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Arthroplasty analgesia

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https://www.readbyqxmd.com/read/29668658/anesthesia-and-analgesia-for-total-knee-arthroplasty-where-is-the-evidence
#1
Henrik Kehlet
No abstract text is available yet for this article.
May 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29658975/thumb-basal-joint-arthroplasty-prospective-comparison-of-perioperative-analgesia-and-opioid-consumption
#2
Andrew J Miller, Michael Livesey, Dennis P Martin, Jack Abboudi, William H Kirkpatrick, Frederic E Liss, Christopher M Jones, Mark L Wang, Jonas L Matzon, Asif M Ilyas
Trapeziectomy alone or in combination with a suspensionplasty technique is a common surgical treatment for symptomatic thumb basal joint arthritis. The authors undertook a prospective comparative study to test the hypothesis that peripheral nerve blocks would provide better pain control than local anesthesia with bupivacaine or liposomal bupivacaine regarding pain scores and opioid pill consumption. Patients who elected to undergo basal joint arthroplasty were allocated to 1 of 3 postoperative pain management groups: (1) peripheral nerve block, (2) local anesthesia with bupivacaine, or (3) local anesthesia with liposomal bupivacaine...
April 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29643876/clinical-effects-of-single-femoral-nerve-block-in-combination-with-general-anesthesia-on-geriatric-patients-receiving-total-knee-arthroplasty
#3
Jing Zhang, Yan Yuan, Yongjun Zhang, Ying Wang
Objective: To evaluate the clinical effects of single femoral nerve block (sFNB) combined with general anesthesia on geriatric patients receiving unilateral total knee arthroplasty (UTKA). Methods: Sixty geriatric UTKA patients who were treated in The First People's Hospital of Changzhou from January 2015 to August 2015 were randomly divided into an sFNB + laryngeal mask airway (FLA) group, an sFNB + tracheal intubation (FGA) group and a tracheal intubation (GA) group...
January 2018: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29629590/higher-preoperative-sensitivity-to-pain-and-pain-at-rest-are-associated-with-worse-functional-outcome-after-stemless-total-shoulder-arthroplasty
#4
B Kadum, C Inngul, R Ihrman, G O Sjödén, A S Sayed-Noor
Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty (TSA). Patients and Methods In this prospective study, we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively. There were 31 women and 32 men; their mean age was 71 years (53 to 89). The pain threshold, which was measured using a Pain Matcher (PM) unit, the degree of pain (visual analogue scale at rest and on exertion, and function using the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded preoperatively, as well as three and 12 months postoperatively...
April 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29628682/perioperative-pain-management-following-total-joint-arthroplasty-a-review-and-update-to-an-institutional-pain-protocol
#5
REVIEW
Kimberly L Stevenson, Alexander L Neuwirth, Neil Sheth
As the rate of total joint arthroplasty increases with the aging population of the United States, new focus on decreasing opioid use through the development of multimodal pain regimens (MPRs) is becoming an important area of research. MPRs use different agents and modes of delivery in order to synergistically address pain at many levels of the pain pathway. MPRs include a combination of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, opioids (short- and long-acting), spinal/epidural analgesia, regional nerve blocks, and local anesthetics...
January 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29624535/comparison-of-intraoperative-sedation-with-dexmedetomidine-versus-propofol-on-acute-postoperative-pain-in-total-knee-arthroplasty-under-spinal-anesthesia-a-randomized-trial
#6
Hyun-Jung Shin, Sang-Hwan Do, Jae-Sung Lee, Tae-Kyun Kim, Hyo-Seok Na
BACKGROUND: In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS: Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0...
April 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29580593/multimodal-perioperative-analgesia-regimen-to-improve-patient-outcomes-after-total-knee-arthroplasty-a-multidisciplinary-quality-improvement-project
#7
Rebecca E Donahue, George R Bradbury, Michael E Zychowicz, Virginia C Muckler
PURPOSE: The primary aim of this quality improvement project was to improve mobilization for patients after total knee arthroscopy by developing and implementing a standardized, evidence-based, multimodal analgesia regimen and patient-educational video. Secondary outcomes included opioid consumption, pain, and length of stay. DESIGN: A pre-post implementation design was used to compare two independent samples. METHODS: Patients were screened based on inclusion and exclusion criteria 1-2 weeks before surgery...
April 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29562395/-dexmedetomidine-combined-with-ropivacaine-for-continuous-femoral-nerve-block-improved-postoperative-sleep-quality-in-elderly-patients-after-total-knee-arthroplasty
#8
X L Wang, J Wang, D L Mu, D X Wang
Objective: To investigate the effect of dexmedetomidine adding to ropivacaine for continuous femoral nerve block on the improvement of postoperative sleep quality in elderly patients after total knee arthroplasty. Methods: One hundred and sixty patients aged 60 years or older in Jishuitan Hospital scheduled for single total knee arthroplasty between Nov. 2016 and Jun. 2017 were recruited. All patients received spinal anesthesia and were randomized to receive either combined ropivacaine and dexmedetomidine (0...
March 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29535279/intra-operative-periarticular-multimodal-injection-in-total-knee-arthroplasty-a-local-hospital-experience-in-hong-kong
#9
J Ch Fan
INTRODUCTION: Data from a local report revealed the superior outcome of regional anaesthesia and analgesia compared with general anaesthesia and intravenous patient-controlled analgesia in total knee arthroplasty. This retrospective study aimed to assess the efficacy of intra-operative periarticular multimodal injection in improving postoperative pain and reducing morphine consumption with patient-controlled analgesia after total knee arthroplasty in patients with knee osteoarthritis...
March 14, 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29534382/-effects-and-safety-of-quadratus-lumborum-block-in-analgesia-after-hip-arthroplasty
#10
J He, X Q Zheng, C H Luo, Z X Huang, W Y He, H B Wang, C X Yang
Objective: To evaluate the efficacy of ultrasound guided quadratus lumborum block combined with non-steroidal anti-inflammatory drugs for postoperative analgesia in patients undergoing total hip arthroplasty. Methods: From January to June 2017, sixty American Society of Anesthesiologists (ASA) physical status Ⅰ to Ⅲ patients, aged 55-75 yr, scheduled for total hip arthroplasty, were randomly divided into control group(group N) and quadratus lumborum block (group R). Ultrasound guided quadratus lumborum block was implemented on the affected side at the end of operation...
February 27, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29530519/systematic-review-of-three-electrical-stimulation-techniques-for-rehabilitation-after-total-knee-arthroplasty
#11
REVIEW
Chen Yue, Xue Zhang, Yingjie Zhu, Yudong Jia, Huichao Wang, Youwen Liu
BACKGROUND: The comparative effectiveness of neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and electroacupuncture (EA) for improving patient rehabilitation following total knee arthroplasty (TKA) is controversial. Therefore we conducted this systematic review to assess the available evidence. METHODS: The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations...
February 6, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29529623/can-multimodal-pain-management-in-tka-eliminate-patient-controlled-analgesia-and-femoral-nerve-blocks
#12
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29520522/the-role-of-sciatic-nerve-block-to-complement-femoral-nerve-block-in-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#13
Andres Zorrilla-Vaca, Jinlei Li
INTRODUCTION: Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA. METHODS: Our group conducted a systematic literature search in PubMed, EMBASE and Google Scholar...
March 8, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29514376/contemporary-perioperative-analgesia-in-total-knee-arthroplasty-multimodal-protocols-regional-anesthesia-and-peripheral-nerve-blockade
#14
Jacob M Drew, Jonathan Neilio, Lisa Kunze
Perioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options...
March 7, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29508066/local-infiltration-analgesia-combined-with-a-standardized-multimodal-approach-including-an-adductor-canal-block-in-total-knee-arthroplasty-a-prospective-randomized-placebo-controlled-double-blinded-clinical-trial
#15
Dimitra Tziona, Marianna Papaioannou, Argyro Mela, Styliani Potamianou, Alexandros Makris
PURPOSE: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. This study evaluates the technique of local infiltration analgesia (LIA), by comparing it to saline injections in addition to a standardized multimodal regimen including an adductor canal block. METHODS: Between September 2015 and March 2016, forty patients aged 18 years and older, ASA I-III, undergoing primary unilateral cemented TKA under spinal anesthesia were randomized to receive either LIA (LIA group) or normal saline (sham LIA group)...
March 5, 2018: Journal of Anesthesia
https://www.readbyqxmd.com/read/29503579/a-randomized-study-of-the-efficacy-and-safety-of-parecoxib-for-the-treatment-of-pain-following-total-knee-arthroplasty-in-korean-patients
#16
Margaret Noyes Essex, Hee-Youn Choi, Pritha Bhadra Brown, Raymond Cheung
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...
2018: Journal of Pain Research
https://www.readbyqxmd.com/read/29498951/association-of-multimodal-pain-management-strategies-with-perioperative-outcomes-and-resource-utilization-a-population-based-study
#17
Stavros G Memtsoudis, Jashvant Poeran, Nicole Zubizarreta, Crispiana Cozowicz, Eva E Mörwald, Edward R Mariano, Madhu Mazumdar
BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complications, and resource utilization. METHODS: Total hip/knee arthroplasties (N = 512,393 and N = 1,028,069, respectively) from the Premier Perspective database (2006 to 2016) were included. Analgesic modes considered were opioids, peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, or ketamine...
March 2, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29455938/comparison-of-periarticular-local-infiltration-analgesia-with-femoral-nerve-block-for-total-knee-arthroplasty-a-meta-analysis-of-randomized-controlled-trials
#18
Lu-Kai Zhang, Jian-Xiong Ma, Ming-Jie Kuang, Xin-Long Ma
BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate-to-severe postoperative pain. Postoperative pain will hamper functional recovery and lower patients' satisfaction with surgery. Recently, periarticular local infiltration analgesia (LIA) has been widely used in TKA. However, there is no definite answer as to the efficacy and safety of LIA compared with femoral nerve block (FNB). METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2017), Embase (1980 to July 2017), and Cochrane Library (CENTRAL, July 2017)...
January 11, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29442160/peri-articular-injection-of-an-analgesic-mixture-in-primary-total-hip-arthroplasty-an-effective-strategy-for-pain-control-during-the-first-post-operative-day
#19
Maria Bautista, Meilyn Muskus, Adolfo Llinás, Guillermo Bonilla, Carlos Guerrero, Jairo Moyano
BACKGROUND: Previous studies of soft tissue infiltration in hip arthroplasty present variable results. The purpose of this study is to identify whether injection of an analgesic mixture improves pain management during the immediate post-operative period. MATERIALS AND METHODS: This cohort study compared 129 patients that received peri-articular soft tissue injection with 20 ml of 0.25% bupivacaine and 2 ml of ketorolac (30 mg/1 ml) in 28 ml of saline solution, with 71 patients who did not received injections...
February 13, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29433962/does-intrathecal-morphine-in-spinal-anesthesia-have-a-role-in-modern-multimodal-analgesia-for-primary-total-joint-arthroplasty
#20
Jonathan W Cheah, David C Sing, Erik N Hansen, Pedram Aleshi, Thomas P Vail
BACKGROUND: Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). METHODS: We performed a retrospective study of primary TJA patients who underwent a standardized multimodal recovery pathway and received bupivacaine neuraxial anesthesia with ITM vs bupivacaine neuraxial anesthesia alone (control)...
January 31, 2018: Journal of Arthroplasty
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