Patient-controlled analgesia in a postoperative total joint arthroplasty population

Albert, Todd J.; Cohn, Joy C.; Rothman, Jane S.; Springstead, James; Rothman, Richard H.; Booth, Robert E.

doi:10.1016/s0883-5403(08)80052-6

Cited by 36 publications

(20 citation statements)

References 6 publications

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“…Parenteral narcotics continue to play a major role in postoperative pain control strategies despite major side effects [1,11,23]. With the aim of decreasing the occurrence of side effects, a good analgesia protocol preferably should be multimodal and should block pain influx at its origin.…”

Section: Introductionmentioning

confidence: 99%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Introductionmentioning

confidence: 99%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Many authors developed variety of methods, such as continuous epidural anesthesia, injection of analgesics into the joint cavity, intravenous patient-controlled analgesia, and nerve blocks12,14-16) and described their efficacy in postoperative pain management. Some authors reported that a single pain management method had only limited effects 1-5). In addition, various complications related to medications, such as nausea, vomiting, respiratory failure, hypotension, paralysis and dysuria, were also reported 10-13,17-19)…”

Section: Discussionmentioning

confidence: 99%

“…However, its efficacy is often limited by perioperative pain management 1-5). In some studies, proper pain control is not obtained in more than half of patients, who undergo THA 6,7).…”

mentioning

confidence: 99%

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

et al. 2009

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BackgroundThis study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty.MethodsBetween March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates.ResultsThere was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group.ConclusionsThe multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.

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“…For example, patients undergoing a total knee arthroplasty (TKA) typically experience significant postoperative pain for 1-2 months [44][45][46]. However, the most common analgesic -opioids -are associated with undesirable side effects such as nausea, vomiting, pruritis, respiratory depression, sedation, and ileus [44,46,47]. Furthermore, the threat of prescribed opioid drug abuse is persistent and growing, with the annual economic cost of nonmedical use of prescription opioids in the U.S. estimated at over $53 billion in 2011 [48].…”

Section: Perioperative Treatment For Post-surgical Painmentioning

confidence: 99%

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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Introduction: Cryoneurolysis is the direct application of low temperatures to reversibly ablate peripheral nerves to provide pain relief. Recent development of a handheld cryoneurolysis device with small gauge probes and an integrated skin warmer broadens the clinical applications to include treatment of superficial nerves, further enabling treatments for pre-operative pain, post-surgical pain, chronic pain, and muscle movement disorders. Areas covered: Cryoneurolysis is the direct application of cold temperatures to a peripheral nerve, resulting in reversible ablation due to Wallerian degeneration and nerve regeneration. Use over the last 50 years attests to a very low incidence of complications and adverse effects. Cryoprobes have traditionally been applied through a surgical incision; but, recent technical advances allow percutaneous administration. A new hand-held device is now approved for use within the United States. Cryoneurolysis has been used to treat postoperative and chronic pain states as well as spasticity. Expert commentary: Changes in the US healthcare system such as a push for the reduction of opioid use and the incorporation of Diagnostic Related Group codes, as well as recent technological advances including a handheld unit that allows for treatment of superficial nerves while protecting the skin from damage, may contribute to the resurgence of cryoneurolysis for the treatment of peripheral nerves. ARTICLE HISTORY

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Patient-controlled analgesia in a postoperative total joint arthroplasty population

Cited by 36 publications

References 6 publications

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

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