Effectiveness of Novel Adjuncts in Pain Management Following Total Knee Arthroplasty: A Randomized Clinical Trial

Suárez, Juan C.; Al-Mansoori, Ahmed; Kanwar, Sumit; Semien, George; Villa, Jesus M.; McNamara, Colin A.; Patel, Preetesh D.

doi:10.1016/j.arth.2018.02.088

Cited by 27 publications

(23 citation statements)

References 31 publications

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“…Methodological quality of 13 RCTs was evaluated with Cochrane collaboration’s tool for assessing the risk of bias [28]. Randomization was achieved using a random number table in 3 RCTs [13, 25, 26], excel software in 2 RCTs [17, 20], and a centralized randomization system in 2 RCTs [18, 22]. Only 2 RCTs [17, 19] described the concealment of allocation.…”

Section: Resultsmentioning

confidence: 99%

“…Only 2 RCTs [17, 19] described the concealment of allocation. Only 2 RCTs [24, 26] were single blinded, and the others were double-blinded. All RCTs mention information about withdrawal and dropout.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies involving 337 patients reported the consumption of morphine equivalents from 0 to 72 h postoperatively [12, 21, 25, 26]. During the first 24 h, fixed-effects meta-analysis revealed that patients in the liposomal bupivacaine group did not consume significantly less morphine equivalents than TPAI (MD = -1.22, 95% CI: [− 4.37, 1.94], P = 0.45, I 2 = 40%, Fig.…”

Section: Resultsmentioning

confidence: 99%

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The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

Yuan

Zeng

et al. 2019

BMC Musculoskelet Disord

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Background The efficacy of postoperative pain management is an important factor that influences the final outcome of total knee arthroplasty (TKA). Whether liposomal bupivacaine offers better efficacy compared with traditional peri-articular injection after TKA remains inconclusive. We conduct this study to compare the true efficacy of liposomal bupivacaine (LB) with traditional peri-articular injection (TPAI) following TKA. Materials and methods Randomized controlled trials (RCTs) from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science were searched. Thirteen RCTs involving 1373 patients were finally included in our meta-analysis (LB = 691, TPAI = 682). The continuous and dichotomous outcome were collected in a standard form, and the data were analysed by using Review Manager 5.3 software. Finally, the results were presented in the forest plots. Result The pooled data demonstrated that the postoperative visual analogue score (VAS) in the LB group was not significantly different compared with that in the TPAI group at every time period after TKA. The liposomal bupivacaine group had significantly lower consumption of morphine equivalents 24 to 72 h postoperatively and reduced incidence of nausea and vomiting after TKA compared with the TPAI group. Finally, the length of hospital stay in the two groups was not significantly different. Conclusion Liposomal bupivacaine did not yield different results on the visual analogue scale compared with traditional peri-articular injection after total knee arthroplasty. However, liposomal bupivacaine was preferred in terms of lower consumption of morphine equivalents 24–72 h postoperatively and lower incidence of nausea and vomiting after total knee arthroplasty.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

Yuan

Zeng

et al. 2019

BMC Musculoskelet Disord

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“…Total Knee Arthroplasty (TKA) is a reliable treatment with suitable radiological and clinical outcomes for the patients of severe knee osteoarthritis. 1,2 Balancing of tissues, precise bone cuts and appropriate placement of implant are necessary for better outcomes. In the course of arthrotomy, surgeons crucially require adequate exposure along with the maintenance of quadriceps tendon integrity in order to ensure good repair.…”

Section: Introductionmentioning

confidence: 99%

Disrupted quadriceps tendon post knee arthroplasty: A case series.

Maqsood¹,

Maqsood²,

Maqsood³

2020

TPMJ

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QTR (Quadriceps Tendon Rupture) occurs rarely after TKA (Total Knee Arthroplasty) but is a severe complication which has an association with morbidity and adverse outcomes. Rare literary evidence is available which deals with the complications. Delayed management may cause adverse outcomes so the focus is on the timely management of the disease; although, the diagnosis process is full of challenges because we expect weaker quadriceps after TKA as the surgical intervention violates quadriceps muscle. In case of postoperative trauma with the outcomes of weaker extensor weakness, a USG assessment is necessary to reduce the chances of prompt QTR performance after exclusion of the fracture. We have shared our experience about the treatment of four cases of QTR in the early postoperative time with focused efforts on prevention. We can reduce the chances of rupture with meticulous surgical approaches in the course of medial parapatellar method in order to preserve quadriceps integrity.

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“…Inadequate pain management may result in dissatisfaction, complications, stunted postoperative functional recovery, and longer hospital stays [ 3 , 4 ]. Conventionally, multimodal pain management is widely recommended and accepted [ 5 , 6 ]. Multimodal pain management usually includes two or more analgesics, such as opioids, nonsteroidal anti-inflammatory medications, steroid hormones, and epinephrine [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

et al. 2018

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BackgroundThe efficacy of intravenous acetaminophen in multimodal pain management in patients undergoing total knee arthroplasty (TKA) is controversial. The purpose of this meta-analysis was to compare the efficacy of intravenous acetaminophen versus placebo in TKA.MethodsRandomized controlled trials (RCTs) or retrospective cohort studies (RCSs) concerning related topics were retrieved from PubMed (1996–June 2018), Embase (1980–June 2018), and the Cochrane Library (CENTRAL June 2018). Any studies comparing intravenous acetaminophen with a placebo were included in this meta-analysis. Meta-analysis results were collected and analyzed by Stata 12.0. Subgroup analysis was performed according to the general characteristics of the patients.ResultsIn total, the patients from six studies met the inclusion criteria. Our meta-analysis results indicated that compared with a control group, intravenous acetaminophen was associated with reductions in total morphine consumption and visual analogue scale (VAS) score at postoperative day (POD) 3. However, there was no significant difference in morphine consumption at POD 1 or in VAS at POD 1 or POD 2. Moreover, there was no significant difference in the length of hospital stay.ConclusionsBased on our results, intravenous acetaminophen in multimodal management has shown better efficacy in pain relief at POD 3 and has morphine-sparing effects. High-quality studies with more patients are needed in the future.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0950-7) contains supplementary material, which is available to authorized users.

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Effectiveness of Novel Adjuncts in Pain Management Following Total Knee Arthroplasty: A Randomized Clinical Trial

Cited by 27 publications

References 31 publications

The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

Disrupted quadriceps tendon post knee arthroplasty: A case series.

Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

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