Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study

Becchi, C.; Malyan, M. Al; Coppini, Raffaele; Campolo, Maria Consolata; Magherini, Manuela; Boncinelli, S

doi:10.1017/s026502150700302x

Cited by 52 publications

(32 citation statements)

References 28 publications

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“…Early rehabilitation decreases postoperative pain and improves function and self-efficacy [10,39]. Revised anesthesia protocols with emphasis on regional and local approach in the form of peripheral nerve blocks, PCB, LPB, and local infiltration techniques have reduced nausea and vomiting and shortened hospital stay [2,4,21,42,44,58]. Aggressive pain control with revised anesthesia protocols improves participation in postoperative rehabilitation [45].…”

Section: Discussionmentioning

confidence: 99%

“…However, the ambulation and functional ability were similar between groups at 6 weeks and 3 months after surgery [44]. Becchi et al [4] reported a prospective randomized study of 73 patients undergoing THA to compare opioidfree continuous psoas compartment block (cPCB) with an opioid/nonsteroidal antiinflammatory drugs continuous intravenous infusion. Both groups received spinal anesthesia for surgery.…”

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

“…Pain scores at rest and after mobilization, amount of rescue analgesia, nausea/vomiting, and hemodynamic parameters were recorded. The patients receiving cPCB did better in all the parameters [4]. Siddiqui et al [58] published a prospective study of 34 patients undergoing THA under general anesthesia who were randomized to continuous lumbar plexus block (cLPB) combined with PCA or PCA alone for postoperative pain.…”

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

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Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and welldesigned prospective randomized studies with outcome measures are necessary to confirm its efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

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Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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“…administration of vagolytics (atropine, glycopyrrolate) or frequency-increasing sympathomimetics (ephedrine, dopamine, others) or negative sequelae. The postoperative incidence of bradycardia was assessed in two studies (evidence level II) [72,74] and one review [14] investigating total hip arthroplasty and did not significantly differ from either epidural nor regional anaesthesia.…”

Section: Arrhythmiamentioning

confidence: 99%

“…However, another study using postoperative epidural anaesthesia reported reduced pain scores or morphine consumption as compared to systemic analgesia [73]. However, the analgesic benefit lasted only from 8 to 48 h and had no significant influence on overall outcome [74]. The question necessarily arises whether the longer immobility with epidural anaesthesia might also have exerted a negative impact on outcome.…”

Section: Postoperative Analgesiamentioning

confidence: 99%

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

173

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The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in geriatric patients sustaining a hip fracture. Following a current literature search within the Pubmed and Cochrane database (1967-2010), 34 randomised controlled trials, 14 observational studies and eight reviews/meta-analysis publications were included. Potentially outcome-influencing factors such as mortality, deep vein thrombosis, pulmonary embolism, postoperative confusion and other anaesthesia-related outcomes were evaluated. After analysing the current literature with 56 references, covering 18,715 patients with hip fracture, it can be concluded that spinal anaesthesia is associated with significantly reduced early mortality, fewer incidents of deep vein thrombosis, less acute postoperative confusion, a tendency to fewer myocardial infarctions, fewer cases of pneumonia, fatal pulmonary embolism and postoperative hypoxia. General anaesthesia has the advantages of having a lower incidence of hypotension and a tendency towards fewer cerebrovascular accidents compared to neuroaxial anaesthesia. Otherwise, general anaesthesia and respiratory diseases were significant predictors of morbidity in hip fracture patients. These data suggest that regional anaesthesia is the preferred technique, but the limited evidence available does not permit a definitive conclusion to be drawn for mortality or other outcomes. For hip fracture surgery, the choice of anaesthesia (general or neuroaxial) is made by the anaesthesiologist and is based on the patient's preference, comorbidities, potential general postoperative complications and the clinical experience of the anaesthesiologist. The overall therapeutic approach in hip fracture care should be determined jointly by the orthopaedic surgeon, the geriatrician and the anaesthesiologist (multidisciplinary approach).

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Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults

Guay

Johnson

Kopp

2017

Cochrane Database of Systematic Reviews

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Compared to systemic analgesia alone, there is moderate-quality evidence that peripheral nerve blocks reduce postoperative pain, low-quality evidence that patient satisfaction is increased and very low-quality evidence for reductions in acute confusional status, pruritus and hospital length of stay .We found moderate-quality evidence that peripheral nerve blocks reduce pruritus compared with neuraxial blocks.The 11 ongoing studies, once completed, and the three studies awaiting classification may alter the conclusions of the review once assessed.

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Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study

Abstract: Opioid-free continuous psoas compartment block seems to be an appropriate and reliable technique in providing effective postoperative analgesia at rest and during physiotherapy after total hip arthroplasty when compared to intravenous morphine/ketorolac infusion.

Cited by 52 publications

References 28 publications

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults

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