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1.
Clayton R. Perry Adam M. Fahs Michael D. Kurdziel Denise M. Koueiter Randy J. Fayne James J. Verner 《The Journal of arthroplasty》2018,33(6):1770-1774
Background
Modern joint arthroplasty protocols place an emphasis on minimizing patient-reported postoperative pain while minimizing opioid consumption. The use of multimodal pain management protocols has been reported to improve patient outcomes and satisfaction after total hip arthroplasty.Methods
In a prospective, single-surgeon trial, 50 patients undergoing primary direct anterior approach total hip arthroplasty were randomized to receive a preoperative fascia iliaca compartment block (FICB) or an intraoperative surgeon-delivered psoas compartment block (PCB). Patient-reported pain was recorded in the postanesthesia care unit, recovery floor and 3 weeks postoperatively. Opioid use was recorded during the hospital stay.Results
Average visual analog scale pain scores in the postanesthesia care unit were 38.7 ± 8.7 vs 35.6 ± 8.3 (P = .502) for the preoperative FICB and intraoperative PCB groups, respectively. No significant difference was found between groups at the 3-week visit for postoperative pain (FICB: 2.9 ± 1.4; PCB: 3.2 ± 2.0; P = .970) and patient-reported pain satisfaction (FICB: 8.8 ± 2.2; PCB: 9.7 ± 0.6; P = .110).Conclusion
During the direct anterior approach for total hip arthroplasty, PCB is an effective and efficient regional anesthesia technique. It may be used to obtain satisfactory postoperative pain control and patient satisfaction while decreasing hospital resources. 相似文献2.
Molly A. McGraw-Tatum Michael T. Groover Nicole E. George John S. Urse Victor Heh 《The Journal of arthroplasty》2017,32(7):2181-2185
Background
Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS).Methods
We performed a prospective randomized, controlled study involving 79 patients undergoing elective THA between June 2015 and February 2016. Forty patients received liposomal bupivacaine and 39 patients received a fascia iliaca compartment block (FICB). In addition, the medical records of 28 patients who underwent elective THA between May 2015 and December 2015 were retrospectively examined. The primary outcome was visual analog scale pain scores and the secondary outcomes were LOS and total opioid consumption. SPSS, version 22, was used to run 1-way analysis of variance with contrast and Mood's median test on the data.Results
There were statistically significant decreases in pain intensity (P = .019) and LOS (P = .041) in both the liposomal bupivacaine group and the FICB group compared with those in the retrospective control group. In addition, only the FICB group showed statistically significant decreased total opioid consumption compared with that in the retrospective group (P = .028).Conclusion
Patients undergoing elective THA have decreased overall pain intensity and a shorter LOS with multimodal pain management regimen that includes either liposomal bupivacaine or FICB. Patients who received FICB required less overall total opioids than the control group. 相似文献3.
Background and objectives
Postoperative pain relief is crucial in elderly, however, the use of opioids is limited owing to their potential side effects. We studied the effects of patient-controlled ultrasound guided fascia iliaca compartment block (FICB) with Levobupivacaine versus patient-controlled intravenous fentanyl on postoperative pain score in patients scheduled for fixation of femur fractures under general anesthesia.Methods
60 patients ASA physical status I and II undergoing elective fixation of fracture femur were enrolled in this randomized study into two groups. Patient-controlled IV fentanyl group (PC-IVF): patients received fentanyl 20?µg/ml solutions through a PCA pump programmed to give a basal infusion of 10?µ/h and bolus doses of 2?ml/dose with a 15?min lockout interval. Patient-controlled fascia iliaca compartment analgesia (PC-FICA): PCA was adjusted to deliver a continuous basal infusion of 4?ml/h levobupivacaine 0.125% and 2?ml demand boluses with a lockout interval of 15?min. Visual analogue score (VAS) and total postoperative rescue analgesic consumption were assessed.Results
VAS scores were significantly lower in PC-FICA group compared to PC-IVF group at 1?h, 3?h and 6?h postoperative. 7 patients requested post-operative rescue analgesia in PC-FICA group compared to 19 patients in PC-IVF group. Total consumption of rescue analgesia was significantly decreased in PC-FICA group (31.4?±?10.7?mg) compared to PC-IVF group (70.5?±?20.4?mg) (P?<?.05).Conclusion
PC-FICA provided a better quality of analgesia and decreased postoperative rescue analgesic requirement without increased side effects compared to PCA IV fentanyl.Pan African Clinical Trial Registry: PACTR201512001367158 相似文献4.
A. D. Leeper P. T. Brandon A. V. M. Morgan S. Cutts A. M. M. Cohen 《European journal of trauma and emergency surgery》2012,38(6):673-677
Introduction
Fascia iliaca compartment block, performed in the emergency department (A&E) in patients presenting with femoral neck fracture, has gained increasing recognition as an adjunctive analgesic. The purpose of this study was to investigate whether fascia iliaca block (FIB) significantly reduced the requirement for systemic opiates in the pre-operative setting.Materials and methods
Analgesia requirements for all patients admitted with fractured neck of femur to one unit over a 9-month period were gathered prospectively. Fifty percent of patients had received FIB at diagnosis in the A&E, dependant on the expertise of the attending physician. Morphine administration between groups was analysed.Results
Over a 9-month period, 286 patients with complete documentation were admitted with fractured neck of femur. At the start of the study, an informal education programme in A&E was introduced, increasing the incidence of FIB provision at diagnosis (p?=?<0.0001, Fisher??s exact test) and reducing the average amount of morphine administered (p?=?0.027, linear regression analysis). The administration of FIB reduced the average morphine requirement for a patient in A&E by 41?% when compared with those who received systemic analgesia alone (p?=?0.018, Mann?CWhitney test). No adverse effects were reported with FIB.Conclusion
Fascia iliaca compartment block is a safe and effective method of providing analgesia to patients with fractured neck of femur and reduces morphine requirement. 相似文献5.
J.D. Turner S.W. Dobson R.S. Weller G.B. Russell D.S. Henshaw 《British journal of anaesthesia》2018,120(2):308-316
Background
Recent studies have concluded that i.v. dexamethasone can prolong the duration of peripheral nerve blockade. We hypothesized that a 4 mg dose would equally prolong the duration of psoas compartment blocks (PCBs) when compared with 8 mg, and that both doses would prolong the duration when compared with placebo.Methods
This was a prospective, randomized, placebo-controlled, dose-dependent, equivalency trial with 115 patients undergoing total hip arthroplasty. The patients received a PCB. Subsequently, 15 patients received i.v. normal saline (placebo), 50 patients received i.v. dexamethasone 4 mg, and 50 patients received i.v. dexamethasone 8 mg. The primary outcome was the duration in hours of PCB, determined by serial pinprick assessments. Secondary outcomes included pain scores, time to first analgesic, and opioid consumption. An intention-to-treat-analysis (ITA) and per-protocol analysis (PPA) were performed.Results
The ITA showed that block duration in the 4 and 8 mg groups was equivalent [mean (standard deviation), 18.5 h (8.0) vs 18.1 h (7.1)]. However, neither group differed from placebo [19.6 h (6.7), (4 mg vs placebo), P=0.97; (8 mg vs placebo), P=0.77)]. Postoperative pain scores and opioid consumption were not different between groups. Time to first analgesic was not different between the 4 and 8 mg groups, or the 4 mg and placebo groups. The 8 mg group, however, had a longer time to first analgesic (median of 533 vs 432 min, P=0.047) when compared with placebo, although the significance was not observed in the PPA (P=0.058).Conclusions
I.V. dexamethasone did not prolong PCB when duration was objectively assessed, or decrease total opioid consumption. However, dexamethasone 8 mg prolonged the time to first analgesic.Clinical trial registration
NCT 02464176. 相似文献6.
Joseph J. Ruzbarsky Elizabeth B. Gausden Elan M. Goldwyn Isaac P. Lowenwirt Vitaly Kotlyar 《HSS journal》2018,14(1):77-82
Background
Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia.Questions/Purposes
The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile.Methods
A retrospective chart review was conducted to identify patients with intertrochanteric hip fractures who underwent anesthesia with a fascia iliaca block over a 1.5-year period.Results
In the six patients identified, there were no intraoperative conversions to general anesthesia requiring airway support. Additionally, there were no intraoperative complications, no mortalities within 30 days, 2 patients on anticoagulation who required a blood transfusion, and a single patient who developed a postoperative hospital-acquired pneumonia that resolved with an antibiotic course.Conclusions
In this series of patients, we demonstrate that a fascia iliaca block can reliably be utilized as the primary anesthetic for patients undergoing surgical fixation of intertrochanteric hip fractures, with an acceptable perioperative complication profile. Although concomitant sedation was provided with the block, this anesthesia strategy has the potential to reduce preoperative delays and minimize the overall burden of sedative and anesthetic medications in a geriatric population. These initial findings may serve as a basis for future, higher-quality prospective and comparative studies.7.
Ming-jie Kuang Jian-xiong Ma Lin Fu Wei-wei He Jie Zhao Xin-long Ma 《The Journal of arthroplasty》2017,32(10):3238-3248.e3
Background
Total knee arthroplasty (TKA) is associated with intense postoperative pain with a need for early ambulation to gain function and prevent postoperative complications. Compared with femoral nerve block (FNB), adductor canal block (ACB) can relieve postoperative pain and preserve quadriceps muscle strength. This meta-analysis was conducted to investigate which analgesic method provides better pain relief and functional recovery after TKA.Method
We conducted a meta-analysis to identify relevant randomized controlled trials involving ACB and FNB after TKA in electronic databases, including Web of Science, Embase, PubMed, and the Cochrane Library, up to November 2016. Finally, 9 randomized controlled trials involving 609 patients (668 knees) were included in our study. Review Manager Software and Grading of Recommendations Assessment, Development, and Evaluation profiler were used to perform the meta-analysis.Results
Compared with FNB, ACB resulted in better quadriceps muscle strength and mobilization ability. There were no significant differences in the visual analog scale at rest, visual analog scale with mobilization, rescue opioid consumption, patient satisfaction, and length of hospital stay.Conclusion
Compared with FNB, ACB shows similar pain control after TKA. However, ACB can better preserve quadriceps muscle strength and improve mobilization ability. In conclusion, ACB showed better functional recovery after TKA without compromising pain control. Therefore, ACB is recommended as an alternative analgesic method for early ambulation after TKA. 相似文献8.
S.C. Ng A.S. Habib S. Sodha B. Carvalho P. Sultan 《British journal of anaesthesia》2018,120(2):252-263
Background
The optimal local-anaesthetic (LA) dose for transversus-abdominis-plane (TAP) block is unclear. In this meta-analysis, we aimed to determine whether TAP blocks for Caesarean delivery (CD) with low-dose (LD) LA demonstrated non-inferiority in terms of analgesic efficacy, compared with high-dose (HD) LA.Methods
A literature search was performed for randomised controlled trials examining the analgesic efficacy of TAP blocks vs control after CD. The different dosing used in these studies was classified as HD or LD (bupivacaine equivalents >50 or ≤50 mg per block side, respectively). The pooled results of each dose group vs control were indirectly compared using the Q test. The primary outcome was 24 h opioid consumption. Secondary outcomes included 6 and 24 h postoperative pain scores, time to first analgesia, 6 h opioid consumption, opioid-related side-effects, and maternal satisfaction.Results
Fourteen studies consisting of 770 women (389 TAP and 381 control) were included. Compared with controls, the 24 h opioid consumption (milligram morphine equivalents) was lower in HD [mean difference (MD) 95% confidence interval (CI) –22.41 (–38.56, –6.26); P=0.007; I2=93%] and LD [MD 95% CI –16.29 (–29.74, –2.84); P=0.02; I2=98%] TAP groups. However, no differences were demonstrated between the HD and LD groups (P=0.57). There were also no differences between the HD and LD groups for the 6 h opioid consumption, time to first analgesia, 6 and 24 h pain scores, postoperative nausea and vomiting, pruritus, and maternal satisfaction.Conclusions
Low-dose TAP blocks for Caesarean delivery provide analgesia and opioid-sparing effects comparable with the high-dose blocks. This suggests that lower doses can be used to reduce local anaesthetic toxicity risk without compromising the analgesic efficacy. 相似文献9.
Kerri L. Bell Noam Shohat Karan Goswami Timothy L. Tan Irene Kalbian Javad Parvizi 《The Journal of arthroplasty》2018,33(10):3246-3251.e1
Background
Opioids have well-known immunosuppressive properties and preoperative opioid consumption is relatively common among patients undergoing total joint arthroplasty (TJA). The hypothesis of this study was that utilization of opioids preoperatively would increase the incidence of subsequent periprosthetic joint infection (PJI) in patients undergoing primary TJA.Methods
A comparative cohort study design was set up that used a cohort of 23,754 TJA patients at a single institution. Patient records were reviewed to extract relevant information, in particular details of opioid consumption, and an internal institutional database of PJI was cross-referenced against the cohort to identify patients who developed a PJI within 2 years of index arthroplasty. Univariate and multivariate linear regression analyses were used to examine the potential association between preoperative opioid consumption and the development of PJI.Results
Among the total cohort of 23,754 patients, 5051 (21.3%) patients used opioids before index arthroplasty. Preoperative opioid usage overall was found to be a significant risk factor for development of PJI in the univariate (odds ratio, 1.63; P = .005) and multivariate analyses (adjusted odds ratio, 1.53 [95% confidence interval, 1.14-2.05], P = .005).Conclusion
Preoperative opioid consumption is independently associated with a higher risk of developing a PJI after primary TJA. These findings underscore a need for caution when prescribing opioids in patients with degenerative joint disease who may later require arthroplasty. 相似文献10.
D. Mayhew N. Sahgal R. Khirwadkar J.M. Hunter A. Banerjee 《British journal of anaesthesia》2018,120(2):241-251
Background
Thyroid surgery is moderately painful, but is increasingly being considered as a day-case procedure. Bilateral superficial cervical plexus block (BSCPB) provides an adjuvant technique to facilitate this approach, but there is great evidential heterogeneity in randomised controlled trials (RCTs) about its use.Methods
A systematic search, critical appraisal, and analysis of RCTs was performed. Trials investigating preoperative or postoperative BSCPB compared with control in patients undergoing thyroid surgery via neck incision were included. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated for dichotomous data, whilst continuous data were analysed using standard mean difference. Primary outcome was rescue analgesic requirement in the first 24 postoperative hours. Secondary outcomes were visual analogue scale (VAS) scores at 0, 4, and 24 h, time until first analgesic request, intraoperative analgesic requirements, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV).Results
Fourteen RCTs published between 2001 and 2016 including 1154 patients were included. The overall effect of BSCPB compared with control showed a reduction in analgesic requirement (OR 0.30; 95% CI 0.18, 0.51; P<0.00001). There was improvement in VAS scores (P<0.002) and time to first analgesic requirement in the BSCPB group (P<0.00001). Length of hospital stay was reduced by 6 h by use of BSCPB. There was no significant change in the incidence of PONV with its use (OR 0.82; 95% CI 0.49–1.37; P=0.44).Conclusions
BSCPB offers analgesic efficacy in the early postoperative period for up to 24 h after thyroid surgery, with reduced length of hospital stay, but without any beneficial effect on PONV. 相似文献11.
Tamer M. Shaker Joseph T. Carroll Mathew H. Chung Tracy J. Koehler Brian R. Lane Andrea M. Wolf G. Paul Wright 《American journal of surgery》2018,215(3):498-501
Background
The purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks.Methods
A prospective, randomized trial was performed for patients undergoing abdominal oncologic surgeries.Results
There were 32 TAP and 35 TEA subjects. The TEA group demonstrated increased episodes of hypotension in the first 24 h (3 v 0.6, p = 0.02). There was no difference in 24–48 h fluid balance between the groups. Overall parenteral morphine equivalents of opioids administered for the TEA group were higher for each postoperative day (p < 0.05). The post-operative survey did not demonstrate any difference in subjective pain between the TAP and TEA groups (6 v 6 p = 0.35). There was no attributable morbidity associated with either technique.Conclusions
TAP block use was associated with lower parenteral morphine equivalent usage and decreased incidence of hypotension in the early post-operative period compared to TEA. 相似文献12.
L. Vorobeichik R. Brull R. Bowry J.G. Laffey F.W. Abdallah 《British journal of anaesthesia》2018,120(4):679-692
Background
Major shoulder surgery is associated with moderate-to-severe pain, but consensus on the optimal analgesic approach is lacking. Continuous catheter-based interscalene block (CISB) prolongs the analgesic benefits of its single-injection counterpart (SISB), but concerns over CISB complications and difficulties in interpreting comparative evidence examining major and minor shoulder procedures simultaneously, despite their differences in postoperative pain, have limited CISB popularity. This meta-analysis evaluates the CISB analgesic role and complications compared with SISB for major shoulder surgery.Methods
We retrieved randomised controlled trials (RCTs) comparing the effects of CISB to SISB on analgesic outcomes and side-effects after major shoulder surgery. Postoperative opioid consumption at 24 h was designated as the primary outcome. Secondary outcomes included 24–48 h opioid consumption, postoperative rest and dynamic pain scores up to 72 h, time-to-first analgesic, recovery room and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, respiratory function, and block-related complications.Results
Data from 15 RCTs were pooled using random-effects modelling. Compared with SISB, CISB reduced 24- and 48-h oral morphine consumption by a weighted mean difference [95% confidence interval] of 50.9 mg [–81.6, –20.2], (P=0.001) and 44.7 mg [–80.9, –8.7], (P<0.0001), respectively. Additionally, CISB provided superior rest and dynamic pain control beyond 48 h, prolonged time-to-first analgesic, enhanced satisfaction, and reduced postoperative nausea and vomiting without complications. CISB caused an 11.0–11.7% decrease in respiratory indices. Result heterogeneity was successfully explained.Conclusions
High-level evidence indicates that CISB provides superior analgesia up to 48 h after major shoulder surgery, without increasing side-effects, compared with SISB. The importance of CISB-related changes in respiratory indices is questionable. 相似文献13.
Adam M. Fahs Denise M. Koueiter Michael D. Kurdziel Kristine A. Huynh Clayton R. Perry James J. Verner 《The Journal of arthroplasty》2018,33(7):2192-2196
Background
The psoas compartment block (PCB) or periarticular soft-tissue local anesthetic injection are forms of regional anesthesia often used as one of the components in multimodal anesthesia applied during total hip arthroplasty (THA). The most efficacious form of regional anesthesia for THA has yet to be determined.Methods
In a single-surgeon, prospective, clinical trial, patients undergoing THA via direct anterior approach were randomized to receive an intraoperative periarticular local anesthetic infiltration (periarticular injection) or a PCB. Postoperative pain scores, narcotic consumption, and complications were recorded.Results
Forty-nine patients were randomized to the PCB and 50 were randomized to the periarticular injection. The resting pain score 3 hours postoperatively was statistically significantly lower in the periarticular injection group by 1.1 point (2.9 ± 2.2 vs 4.0 ± 2.2, P = .036). No difference was found in resting pain scores or ambulatory pain scores in the morning or evening of postoperative day 1, 2, or at the 3-week follow-up visit. There was no difference in in-hospital narcotic consumption between groups (P = 1.0). There were no major complications directly related to the block in either group. A total of 6 patients reported complaints of transient numbness, 5 in the PCB group (5/49, 10.2%), and one in the periarticular injection group (1/50, 2%, P = .087).Conclusion
These results demonstrate similarity between the 2 methods. We prefer periarticular anesthetic infiltration over PCB due to improved immediate postoperative pain scores and avoidance of potential symptoms associated with nerve blockade. 相似文献14.
Antònia Dalmau Noelia Fustran Imma Camprubi Resurrección Sanzol Susana Redondo Emilio Ramos Jaume Torras Antoni Sabaté 《American journal of surgery》2018,215(1):138-143
Background
Surgical wound is source of pain in hepatectomy with laparotomy. Continuous wound infusion of ropivacaine may provide effective analgesia.Methods
This prospective, randomized trial, patients scheduled for hepatectomy received a 48-h preperitoneal continuous wound infusion of either 0.23% ropivacaine or 0.9% saline at 5 ml/h. Primary endpoint was 48 h morphine consumption.Results
53 patients included in the ropivacaine group and 46 in the saline group. Morphine consumption was 24.63 mg in the ropivacaine group, and 26.78 mg (p = 0.669) in the saline group. Pain was comparable between groups and there were no differences in solid food intake, ambulation, or length of hospital stay. No local or systemic complications were recorded.Conclusions
Continuous wound infusion with ropivacaine is safe, but it neither reduced morphine consumption nor enhanced recovery in patients undergoing hepatectomy. Success of enhanced recovery in hepatectomy is not influenced by the analgesic regimen if pain is well controlled. 相似文献15.
Preet Mohinder Singh Anuradha Borle Anjan Trikha Lia Michos Ashish Sinha Basavana Goudra 《The Journal of arthroplasty》2017,32(2):675-688.e1
Background
Over last 2 years, many trials have evaluated newly approved liposomal bupivacaine for periarticular infiltration in total knee arthroplasty (TKA) with mixed results. Our meta-analysis attempts to consolidate the results and make evidence-based conclusions.Methods
Trails comparing periarticular infiltration of liposomal bupivacaine to conventional analgesic regimens for total knee arthroplasty published till June 2016 were searched in medical database. Comparisons were made for length of stay (LOS), postoperative pain scores, range of motion, and opioid consumption. Meta-regression was performed for LOS to evaluate various analgesic control subgroups.Results
Sixteen trials were included in the final analysis. Liposomal bupivacaine group showed a shorter LOS (reported in 13 subgroups) than control group by 0.17 ± 0.04 days (random effects, P < .001, I2 = 84.66%). Meta-regression for various types of control showed a predictability (R2) of 73%, τ2 = 0.013 (random effects, P < .001, I2 = 45.16). Only femoral block subgroup attained statistically significant shorter LOS on splitting the control group. Numeric pain scores were lower for pooled control group and local anesthetic infiltration subgroup in immediate postoperative phase. Second postoperative day analgesia was statistically superior to overall clubbed controls and femoral block subgroup. Superiority and/or inferiority of liposomal bupivacaine could not be proven for opioid consumption and range of motion because of a small pooled sample size. Publication bias is likely for LOS (Egger test, X intercept = 2.42, P < .001).Conclusion
Liposomal bupivacaine infiltration has questionable clinical advantage, as it marginally shortens patient's hospital stay especially in comparison with patients receiving analgesic femoral nerve block. Compared with conventional regimens, it can provide slightly superior yet sustained (till second postoperative day) perioperative analgesia. High heterogeneity suggests need for standardization of infiltration techniques for better predictability of results. 相似文献16.
Wirinaree Kampitak Aree Tanavalee Srihatach Ngarmukos Chavarin Amarase 《The Journal of arthroplasty》2019,34(2):295-302
Background
Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when combined with continuous adductor canal block and LIA.Methods
Ninety patients were recruited into the study and received spinal anesthesia, LIA, and continuous adductor canal block. They were further randomized to receive either an ONB (group 1), a TNB (group 2), or both (group 3). The primary outcome was total morphine consumption over the postoperative 24 hours. The secondary outcomes included visual analog scale scores, time to first and total dosage of rescue analgesia, Timed Up and Go test, range of motion, muscle strength test, hospital stay, and patient satisfaction.Results
Eighty-nine patients completed analysis. The median total morphine consumption during the first 24 postoperative hours was 2 mg (interquartile range [IQR] 0-4) in group 3, 4 mg (IQR 2-8) in group 2, and 6 mg (IQR 6-14) in group 1 (P < .001). Posterior knee pain during the first 24 hours postoperatively was significantly lower in group 3 than in group 1 (P = .006). The ability to ambulate and quadriceps strength were significantly better in group 3 than in the other groups.Conclusion
The combination of triple nerve block was superior to double nerve block in improving analgesia and functional outcomes in the immediate postoperative period after total knee arthroplasty, when combined with LIA. 相似文献17.
Erdan Kayupov Kamil Okroj Adam C. Young Mario Moric Timothy J. Luchetti Gilat Zisman Asokumar Buvanendran Tad L. Gerlinger Craig J. Della Valle 《The Journal of arthroplasty》2018,33(4):1040-1044.e1
Background
Adductor canal blocks (ACBs) are an alternative to femoral nerve blocks that minimize lower extremity weakness. However, it is unclear whether this block will provide analgesia that is equivalent to techniques, such as epidural analgesia. The purpose of this randomized controlled trial was to compare continuous ACBs with epidural analgesia for primary total knee arthroplasty.Methods
Following institutional review board approval, 145 patients were randomized to 1 of 3 groups: combined spinal-epidural (CSE), spinal + continuous ACB (CACB), or general + CACB. Epidural analgesia was used postoperatively in the CSE group, and an adductor canal catheter was used in the CACB groups. Power analysis determined that 84 patients per group were needed to demonstrate a 35% increase in ambulation with an alpha of 0.05 at a power of 90%.Results
At interim analysis, 13 patients were removed for protocol deviations, leaving 45 in CSE, 41 in spinal + CACB and 46 in general + CACB groups. Patient demographics were similar in all comparisons suggesting appropriate randomization. Patients in the CACB groups walked further on postoperative day 1, 2, and 3 (P = .02). Mean daily pain scores were lower in the CACB groups (4.1 CSE, 3.0 spinal + CACB, 3.4 general + CACB, P = .009). There was no significant difference in total opioid consumption between groups (158 morphine equivalents CSE, 149 spinal + CACB, and 172 general + CACB). More patients reported being “very satisfied” in CACB groups (68% general + CACB, 63% spinal + CACB, and 36% CSE; P = .001).Conclusion
Continuous adductor analgesia provides superior ambulation, lower pain scores, faster discharge, and greater patient satisfaction when compared to epidural analgesia for primary total knee arthroplasty. 相似文献18.
A randomised,controlled, double blind,non‐inferiority trial of ultrasound‐guided fascia iliaca block vs. spinal morphine for analgesia after primary hip arthroplasty 
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下载免费PDF全文 R. Kearns A. Macfarlane A. Grant K. Puxty P. Harrison M. Shaw K. Anderson J. Kinsella 《Anaesthesia》2016,71(12):1431-1440
We performed a single centre, double blind, randomised, controlled, non‐inferiority study comparing ultrasound‐guided fascia iliaca block with spinal morphine for the primary outcome of 24‐h postoperative morphine consumption in patients undergoing primary total hip arthroplasty under spinal anaesthesia with levobupivacaine. One hundred and eight patients were randomly allocated to receive either ultrasound‐guided fascia iliaca block with 2 mg.kg?1 levobupivacaine (fascia iliaca group) or spinal morphine 100 μg plus a sham ultrasound‐guided fascia iliaca block using saline (spinal morphine group). The pre‐defined non‐inferiority margin was a median difference between the groups of 10 mg in cumulative intravenous morphine use in the first 24 h postoperatively. Patients in the fascia iliaca group received 25 mg more intravenous morphine than patients in the spinal morphine group (95% CI 9.0–30.5 mg, p < 0.001). Ultrasound‐guided fascia iliaca block was significantly worse than spinal morphine in the provision of analgesia in the first 24 h after total hip arthroplasty. No increase in side‐effects was noted in the spinal morphine group but the study was not powered to investigate all secondary outcomes. 相似文献
19.
P. O&#x;Scanaill S. Keane V. Wall G. Flood D.J. Buggy 《British journal of anaesthesia》2018,120(4):846-853
Background
Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery.Methods
This single-centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h?1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h.Results
AUC moving was mean (SD) 71 (34) mm h?1vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25–75%)] was 14 mg (9–26) vs 11 (8–24) vs 9 (5–11); P=0.4. No adverse events were observed.Conclusions
The combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery.20.
Doaa Rashwan 《Egyptian Journal of Anaesthesia》2013,29(2):155-159
This study was designed to compare the analgesic efficacy of levobupivacaine patient controlled analgesia epidural versus patient controlled analgesia with fascia lliaca compartment block. In patients undergoing fixation of fracture neck femur.MethodsSixty patients ASA II&III undergoing fixation of fracture neck femur were randomly allocated into two groups (n = 30).Group EEpidural group given levobupivacaine 0.25% 15 ml before induction of general anesthesia, followed by postoperative PCEA with levobupivacaine (0.125%).Group FFascia iliaca block group given levobupivacaine 0.25% 30 ml through the catheter before induction of general anesthesia, followed by postoperative patient controlled fascia illiaca analgesia with levobupivacaine (0.125%).Severity of postoperative pain at rest in 24 h using VAS, number of patients required additional analgesia (tramadol) in 24 h, doses of postoperative 24 h tramadol consumed, postoperative mean arterial blood pressure and heart rate were recorded.ResultsThe severity of postoperative pain was statistically significantly less in E group, number of patients required tramadol in 24 h were statistically significantly less in E group than F group, postoperative tramadol consumed was statistically significantly less in E group than F group.ConclusionPCEA with levobupivacaine (0.125%) was associated with satisfactory analgesia than patient controlled analgesia with fascia iliaca block in patients undergoing fixation of fracture neck femur. 相似文献