Effective Pain Management After Total Hip Arthroplasty in a Sickle Cell Patient Emphasizing Dexamethasone Sodium Phosphate/Methylprednisolone Acetate Administered via a Peripheral Nerve Blockade: A Case Report

Perese, Francisco; Rubin, Lee E.; Carlyle, Daniel

doi:10.1213/xaa.0000000000000877

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…Liposomal bupivacaine is another option for prolonging one-time injections; however, its potential duration of 72 h has not been universally established and its cost is prohibitive in many settings. Several local anesthetic adjuvants such as dexamethasone, 36 dexmedetomidine, 37 compound betamethasone 38 and methylprednisolone acetate 39 , 40 have been used to prolong the analgesic effects of single-shot blocks from hours to days. Such adjuvants have the potential to prolong ESP blocks; further investigations of this block for lumbar spine surgery that include local anesthetic adjuvants would be helpful.…”

Section: Discussionmentioning

confidence: 99%

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Jin¹,

Zhao²,

Cai³

et al. 2021

JPR

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Background Spine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty. Methods In this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS). Results Significant differences in pain scores over time were found between the two groups ( P =0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours ( P =0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively ( P =0.000) and postoperatively ( P =0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients. Conclusion ESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.

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Section: Discussionmentioning

confidence: 99%

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Jin¹,

Zhao²,

Cai³

et al. 2021

JPR

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“…Therefore, MPA alone has been used extensively in chronic pain management but not in acute pain control. For these reasons, in this case, DEX was utilized as a "bridge" between the local anesthetic and the longer-acting MPA [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Periarticular Injection Versus Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

Sivco¹,

Townsend²,

Leslie³

2023

Cureus

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Pain control after total hip arthroplasty is associated with patient satisfaction, early discharge, and improved surgical outcomes. Two commonly utilized opioid-reducing analgesic modalities are periarticular injection (PAI) by surgeons and motor-sparing peripheral nerve block (PNB) by anesthesiologists. We present a case contrasting PAI and PNB in a single patient undergoing bilateral total hip arthroplasty. For the left hip, the patient received preoperative transmuscular quadratus lumborum, femoral nerve, and lateral femoral cutaneous nerve blocks using a combination of low-concentration local anesthetic and glucocorticoids. For the right hip, the patient received an intraoperative PAI with liposomal bupivacaine. The patient's pain scores and recovery were evaluated for three months postoperatively. The patient's pain scores on postoperative day (POD) zero to five were consistently lower in the left hip than in the right hip. For this patient undergoing bilateral hip replacement, preoperative PNBs were superior to PAI for postoperative pain control.

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“…In addition, the follow-up period of 12-week was relatively short and may have missed potential long term adverse events and complications. DEX/MPA combination has been recently used in several other types of nerve blocks, including paravertebral block for breast surgery, 24 femoral nerve block and lateral femoral cutaneous nerve block for total hip arthroplasty, 9 and quadratus lumborum and lateral femoral cutaneous nerve block for total hip 25 that the analgesic duration lasted from at least 3 days to one week. In addition, selection of DEX vs DEX/MPA was based on individual attending anesthesiologist preference, even though the number of patients with diabetes and ASA status were comparable between groups.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…8 In comparison, Methylprednisolone acetate (MPA) is a lipophilic glucocorticoid that is commonly used in chronic pain procedures with good safety record and can last from days to weeks. 9 The use of MPA in peripheral nerve blocks for acute and subacute pain management is under-investigated and promising. 10,11 Here, we presented a hypothesis-generating retrospective study assessing the analgesic effects of adding MPA depot formulation to the commonly used DEX and ropivacaine in adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks for patients undergoing TKA, with the hypothesis that the addition of MPA to the PNB "cocktail" will result in less opioid consumption during hospitalization by further augmenting the analgesic effects generated from DEX and ropivacaine alone.…”

Section: Introductionmentioning

confidence: 99%

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Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty

Toro-Pagán¹,

Dai²,

Banack³

et al. 2022

JPR

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Purpose Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption. Methods A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay. Results Cumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = −45.3 (−80.5 to −10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = −1.3 (−2.3 to −0.4), P = 0.005 and −0.9 (−1.8 to −0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = −22.5 (−36 to −8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups. Conclusion Compared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC. Level of Evidence III.

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Effective Pain Management After Total Hip Arthroplasty in a Sickle Cell Patient Emphasizing Dexamethasone Sodium Phosphate/Methylprednisolone Acetate Administered via a Peripheral Nerve Blockade: A Case Report

Cited by 3 publications

References 11 publications

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial

Periarticular Injection Versus Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty

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