function compared to single-shot LIA in the immediate post-operative period. METHODS 50 consecutively selected patients undergoing TKA received either a single-shot LIA (S-LIA group, 25 knees) or single-shot LIA combined with a continuous post-operative intra-articular perfusion for three post-operative days (CP-LIA group, 25 knees). VAS (visual analogue scale) for pain, pain medication consumption and flexion ability were recorded postoperatively for 6 days. All patients had the same implant, surgeon and intra- as well as post-operative setting. RESULTS The VAS score was significantly better for CP-LIA 6 h after surgery and on post-operative day 1, 2 and 6. There was no significant difference with regard to additional opioid consumption or flexion ability of the knee. However, there was a trend of the CP-LIA group requiring less additional opioids over the complete post-operative period compared to the S-LIA group. There were no complications or revisions. CONCLUSION LIA combined with an additional intra-articular catheter provides better short-term pain control compared to single-shot LIA. However, no significant differences in terms of knee flexion were observed. This limited benefit should be balanced against the additional costs and the possible higher risk of infection. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Malin Meier
- Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany.
| | - Sarah Sommer
- Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Jochen Huth
- Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany
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Laoruengthana A, Chaibhuddanugul N, Rattanaprichavej P, Malisorn S, Tangsripong P, Pongpirul K. Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty. Clin Orthop Surg 2020; 13:160-167. [PMID: 34094006 PMCID: PMC8173236 DOI: 10.4055/cios20154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 12/03/2022] Open
Abstract
Backgroud Postoperative pain following total knee arthroplasty (TKA) may hamper patients from a rapid recovery and increase perioperative blood loss and stress on the cardiovascular system. Therefore, our objective was to assess perioperative outcomes after TKA in patients who were not candidates for the additional nonsteroidal anti-inflammatory drugs (NSAIDs) in a multimodal pain control regimen. Methods Propensity score matching for age, sex, body mass index, American Society of Anesthesiologists class, and preoperative hemoglobin level was conducted on patients undergoing unilateral TKA, and thereby 52 patients remained in each group. The control group comprised patients who received parenteral parecoxib every 12 hours during the first 48 hours after TKA. The No-NSAIDs group did not receive NSAIDs because of known contraindications. Identical postoperative pain control including intravenous patient-controlled analgesia was applied for all patients. Visual analog scale (VAS) score for pain, knee flexion, blood loss, serum cardiac troponin-T (cTnT), and length of stay (LOS) were determined. Results The No-NSAIDs group had significantly higher VAS scores in 6–96 hours and consumed more morphine at 24 hours and 48 hours after the surgery than the control group. The No-NSAIDs group had significantly less knee flexion at 48 hours (p = 0.045) and tended to have more emesis and longer LOS than the control group. The blood loss of the No-NSAIDs and control group was 552.52 mL and 397.65 mL (p = 0.02), respectively, and blood transfusion rate was 23.1% and 17.3% (p = 0.63), respectively. The cTnT of the No-NSAIDs group rose over the first 48 hours and was significantly higher than that of the control group at 48 hours. Conclusions Patients who were not candidates for NSAIDs had significantly higher pain scores and consumed more morphine after TKA. They also tended to have greater blood loss and the rising of cardiac biomarkers during the first 48 hours after TKA. Hence, these patients may benefit from supplementary analgesia and appropriate perioperative monitoring.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Saran Malisorn
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piroon Tangsripong
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Assessing Preoperative Pain Sensitivity Predicts the Postoperative Analgesic Requirement and Recovery after Total Knee Arthroplasty: A Prospective Study of 178 Patients. J Arthroplasty 2020; 35:3545-3553. [PMID: 32773269 DOI: 10.1016/j.arth.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/04/2020] [Accepted: 07/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this article is to study the correlation between preoperative pain sensitivity and postoperative pain and analgesic requirements for patients undergoing primary total knee arthroplasty. METHODS Between December 2018 and April 2019, the pain sensitivity of 178 consecutive patients undergoing primary total knee arthroplasty was assessed preoperatively with a digital algometer. The patients reported the VAS (visual analog scale) score at 3 instances of needle prick (phlebotomy, glucometer blood sugar, intradermal antibiotic test dose), during the range of movements and completed the Depression Anxiety Stress Scale score. Postoperative VAS score, analgesic requirement, and physiotherapy milestones were recorded in all these patients on day 0 to day 4. RESULTS The average age of the patients was 64.13 years and 69.1% were females. Females had lower mean algometry values (56.12 ± 12.77 [standard deviation]) compared to males (71.09 ± 18.78 [standard deviation]) (P < .001). Higher Depression Anxiety Stress Scale correlated with lower algometry values (P < .001). The postoperative VAS score was 2.54 ± 0.59 on the day of surgery which increased to 3.27 ± 0.69 on day 1 after mobilization (P < .001) and reduced to 1.67 ± 0.62 on day 4. Low algometer score correlated with higher postoperative VAS score (P < .05), increased analgesic requirement, and opioid utilization (P < .001), delay in achieving an optimum range of movements (P < .001) and independent ambulation (P < .001). CONCLUSION Preoperative assessment of pain sensitivity predicts postoperative analgesic requirements and recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively and prolonged physiotherapy.
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Prasad AK, Tan JHS, Bedair HS, Dawson-Bowling S, Hanna SA. Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2020; 5:793-798. [PMID: 33312706 PMCID: PMC7722941 DOI: 10.1302/2058-5241.5.200030] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over 100,000 total knee replacements (TKRs) are carried out in the UK annually, with cemented fixation accounting for approximately 95% of all primary TKRs. In Australia, 68.1% of all primary TKRs use cemented fixation, and only 10.9% use cementless fixation. However, there has been a renewed interest in cementless fixation as a result of improvements in implant design and manufacturing technology. This meta-analysis aimed to compare the outcomes of cemented and cementless fixation in primary TKR. Outcome measures included the revision rate and patient-reported functional scores. MEDLINE and EMBASE were searched from the earliest available date to November 2018 for randomized controlled trials of primary TKAs comparing cemented versus cementless fixation outcomes. Six studies met our inclusion criteria and were analysed. A total of 755 knees were included; 356 knees underwent cemented fixation, 399 underwent cementless fixation. They were followed up for an average of 8.4 years (range: 2.0 to 16.6). This study found no significant difference in revision rates and knee function in cemented versus cementless TKR at up to 16.6-year follow-up.
Cite this article: EFORT Open Rev 2020;5:793-798. DOI: 10.1302/2058-5241.5.200030
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Affiliation(s)
- Anoop K Prasad
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jaimee H S Tan
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Hany S Bedair
- Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Department of Orthopaedics, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Sebastian Dawson-Bowling
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sammy A Hanna
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
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Herregodts S, Verhaeghe M, Paridaens R, Herregodts J, Vermue H, Arnout N, De Baets P, Victor J. Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty. Bone Joint J 2020; 102-B:1324-1330. [PMID: 32993324 DOI: 10.1302/0301-620x.102b10.bjj-2019-1602.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.
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Affiliation(s)
- Stijn Herregodts
- Department of Physical Medicine and Orthopaedic Surgery, Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Mathijs Verhaeghe
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Rico Paridaens
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Jan Herregodts
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Hannes Vermue
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Nele Arnout
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Patrick De Baets
- Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Jan Victor
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
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Rao PB, Mandal I, Tripathy S, Bandyopadhyay D, Tripathy S, Singh N, Panda A. Preventive Epidural Analgesia in Bilateral Single-Stage Knee Arthroplasty: A Randomized Controlled Trial. Pain Ther 2020; 9:241-248. [PMID: 31900815 PMCID: PMC7203305 DOI: 10.1007/s40122-019-00145-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Although controversial, pre-emptive analgesia has shown some promise in preventing altered pain perception and reducing pain amplification after surgery. Hence, it has the potential to be more effective than a similar analgesic regimen started after surgery with an appropriate combination of patient category and analgesic modality. Hence, the present study was undertaken to evaluate the effect of preventive epidural analgesia in reducing pain severity and duration after bilateral single-stage knee arthroplasty. METHODS Fifty patients, 18-70 years, with American Society of Anesthesiologists physical status class I & II posted for bilateral single-stage knee replacement under regional anesthesia were randomly allocated into preventive versus postoperative epidural analgesia group to compare severity of post-operative pain, analgesic consumption, day of mobilization, C-reactive protein (CRP) levels, and hospital stay. RESULTS The pain score after surgery [2.0 (1.5, 2.0); 3.0 (1.5, 3.0), p = 0.005] and day of mobilization [(2. 92 ± 0. 28; 3. 31 ± 0. 48; p value 0.02)] were significantly lesser in the preventive epidural group. However, there was no difference in the hospital stay (9.92 ± 3.71 and 9.00 ± 2.12, p = 0.95) and analgesic consumption (65.38 ± 37.55 and 73.08 ± 43.85, p = 0.30). The preventive group had a larger drop in CRP and experienced a lesser number of days with pain after surgery as compared to the controls [(64.29 ± 21.29); (142.37 ± 80.04), p = 0.0001]. Six patients in the preemptive group (24%) and 13 of the control group (24 vs. 56.5%; p = 0.02) had chronic postsurgical pain. CONCLUSIONS Preventive epidural analgesia reduces the severity and number of chronic pain days after bilateral single-stage knee replacement. TRIAL REGISTRATION The study was registered in the Indian national registry (CTRI/2017/03/008240 on 28/03/2017).
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Affiliation(s)
- Parnandi Bhaskar Rao
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India.
| | - Indraprava Mandal
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Sujit Tripathy
- Department of Orthopaedics, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Debapriya Bandyopadhyay
- Department of Biochemistry, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Swagata Tripathy
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Neha Singh
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Aparajita Panda
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
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30
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Effects of combining manual lymphatic drainage and Kinesiotaping on pain, edema, and range of motion in patients with total knee replacement: a randomized clinical trial. Int J Rehabil Res 2020; 43:240-246. [DOI: 10.1097/mrr.0000000000000417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krishna Prasad GV. Post-operative analgesia techniques after total knee arthroplasty: A narrative review. Saudi J Anaesth 2020; 14:85-90. [PMID: 31998025 PMCID: PMC6970359 DOI: 10.4103/sja.sja_494_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Post-operative knee pain management has become a challenge to provide early relief and pain-free postoperative care to the patient. The major objectives of post-operative analgesic treatment are to reduce opioid requirements, post-operative pain, and adverse events related to opioid intake. This narrative review aimed to document post-operative analgesia techniques after total knee arthroplasty (TKA). The traditional approach involved high-dose opioid-based regimen, though opioid is considered strong analgesic, but are associated with a number of unwanted side effects to seek for alternative techniques. The role of sciatic nerve block in TKA pain is doubtful. Femoral Nerve Block (FNB) is still considered as the gold standard; however, FNB is associated with quadriceps weakness and risk of fall and sciatic block with foot drop. To overcome these drawback more distal nerve block techniques has evolved, namely saphenous nerve block in adductor canal, selective tibial which are claimed to provide comparable analgesia to that of femoral and sciatic nerve block. The combination of pre-emptive and multi-modal analgesia and technically well-delivered regional nerve blocks and postoperative physical therapy are an essential component which not only minimize the side effects of traditional opioid-based analgesia but also speed up functional recovery, increases patient satisfaction, and reduces the overall length of hospitalization and cost.
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32
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Jung DW, Shon WY, Seo SS, Kim OG, Lee IS. Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period. Knee Surg Relat Res 2020; 32:1. [PMID: 32660618 PMCID: PMC7219207 DOI: 10.1186/s43019-019-0025-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/28/2019] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty. Methods Among patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study. We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups. Results NRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred. Conclusions IPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.
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Affiliation(s)
- Dae-Won Jung
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeun-daero, Haeundae-gu, Busan, South Korea
| | - Won-Yong Shon
- Department of Orthopedic Surgery, Busan Bumin Hospital, 59, Mandeok-daero, Buk-gu, Busan, South Korea
| | - Seung-Suk Seo
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeun-daero, Haeundae-gu, Busan, South Korea
| | - Ok-Gul Kim
- Department of Orthopedic Surgery, Busan Bumin Hospital, 59, Mandeok-daero, Buk-gu, Busan, South Korea.
| | - In-Seung Lee
- Department of Orthopedic Surgery, Busan Bumin Hospital, 59, Mandeok-daero, Buk-gu, Busan, South Korea
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Cooper HJ, Lakra A, Maniker RB, Hickernell TR, Shah RP, Geller JA. Preemptive Analgesia With Oxycodone Is Associated With More Pain Following Total Joint Arthroplasty. J Arthroplasty 2019; 34:2878-2883. [PMID: 31402074 DOI: 10.1016/j.arth.2019.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preemptive multimodal analgesia (PMA) is a commonly used technique to control pain following total joint arthroplasty. PMA protocols use multiple analgesics immediately preoperatively to prevent central sensitization and amplification of pain during surgery. While benefits of some individual components of a PMA protocol have been established, there are little data to support inclusion or exclusion of opioids in this context. METHODS This is a retrospective cohort study of 550 patients undergoing elective, primary total joint arthroplasty at a single institution using a standardized preoperative perioperative protocol. Two hundred seventy-five patients received oxycodone in addition to a standard multimodal preoperative analgesia regimen just before surgery and were compared to a matched cohort of 275 patients who received the standard regimen alone. Outcome measures included inpatient visual analog scale pain scores, inpatient opioid consumption, length of stay, and ambulation distance with physical therapy. RESULTS Patients who received opioids in preoperative holding reported significantly greater visual analog scale pain scores on postoperative day 1 (3.7 vs 3.1; P = .01), when compared to those who did not. These patients also walked shorter distances on postoperative day 0 (59.5' vs 125.7'; P < .001) and consumed greater morphine equivalents per hospital day over the course of their hospital stay (52.2 vs 37.2 mg; P < .001). These differences remained significant when stratified by procedure, total knee arthroplasty or total hip arthroplasty. Differences in pain and function between groups were more pronounced in patients undergoing total hip arthroplasty than those undergoing total knee arthroplasty. CONCLUSION Total joint patients who were given preemptive opioids immediately before surgery experienced more pain, consumed more postoperative opioids, and exhibited impaired early function as compared to those who were not given preemptive opioids. Orthopedic surgeons should reconsider routine use of preemptive opioids in this context.
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Affiliation(s)
- H John Cooper
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Robert B Maniker
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Thomas R Hickernell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
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Vendittoli PA, Pellei K, Desmeules F, Massé V, Loubert C, Lavigne M, Fafard J, Fortier LP. Enhanced recovery short-stay hip and knee joint replacement program improves patients outcomes while reducing hospital costs. Orthop Traumatol Surg Res 2019; 105:1237-1243. [PMID: 31588036 DOI: 10.1016/j.otsr.2019.08.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/29/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION An attractive option to reduce hospital length of stay (LOS) after hip or knee joint replacement (THA, TKA) is to follow the Enhanced Recovery After Surgery principles (ERAS) to improve patient experience to a level where they will feel confident to leave for home earlier. The objective of this study was to evaluate the implementation of short-stay protocol following the ERAS principles. HYPOTHESIS We hypothesized that our ERAS THA and TKA short-stay protocol would result in a lower complication rate, shorter hospital LOS and reduced direct health care costs compared to our standard procedure. MATERIAL AND METHODS We compared the complications rated according to Clavien-Dindo scale, hospital LOS and costs of the episode of care between a prospective cohort of 120 ERAS short-stay THA or TKA and a matched historical control group of 150 THA or TKA. RESULTS Significantly lower rate of Grade 1 and 2 complications in the ERAS short-stay group compared with the standard group (mean 0.8 vs 3.0, p<0.001). No difference was found between the 2 groups for Grade 3, 4, or 5 complications. The mean hospital LOS for the ERAS short-stay group decreased by 2.8 days for the THAs (0.1 vs 2.9 days, p<0.001) and 3.9 days for the TKAs (1.0 vs 4.9 days, p<0.001). The mean estimated direct health care costs reduction with the ERAS short-stay protocol was 1489 CAD per THA and 4158 CAD per TKA. DISCUSSION In many short-stay protocols, focus has shifted from ERAS goals of a reduction in complications and improved recuperation to use length of stay as the main factor of success. Implementation of an ERAS short-stay protocol for patients undergoing THA or TKA at our institution resulted not only in reduced hospital LOS, but also in improved patient care and reduced direct health care costs. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Pascal-André Vendittoli
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada.
| | - Karina Pellei
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - François Desmeules
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Vincent Massé
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Christian Loubert
- Anesthesia Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Martin Lavigne
- Surgery Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Josée Fafard
- Internal Medicine Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
| | - Louis-Philippe Fortier
- Anesthesia Department, Montreal University, hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, H1T 2M4 Montréal, Québec, Canada
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Rames RD, Barrack TN, Barrack RL, Nunley RM. Effect of Adductor Canal Block on Acute Perioperative Pain and Function in Total Knee Arthroplasty. J Arthroplasty 2019; 34:S164-S167. [PMID: 30890391 DOI: 10.1016/j.arth.2019.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Multimodal pain management strategies are commonplace in perioperative management of total knee arthroplasty (TKA), although controversy remains regarding the role of adductor canal blocks (ACB) in this algorithm. The purpose of this study is to independently evaluate the effect of ACB on short-term postoperative outcomes including (1) length of stay (LOS), (2) postoperative narcotic utilization, and (3) function with physical therapy in the era of modern TKA. METHODS We retrospectively identified a cohort of consecutive patients from January 2014 to January 2018 who had undergone unilateral primary TKA using a single-shot ACB in addition to a standardized multimodal pain regimen vs those who only received a multimodal pain regimen. These 2 groups were compared using independent sample t-tests with primary end points of interest being LOS, distance ambulated with therapy, and inpatient narcotic use. RESULTS There were 624 patients in the ACB group, with a mean age of 64.5 years. The group without ACB consisted of 69 patients, with a mean age of 67.2 years. We observed no significant difference in narcotic utilization postoperatively (2.361 vs 2.097, P = .088). The ACB group ambulated significantly further with therapy (75.8 vs 59.9 ft, P = .008) and had a shorter LOS in both total hours and percentage of postoperative day 1 (%POD1) discharges (34.8 vs 40.6 hours, P = .01, 83% vs 66.6%, P = .01). CONCLUSION ACB did not decrease postoperative pain medication utilization. The modest improvement in distance ambulated with therapy on POD1 (16 ft) and LOS (16% greater POD1 discharges) may not support the cost-effectiveness of this intervention. LEVEL OF EVIDENCE III, Retrospective Cohort.
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Affiliation(s)
- Richard D Rames
- Department of Orthopaedic Surgery, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO
| | - Toby N Barrack
- Department of Orthopaedic Surgery, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis, MO
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Zhu X, Wang F, Ling W, Dai X. The Efficacy and Safety of Combined Adductor Canal Block with Periarticular Anesthetic Injection Following Primary Total Knee Arthroplasty: A Meta-Analysis. J INVEST SURG 2019; 33:904-913. [PMID: 30885020 DOI: 10.1080/08941939.2019.1579278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Xiaowen Zhu
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Feng Wang
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Weiqi Ling
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Xiaoyu Dai
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
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De Luca ML, Ciccarello M, Martorana M, Infantino D, Letizia Mauro G, Bonarelli S, Benedetti MG. Pain monitoring and management in a rehabilitation setting after total joint replacement. Medicine (Baltimore) 2018; 97:e12484. [PMID: 30290604 PMCID: PMC6200489 DOI: 10.1097/md.0000000000012484] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/24/2018] [Indexed: 12/24/2022] Open
Abstract
Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.
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MESH Headings
- Aged
- Analgesia, Patient-Controlled/methods
- Analgesics/therapeutic use
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Humans
- Male
- Middle Aged
- Pain Management/methods
- Pain Measurement
- Pain, Postoperative/etiology
- Pain, Postoperative/therapy
- Recovery of Function
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
| | - Marcello Ciccarello
- Anesthesia-resuscitation and Intensive care Unit, Rizzoli Sicilia Department, Bagheria
| | | | | | | | | | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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Oktas B, Vergili O. The effect of intensive exercise program and kinesiotaping following total knee arthroplasty on functional recovery of patients. J Orthop Surg Res 2018; 13:233. [PMID: 30208939 PMCID: PMC6136220 DOI: 10.1186/s13018-018-0924-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/22/2018] [Indexed: 01/07/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is a gold standard for terminal term gonarthrosis patients in order to diminish pain, correct deformities, and regain stability. Postoperative functional recovery of patients depends on the current postoperative rehabilitation program to an important extent. The purpose of our study is to compare midterm functional level of gonarthrosis patients who were included in physiotherapy rehabilitation program following TKA with people in similar ages without any surgical indication nor intervention. We have aimed also to compare functionality of people who had additional kinesiotaping (KT) treatment with people who had conservative treatment only after knee arthroplasty. Methods Functional level and knee functionality of people in study were evaluated at the end of postoperative first month by 6-min walk test and Lysholm knee score respectively. Results There was no statistical difference between groups with and without TKA in terms of height, weight, body mass index, Lysholm score, and 6-min walk test score (p > 0.05). In patient group with TKA, people with postoperative KT treatment had greater 6-min walk test score for postoperative first month (p = 0.005). Conclusion TKA is considered a gold standard procedure in order to increase the quality of life and improve functionality of terminal term gonarthrosis patients. It is necessary to immediately control pain and edema of knee and apply intensive rehabilitation program aimed at muscle strengthening around hip and knee in order to increase the success of operation.
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Affiliation(s)
- Birhan Oktas
- Orthopaedie and Traumatology Department, Kirikkale University Faculty of Medicine, Yurtkur Sokak, No:1 Yahsihan, Kirikkale, Turkey.
| | - Ozge Vergili
- Physiotherapy and Rehabilitation Department, Kirikkale University Faculty of Health Sciences, Kirikkale, Turkey
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Lubis AMT, Rawung RBV, Tantri AR. Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial. PAIN RESEARCH AND TREATMENT 2018; 2018:3807217. [PMID: 30174951 PMCID: PMC6106806 DOI: 10.1155/2018/3807217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022]
Abstract
Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov).
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Affiliation(s)
- Andri M. T. Lubis
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
| | - Rangga B. V. Rawung
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
| | - Aida R. Tantri
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
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Lee DW, An J, Kim E, Lee JH, Kim H, Son JC. Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after orthopedic surgery. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dong-won Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jihyun An
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Eunju Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ji-hyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyun Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jong-chul Son
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1391-1395. [DOI: 10.1007/s00590-018-2218-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
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Multimodal Perioperative Analgesia Regimen to Improve Patient Outcomes After Total Knee Arthroplasty: A Multidisciplinary Quality Improvement Project. J Perianesth Nurs 2018; 33:138-152. [DOI: 10.1016/j.jopan.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
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Essex MN, Choi HY, Bhadra Brown P, Cheung R. A randomized study of the efficacy and safety of parecoxib for the treatment of pain following total knee arthroplasty in Korean patients. J Pain Res 2018; 11:427-433. [PMID: 29503579 PMCID: PMC5827681 DOI: 10.2147/jpr.s147481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Parecoxib is an injectable cyclooxygenase-2 inhibitor with proven postoperative analgesic efficacy in a variety of settings, including total knee arthroplasty (TKA). The effect of ethnicity on the efficacy of parecoxib for post-TKA pain has not been studied. Patients and methods This was a parallel-group, double-blind, randomized, placebo- controlled study of ethnically Korean patients aged ≥18 years who had unilateral TKA. Patients who reported moderate or severe pain 6 hours after the end of postoperative opioid analgesia were randomized to receive a single intravenous dose of parecoxib sodium 40 mg or placebo. Patients were evaluated for 24 hours postdose. The primary efficacy endpoints included time-specific pain intensity difference (PID), time-specific pain relief (PR), and time to rescue medication. The incidence and nature of adverse events (AEs) assessed safety. Results Of the 116 patients randomized, 58 received parecoxib and 58 placebo. Mean (SD) PID was significantly greater for parecoxib vs placebo 1 hour postdose (0.69 [0.67] vs 0.40 [0.59], respectively; p<0.05), and for each time point up to 24 hours. Similarly, mean (SD) PR was significantly greater for parecoxib vs placebo 1.5 hours postdose (1.63 [0.85] vs 1.07 [0.90], respectively; p=0.001), and for each time point up to 24 hours. The median time (hours:minutes) to rescue medication was significantly longer for parecoxib vs placebo (21:30 vs 4:08, respectively; p<0.001). Generally, fewer AEs were reported with parecoxib than placebo, and the AE profile was consistent with previous studies. These results are comparable to the findings from a similarly designed study in a Caucasian patient population. Conclusion Parecoxib 40 mg significantly improved postoperative pain vs placebo in Korean patients after TKA. The efficacy and safety of parecoxib in Korean patients is similar to that seen in Caucasian patients.
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In vitro and ex vivo characterisation of an in situ gelling formulation for sustained lidocaine release with potential use following knee arthroplasty. Drug Deliv Transl Res 2018; 8:820-829. [DOI: 10.1007/s13346-018-0492-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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45
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Bhasin S, Dhar M, Sreevastava DK, Nair R, Chandrakar S. Comparison of Efficacy of Epidural Ropivacaine versus Bupivacaine for Postoperative Pain Relief in Total Knee Replacement Surgeries. Anesth Essays Res 2018; 12:26-30. [PMID: 29628549 PMCID: PMC5872876 DOI: 10.4103/aer.aer_134_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Epidural analgesia has become the standard of care for knee replacement surgeries worldwide. Bupivacaine has been used successfully for many years. Epidural ropivacaine is now being used increasingly and seems to have benefits other than just pain relief, in terms of a better safety profile. Aim: To compare the efficacy of bupivacaine 0.125% (Group B) versus two concentrations of ropivacaine 0.1% (Group R1) and 0.2% (Group R2), in terms of pain scores, requirement of rescue analgesia, related adverse effects, and duration of postoperative (PO) hospital stay. Materials and Methods: A retrospective study was conducted from the acute pain service data of patients who underwent joint replacement surgeries in one or both limbs, over a span of 6 months. Patients were allocated to and analyzed under one of the three groups based on the drug concentration used postoperatively by epidural infusion. Data retrieved were demographic data, daily average visual analog scale (VAS) pain scores, rescue analgesia given, adverse effects, and PO hospital stay days for all three groups. Results: Demographic data were comparable between the three groups. Daily average VAS pain scores on days 1 and 2 were significantly higher in Group R1. Groups B and R2 were comparable. There was significantly more requirement of rescue analgesia in Group R1 on day 1. Day 2 showed no significant difference in rescue analgesic requirement in all three groups. Days of PO hospital stay were significantly higher in Group R1. Adverse effects such as hypotension and delayed motor block were higher in Group B. Conclusion: Ropivacaine 0.2% and bupivacaine 0.125% were equally efficacious in terms of VAS pain scores, rescue analgesic requirement, and duration of PO hospital stay, but ropivacaine had a better safety profile in terms of less hypotension and lesser motor block.
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Affiliation(s)
- Sidharth Bhasin
- Department of Anaesthesiology and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Mridul Dhar
- Department of Anaesthesiology and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Deepak Kumar Sreevastava
- Department of Anaesthesiology and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Rajiv Nair
- Department of Anaesthesiology and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Saurabh Chandrakar
- Department of Anaesthesiology and Critical Care, Army Hospital (Research and Referral), New Delhi, India
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Abstract
Postoperative pain control is a highly studied topic because of its significant effect on costs, hospital course, and, most importantly, patient satisfaction. Opioid use has been the "status quo" of postoperative pain management but prolongs hospital stays and increases complications. Optimizing acute pain management in patients with orthopedic trauma is important and can translate into significant positive physiologic and financial outcomes. Although multiple viable examples of optimizing acute pain management in the literature demonstrate outcome improvements, implementation has not been widespread. Significant outcome success will depend more on systemwide implementation than a specific regimen for postoperative pain control.
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Stathellis A, Fitz W, Schnurr C, Koeck FX, Gebauer M, Huth J, Bauer G, Beckmann J. Periarticular injections with continuous perfusion of local anaesthetics provide better pain relief and better function compared to femoral and sciatic blocks after TKA: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2702-2707. [PMID: 25966679 DOI: 10.1007/s00167-015-3633-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Combined femoral and sciatic nerve blocks for post-operative pain management following total knee arthroplasty (TKA) improve patient satisfaction, decrease narcotic consumption and improve pain. However, accompanying motoric weakness can cause falls and related complications. We wonder whether peri-capsular injections in combination with intra-articular perfusion of local anaesthetics would result in equal or less pain without the related complications of nerve blocks. The objective of the study was to verify these aspects in a prospective randomized trial comparing both treatments. METHODS Fifty TKA patients randomly received either a femoral (continuous) and a sciatic (single-shot) nerve block (CFNB group, 25 knees) or periarticular infiltrations and a continuous post-operative intra-articular infusion (PIAC group, 25 knees). VAS for pain, pain medication consumption, functional assessment, straight leg raising as well as KSS were recorded post-operatively for 6 days. RESULTS VAS (p < 0.001) and KSS (p = 0.05) were significantly better for PIAC. There was increased pain following CFNB compared to PIAC. Catheters stayed for 4 days, a pain 'rebound' occurred after removing in CFNB but not after PIAC. There was no difference in regard to knee function (n.s.), but straight leg raising was significant better following PIAC. There were two falls in patients with CFNB. CONCLUSION Peri-capsular injections combined with an intra-articular catheter provide better pain control, no rebound pain with better function and might decrease the risk of complications related to motor weakness. LEVEL OF EVIDENCE I.
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Affiliation(s)
- A Stathellis
- Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - W Fitz
- Brigham and Women's Hospital, Boston, MA, USA
| | - C Schnurr
- St. Vinzenz-Krankenhaus, Düsseldorf, Germany
| | - F X Koeck
- MedArtes Praxisklinik, Neutraubling, Germany
| | - M Gebauer
- HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - J Huth
- Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - G Bauer
- Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - J Beckmann
- Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
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Panwar S, Govind PS, Duarah PJ, Mahajan HK, Korde SA. Comparative Evaluation of Ropivacaine and Fentanyl Versus Ropivacaine and Fentanyl with Clonidine for Postoperative Epidural Analgesia in Total Knee Replacement Surgery. J Clin Diagn Res 2017; 11:UC09-UC12. [PMID: 29207811 DOI: 10.7860/jcdr/2017/25401.10615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022]
Abstract
Introduction Clonidine an alpha 2 adrenoceptor agonist possesses analgesic properties and has been used as an adjuvant in epidural analgesia. The addition of clonidine to other analgesics may result in enhanced analgesia through additive mechanisms or synergistic mechanisms. The enhanced analgesia may lead to a decrease in the dosage of analgesic drugs along with reduction of side effects. Aim The purpose of this study was to evaluate the effect of adding clonidine to epidural ropivacaine and fentanyl mixture in terms of quality of analgesia and side effects in patients of total knee replacement surgery. Materials and Methods A prospective randomised double blind study was conducted on 60 patients of ASA physical status I, II and III who underwent unilateral total knee replacement surgery under combined spinal epidural anaesthesia. Patients were divided into two Groups A and B randomly. Postoperatively Group A received continuous epidural infusion of ropivacaine 2 mg.ml -1 and fentanyl 2 μg.ml -1 along with clonidine 2 μg.ml-1 in the range of 3-7 ml.hr-1 while Group B received the ropivacaine and fentanyl epidural solution. The postoperative VAS scores, haemodynamic parameters, motor block, sedation, nausea, vomiting and any other significant side effects were noted. The two groups were compared with student's t-test, Pearson's Chi square test and t-test using SPSS statistical software. Results Visual analog scale scores were lower in Group A (3.38) than in Group B (3.72). The average infusion rate was lower in Group A (4.7 ± 0.7 ml.hr -1) than in Group B (5.5 ± 0.7 ml.hr-1). Patients in Group A required less dosage of rescue pain medication Paracetamol (1g i.v.), diastolic pressure and heart rate were lower in Group A. The groups were comparable in terms of sedation, motor block and nausea vomiting. Conclusion Clonidine added to a ropivacaine and fentanyl mixture augmented the postoperative epidural analgesia without significant side effects.
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Affiliation(s)
- Shivali Panwar
- Assistant Professor, Department of Anaesthesia, North DMC Medical college and associated Hindu Rao Hospital, New Delhi, India
| | - Preeti S Govind
- Senior Consultant, Department of Anaesthesia, Global Hospital, Hyderabad, Andhra Pradesh, India
| | - Parag Jyoti Duarah
- Attending Consultant, Department of Anaesthesia, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Hari Kishan Mahajan
- Head, Department of Anaesthesia, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Smita Anil Korde
- Head, Critical Care, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
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49
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Song SJ. Pain Management and Anesthesia in Total Knee Arthroplasty. Knee Surg Relat Res 2017; 29:77-79. [PMID: 28545170 PMCID: PMC5450583 DOI: 10.5792/ksrr.17.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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50
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Koh IJ, Choi YJ, Kim MS, Koh HJ, Kang MS, In Y. Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty. Knee Surg Relat Res 2017; 29:87-95. [PMID: 28545172 PMCID: PMC5450580 DOI: 10.5792/ksrr.16.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/13/2016] [Accepted: 10/03/2016] [Indexed: 01/29/2023] Open
Abstract
Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jun Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jung Koh
- Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Min Sung Kang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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