Effects of Perioperative Analgesic Technique on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery

Capdevila, Xavier; Barthelet, Y.; Biboulet, Philippe; Ryckwaert, Yves; Rubenovitch, Josh; d’Athis, F.

doi:10.1097/00000542-199907000-00006

Cited by 936 publications

(535 citation statements)

References 21 publications

Supporting

Mentioning

489

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, diminished muscle control, nerve damage, and local infection are recognized complications, ranging from 0.1% to 2.5% [7,14,15,23], and 15% of femoral nerve blocks are unsuccessful [20]. PAI offers the benefits of blocking pain influx at its origin and maximizing muscle control.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous femoral nerve block and/or sciatic nerve blocks improve postoperative pain control and reduce narcotic consumption [23]. However, 0.1% to 2.5% of patients experience complications associated with nerve blocks including muscle weakness, nerve damage, local infection, or ''double crush'' (in which a distal nerve branch becomes more sensitive to injury if the proximal root is injured, by spinal stenosis or lumbar disc herniation, for examples) with peripheral nerve blocks and tourniquet [7,14,15,23].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Unfortunately, narcotic analgesia is associated with unwanted side effects such as PONV. Many other factors contribute to PONV, including polymethylmethacrylate use, blood loss, and surgical pain [3,7,9,20,26,28]. PONV can occur during the entire hospitalization and can be severe and disabling.…”

Section: Discussionmentioning

confidence: 99%

“…Anesthetic agents and narcotic analgesia commonly cause severe postoperative nausea and vomiting (PONV) after total joint arthroplasty (TJA) [3,7,9,20,26,28]. PONV after lower extremity TJA has a reported incidence of 20 to 83% [14,21].…”

Section: Introductionmentioning

confidence: 99%

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

DiIorio

Sharkey

Hewitt

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics. Questions/purposes We asked whether a single dose of preoperative aprepitant (40 mg orally) reduced postoperative nausea and vomiting after THA or TKA. Methods Fifty patients who received a preoperative dose of aprepitant (study group) were matched demographically to 50 patients who did not receive aprepitant (control group) from a group of patients undergoing THA or TKA. Patients' charts were reviewed to identify episodes of PONV, number of doses of antiemetics needed for breakthrough PONV, and length of stay. Aprepitant side effects, and complications. Results Aprepitant reduced the percentage of patients with PONV (39% of study and 70% of control patients). Moderate or severe PONV occurred in 22% of study and 40% of control patients. The number of episodes of PONV during hospitalization was 2.9 for the control group and 1.6 for the study group. Postoperatively, the control group required on average 1.3 doses of ondansetron compared with 0.6 doses for the study group. Hospital length of stay was reduced from 3.3 days for the control group and to 2.3 days for the study group. Conclusions These data suggest a single preoperative dose of aprepitant reduces the number of episodes and severity of PONV, the need for additional antiemetics, and the length of stay. Level of Evidence Level II, prognostic study. See guidelines for authors for a complete description of levels of evidence.

show abstract

“…1 The duration of analgesia provided by local anesthetics injected via a peripheral nerve catheter has increased over the last few years, with a median of 56 hr 2 and an upper range exceeding 100 hr. 3 However, peripheral nerve blocks with durations [ 48 hr increase the odds of local inflammation or infection (odds ratio [OR] 4.61, 95% confidence interval [CI] 1.6-15.9) 2 and can be associated with rare but well-documented bupivacaineinduced myotoxicity.…”

Section: Résumémentioning

confidence: 99%

Time course of mitochondrial metabolism alterations to repeated injections of bupivacaine in rat muscle

Nouette‐Gaulain

Bringuier

Canal-Raffin

et al. 2010

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

Purpose Bupivacaine-induced myotoxicity is associated with mitochondrial bioenergetic alterations. The impact of the duration of bupivacaine treatment on mitochondrial energy production remains undetermined. Here, we assessed, in vivo, the alteration of mitochondrial metabolism following different durations of bupivacaine exposure (40, 56, or 112 hr) that correspond to 5, 7, or 14 repeated injections of 0.25% bupivacaine, respectively. Methods Rats were divided randomly into seven different groups: one control group (no catheter); three groups with normal saline injections (1 mLÁkg -1 ) every eight hours via a femoral nerve catheter for 40, 56, and 112 hr, respectively; and three groups with 0.25% bupivacaine injections(1 mLÁkg -1 ) every eight hours via a femoral nerve catheter for 40, 56, and 112 hr. Psoas and gracilis muscle samples located within the bupivacaine infusion-diffusion space were investigated. To estimate mitochondrial respiratory capacity, the protein content of the mitochondrial respiratory chain apparatus was evaluated by measuring citrate synthase activity. To measure mitochondrial respiratory function, adenosine diphosphate-stimulated oxygen consumption was measured by polarography in saponinskinned muscle fibres using glutamate-malate or succinate as energy substrates. Results In psoas and gracilis muscles, saline solution had no effect on the two mitochondrial parameters. Bupivacaine induced a significant decrease in the citrate synthase activity in psoas (r 2 = 0.74; P \ 0.001) and gracilis muscle (r 2 = 0.52; P \ 0.001), and there was a significant decrease in the adenosine diphosphatestimulated oxygen consumption using glutamate or succinate as substrates in both muscles (P \ 0.001). Conclusions The severity of bupivacaine-induced myotoxicity is closely linked to the duration of bupivacaine exposure in the muscle fibres located close to the catheter tip. RésuméObjectif La myotoxicite´induite par bupivacaı¨ne est associe´e à des alte´rations du me´tabolisme e´nerge´tique mitochondrial. Nous ne connaissons pas l'impact de la dure´e d'un traitement de bupivacaı¨ne sur la production e´nerge´tique mitochondriale. Dans cette e´tude, nous avons e´value´in vivo l'alte´ration du me´tabolisme mitochondrial al a suite de diffe´rentes dure´es d'exposition a`la bupivacaı¨ne (40, 56 ou 112 h), ce qui correspond respectivement a`cinq, sept ou 14 injections re´pe´te´es de bupivacaı¨ne a`0,25 %. Méthode Les rats ont e´te´randomise´s en sept groupes diffe´rents: un groupe te´moin (pas de cathe´ter); trois groupes avec des injections de se´rum physiologique (1 mLÁkg -1 ) toutes les huit heures via un cathe´ter au niveau du nerf fe´moral pendant 40, 56 et 112 h, respectivement; et trois groupes recevant des injections de bupivacaı¨ne a`0,25 % (1 mLÁkg -1 ) toutes les huit heures via un cathe´ter au niveau du nerf fe´moral pendant 40, 56 et 112 h. Des e´chantillons du muscle psoas et du muscle gracilis situe´s dans l'espace de diffusion de la bupivacaı¨ne ont e´te´examine´s. Le contenu prote´inique ...

show abstract

Effects of Perioperative Analgesic Technique on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery

Abstract: Regional analgesic techniques improve early rehabilitation after major knee surgery by effectively controlling pain during continuous passive motion, thereby hastening convalescence.

Cited by 936 publications

References 21 publications

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Time course of mitochondrial metabolism alterations to repeated injections of bupivacaine in rat muscle

Contact Info

Product

Resources

About