Regional analgesia for improvement of long-term functional outcome after elective large joint replacement

Atchabahian, Arthur; Schwartz, Gary S.; Hall, Charles B.; Lajam, Claudette M.; Andreae, Michael H.

doi:10.1002/14651858.cd010278

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…While these outcomes are clearly important and can substantially impact patient satisfaction and day-of-surgery discharge rates, a significant knowledge gap remains around the longer-term impact of PNBs on post-discharge outcomes. 27,28 The current evidence base features a number of studies evaluating single shot PNBs and their influence on day-of-surgery discharge. [23][24][25][26] Four studies described a reduced admission rate after surgery in patients with a PNB; one study found that admissions were shorter in patients with PNB compared with those without.…”

Section: Discussionmentioning

confidence: 99%

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

Hamilton

Ramlogan

Lui

et al. 2018

Can J Anesth/J Can Anesth

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Purpose Regional anesthesia may have immediate postoperative advantages compared with general anesthesia, but its impact on post-discharge outcomes is poorly described. Our objective was to measure the association between regional anesthesia and outcomes after ambulatory shoulder surgery. Methods We conducted a historical cohort study at The Ottawa Hospital. Adults C 18 yr old having elective ambulatory shoulder surgery from January 1, 2011 to December 31, 2016 were included. Using one-to-many coarsened exact matching (CEM) to adjust for potential confounders, we matched peripheral nerve block (PNB) patients to those without a PNB. Within the matched cohort, we assessed whether PNBs were associated with our primary composite outcomes, comprising unplanned admissions, emergency department visits, readmissions, or death within 30 days of surgery. Results There were 1,623 patients who met the inclusion criteria; PNBs were placed in 1,382 (85.2%) patients. CEM matched 211 patients who did not receive a PNB to 950 patients with similar characteristics who did receive a PNB (n = 1,161; 71.5% of total cohort). In patients who received a PNB compared with those who had no PNB, there was no difference in risk of composite outcome (relative risk, 1.58; 95% confidence interval [CI], 0.83 to 3.01), or hospital costs (ratio of means 0.73; 95% CI, 0.21 to 2.49). Conclusion Peripheral nerve blocks in ambulatory shoulder surgery were not associated with a significant difference in a composite of adverse postoperative outcomes. Nevertheless, given the lower than expected incidence and moderate effect size associating PNBs with post-discharge events, future large prospective trials are needed to assess post-discharge outcomes. Trial registration www.clinicaltrials.gov (NCT03309 644). Registered 13 October 2017.

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Section: Discussionmentioning

confidence: 99%

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

Hamilton

Ramlogan

Lui

et al. 2018

Can J Anesth/J Can Anesth

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Section: Introductionmentioning

confidence: 99%

“…The performance of total joint arthroplasty, a definitive treatment for patients with end-stage osteoarthritis, has increased dramatically over the past two decades and is expected to increase continuously with the ageing process of the population 1. Unfortunately, patients may experience severe postoperative pain, which can impede their rehabilitation and prolong the length of hospitalisation 1–3. As opioids and non-steroidal anti-inflammatory drugs are both commonly used, their adverse effects are frequently seen, especially in patients with chronic pain, who are often dissatisfied with regular analgesia 4.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, a Cochrane review conducted by Brinck and colleagues showed that the perioperative intravenous ketamine might reduce postoperative analgesic consumption and pain intensity; this finding has a significant meaning in guiding clinical practice 9. Nevertheless, to our best knowledge, few studies have investigated the beneficial effect of ketamine on patients after total knee or hip arthroplasty, who are likely to experience severe postoperative pain and suffer from impeded rehabilitation and prolonged hospitalisation 1–3. While most researchers reported that intravenous ketamine could reduce postoperative pain intensity and analgesic consumption after total joint arthroplasty,11–14 there were still several studies disagreeing with such efficacy 15 16.…”

Section: Introductionmentioning

confidence: 99%

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Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

Wang

Zeng

et al. 2019

BMJ Open

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ObjectiveTo examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE and Cochrane Library from inception to 22 May 2019.Eligibility criteria for selecting studiesRandomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty.Data extraction and synthesisData (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration’s recommended tool was used to determine the methodological quality of included studies.ResultsA total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0–8-hour (weighted mean difference (WMD) −1.21, 95% CI −1.45 to −0.98, p<0.001; three studies, 149 participants) but not during 8–24-hour postoperative periods, and effective for reduction of cumulative morphine consumption during both 0–24-hour (WMD −17.76, 95% CI −31.25 to −4.27, p=0.01; five studies, 366 participants) and 0–48-hour (WMD −21.79, 95% CI −25.46 to −18.11, p<0.001; four studies, 252 participants) postoperative periods, without increasing risks of gastrointestinal or psychotic adverse effects. The limited data available for intra-articular (WMD −0.49, 95% CI −0.70 to −0.29, p<0.001; two studies, 83 participants) and epidural (WMD −2.10, 95% CI −3.30 to −0.90, p<0.001; one study, 20 participants) ketamine pointed to a significant reduction in pain intensity during 8–24-hour postoperative period.ConclusionsIntravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.

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“…Total hip arthroplasty (THA) has become one of the most common surgical operations since 1960 and is regarded as a revolutionary technique significantly improving the outlook for patients with degenerative osteoarthritis, rheumatoid arthritis, proximal femoral fractures, or other damaged hip joints [ 1 ]. This technique replaces the dysfunctional joint surface with an artificial prosthesis so that severe pain can be alleviated and normal joint functions can be restored [ 2 , 3 ]. However, THA is usually associated with severe pain during the perioperative period, so it may not be ideal for older patients who often have higher risk of hypertension, renal dysfunction, or ischemic heart disease.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of 3 Different Anesthesia Techniques Used in Total Hip Arthroplasty

et al. 2017

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BackgroundThis study compared the efficacy and safety of 3 different anesthesia techniques used in total hip arthroplasty (THA).Material/MethodsWe allocated 198 patients preparing to undertake THA into 3 groups: general anesthesia group (GA group, n=66), caudal epidural anesthesia group (CEA group, n=66), and spinal-epidural anesthesia group (SEA group, n=66). We compared postoperative adverse effects occurring in patients of the 3 anesthesia groups. The Visual Analog Scale (VAS) score, Minimum Mental State Examination (MMSE) score, and β-amyloid (Aβ) expression were calculated to determine the effects of different anesthesia on the postoperative pain and cognitive dysfunction of patients.ResultsThe CEA and SEA groups had lower rates of perioperative adverse effects than in the GA group. Patients in the GA group required significantly higher administration of analgesics after the surgery than those in CEA and SEA groups. Higher Aβ expression levels and VAS scores, as well as lower MMSE scores, were also seen in the GA group compared with the other 2 groups.ConclusionsCEA and SEA were more effective than GA in THA, and CEA seemed to be a better anesthesia technique than SEA.

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Regional analgesia for improvement of long-term functional outcome after elective large joint replacement

Cited by 11 publications

References 26 publications

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

Efficacy and Safety of 3 Different Anesthesia Techniques Used in Total Hip Arthroplasty

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