Controlling Pain After Total Hip and Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections

Parvataneni, Hari K.; Shah, Vaibhav; Howard, Holly; Cole, Naida M.; Ranawat, Amar S.; Ranawat, Chitranjan S.

doi:10.1016/j.arth.2007.03.034

Cited by 307 publications

(127 citation statements)

References 20 publications

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“…Characteristics of included studies are shown in Table 35 and a risk-of-bias assessment in Appendix 9. Thirteen studies were in patients undergoing THR [385][386][387][388][389][390][391][392][393][394][395][396] or included a large majority of THR patients. 374 Twenty-three studies were in patients undergoing TKR.…”

Section: Resultsmentioning

confidence: 99%

“…374 Twenty-three studies were in patients undergoing TKR. 380,381,386,[397][398][399][400][401][402][403][404][405][406][407][408][409][410][411][412][413][414] Small study effects Inspection of funnel plots for each meta-analysis gave no strong indication of publication bias or small study effects, but numbers of studies in individual analysis groups were small, such that assessment of asymmetry was difficult.…”

Section: Resultsmentioning

confidence: 99%

“…374,[385][386][387][388][390][391][392][393][394][395][396] Overall, as shown in Table 36 and Figures 22 and 23, there was a reduction in pain at 24 and 48 hours at both rest and activity. For example, at rest at 24 hours, the average SMD favouring local anaesthetic infiltration was -0.61 (95% CI -1.05 to -0.16; p = 0.008) and during activity at 48 hours was -0.85 (95% CI -1.45 to -0.25; p = 0.006).…”

Section: Painmentioning

confidence: 99%

“…386,[390][391][392][393][394][395] At rest at 24 hours, the local anaesthetic infiltration group reported reduced pain (average SMD -0.63, 95% CI -1.21 to -0.06; p = 0.031), equivalent to an estimated 12 points lower pain. There was no strong evidence that the intervention had an effect during activity or at 48 hours.…”

Section: Painmentioning

confidence: 99%

“…374,[386][387][388]390,392,[394][395][396] Studies with low risk of bias had a marginally smaller reduction in pain after 24 hours at rest, averaging (SMD -0.49, 95% CI -0.89 to -0.09; p = 0.017), but during activity average pain reduction was greater (SMD -0.99, 95% CI -1.64 to -0.35; p = 0.003), corresponding to 28 points on a 100-point scale.…”

Section: Painmentioning

confidence: 99%

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Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Blom

Artz

Beswick

et al. 2016

Programme Grants Appl Res

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms PROGRAMME GRANTS FOR APPLIED RESEARCH VOLUME 4 ISSUE 12 AUGUST 2016 ISSN 2050 DOI 10.3310/pgfar04120Improving patients' experience and outcome of total joint replacement: the RESTORE programme Ashley W Blom, Neil Artz, Andrew D Beswick, Amanda Burston, Paul Dieppe, Karen T Elvers, Rachael Gooberman-Hill, Jeremy Horwood, Paul Jepson, Emma Johnson, Erik Lenguerrand, Elsa Marques, Sian Noble, Mark Pyke, Catherine Sackley, Gina Sands, Adrian Sayers, Victoria Wells and Vikki Wylde Improving patients' experience and outcome of total joint replacement: the RESTORE programme ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10070. The contractual start date was in December 2008. The final report began editorial review in September 2014 and was accepted for publication in August 2015. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accurac...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

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Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Blom

Artz

Beswick

et al. 2016

Programme Grants Appl Res

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2014

Cochrane Database of Systematic Reviews

164

112

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Background Total knee replacement (TKR) is a common and o en painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Objectives To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web of Science, dissertation abstracts and reference lists of included studies. The date of the last search was 31 January 2013. Selection criteria We included randomized controlled trials (RCTs) comparing FNB with no FNB (intravenous patient-controlled analgesia (PCA) opioid, epidural analgesia, local infiltration analgesia, and oral analgesia) in adults a er TKR. We also included RCTs that compared continuous versus single-shot FNB. Data collection and analysis Two review authors independently performed study selection and data extraction. We undertook meta-analysis (random-e ects model) and used relative risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) or standardized mean di erences (SMDs) for continuous outcomes. We interpreted SMDs according to rule of thumb where 0.2 or smaller represents a small e ect, 0.5 a moderate e ect and 0.8 or larger, a large e ect. Main results We included 45 eligible RCTs (2710 participants) from 47 publications; 20 RCTs had more than two allocation groups. A total of 29 RCTs compared FNB (with or without concurrent treatments including PCA opioid) versus PCA opioid, 10 RCTs compared FNB versus epidural, five RCTs compared FNB versus local infiltration analgesia, one RCT compared FNB versus oral analgesia and four RCTs compared continuous versus single-shot FNB. Most included RCTs were rated as low or unclear risk of bias for the aspects rated in the risk of bias Femoral nerve blocks for acute postoperative pain a er knee replacement surgery (Review)

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Peri-articular/intra-articular infiltration analgesia with local anaesthetic versus nerve block for postoperative pain and function in patients receiving major knee surgery

Peng¹,

Min²,

Sun³

et al. 2015

Cochrane Database of Systematic Reviews

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Controlling Pain After Total Hip and Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections

Cited by 307 publications

References 20 publications

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Peri-articular/intra-articular infiltration analgesia with local anaesthetic versus nerve block for postoperative pain and function in patients receiving major knee surgery

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