WITHDRAWN: Peripheral nerve blocks for postoperative pain after major knee surgery.
Ontology highlight
ABSTRACT:
SUBMITTER: Xu J
PROVIDER: S-EPMC6699645 | biostudies-literature | 2019 Aug
REPOSITORIES: biostudies-literature
Publications
WITHDRAWN: Peripheral nerve blocks for postoperative pain after major knee surgery.
Xu Jin J Chen Xue-Mei XM Ma Chenkai C Wang Xiang-Rui XR
The Cochrane database of systematic reviews 20190806
<h4>Background</h4>Major knee surgery is a common operative procedure to help people with end-stage knee disease or trauma to regain mobility and have improved quality of life. Poorly controlled pain immediately after surgery is still a key issue for this procedure. Peripheral nerve blocks are localized and site-specific analgesic options for major knee surgery. The increasing use of peripheral nerve blocks following major knee surgery requires the synthesis of evidence to evaluate its effective ...[more]
Similar Datasets
Project description:Background Patients undergoing revision total knee arthroplasty (rTKA) have historically received high doses of opioids during the perioperative period. As awareness of opioid use has heightened, opioid administration has continuously decreased. This study aimed to evaluate if peripheral nerve catheter (PNC) use in rTKA reduces opiate consumption while maintaining similar pain control and postoperative function levels. Methods A retrospective review of 354 patients who underwent rTKA between July 2019 and January 2022 was conducted. Fifty total patients who received an adductor canal PNC were propensity-matched 1:1 to a control group of 50 patients that did not receive a PNC. To assess the primary outcome of opiate consumption, nursing documented opiate administration events were converted into morphine milligram equivalents per 24-hour interval. Postoperative pain and functional status were assessed using the verbal rating scale for pain and the Activity Measure for Post-Acute Care scores, respectively. Results Compared to the control group, the PNC group demonstrated significantly lower overall inpatient opiate consumption (98.68 ± 117.03 vs 176.69 ± 203.47 morphine milligram equivalents; 44.15% decrease, P = .021) and lower verbal rating scale pain scores at 60 to 72 hours postoperatively (4.85 ± 1.24 vs 5.83 ± 1.35; 16.81% decrease, P = .038). There was no significant difference in Activity Measure for Post-Acute Care scores postoperatively (raw score: 19.41 ± 3.61 vs 19.46 ± 3.18; 0.26% decrease, P = .952). Finally, the PNC cohort was significantly less likely to be readmitted within 90 days after surgery (0.0% vs 12.0%; P = .012). Conclusions In rTKA patients, PNC can significantly reduce inpatient opioid consumption while maintaining a comparable functional recovery and superior pain control. Level III Evidence Retrospective Cohort Study.
| S-EPMC10472143 | biostudies-literature
Project description:BackgroundThe incidence of neurologic complications from foot and ankle surgery utilizing regional anesthesia is not well established.Questions/purposesThe purpose of this study was to prospectively determine the incidence of neurologic and peripheral nerve block (PNB) site complications on a busy foot and ankle service that utilizes ankle blocks (ABs) and popliteal blocks (POPs).Patients and methodsThis prospective observational study included patients undergoing foot and ankle surgery with ABs or POPs. Block choice was determined by surgeon's preference. Patients were assessed for complications during postoperative visits at 2, 6, and 12 weeks. The relation of each complication to the block was scored by a surgeon and anesthesiologist.ResultsFrom October 2012 to October 2014, 2516 patients underwent 2704 surgeries. There were 195 complications (7.2%) considered neurologic or at the PNB site. The incidence of serious complications was 0.7%. A higher complication rate was reported for POPs (8.8%) than for ABs (2.5%). However, when analysis was limited to forefoot surgery, this difference was not significant. Dexamethasone use was associated with increased complications for POPs. Only 5 of the 195 total complications, and 2 of 20 serious complications, were deemed to have been likely caused by the block by both the surgeon and anesthesiologist reviewer.ConclusionsThe incidences of neurologic or block-related complications and serious complications were 7.2 and 0.7%, respectively, most without a clear surgical vs. nerve block etiology. The higher complication rate for POPs using perineural dexamethasone should be interpreted cautiously in light of the lack of randomization and likely confounders.
| S-EPMC6031533 | biostudies-literature
Project description:Early post-operative mobilization is important both to reduce immobility-related complications and to get the best functional result following surgery on knee. We hypothesized that saphenous nerve block would reduce pain in this patient category compared with placebo injection. In this study, two reviewers independently searched the databases of PubMed, EMBASE, and Cochrane Library (last performed on 12 October, 2014) to retrieve eligible randomized controlled clinical trials. The primary outcomes were visual analog scale (VAS) pain scores within 24 hours after operation when at rest and at an active flexion of knee. Mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) was calculated for each end point. Subgroup analysis was calculated to evaluate potential sources of heterogeneity. Nine randomized controlled trials were retrieved and analyzed. We found that VAS pain scores at rest within postoperative 24 hours were significantly decreased in saphenous nerve block group than that in placebo group (MD = -0.79; 95% CI -1.35 to -0.22; P = 0.007), as well as VAS pain scores at an active flexion of knee within postoperative 24 hours (MD = -0.92; 95% CI -1.61 to -0.22; P = 0.010). In addition, compared to placebo injection group, saphenous nerve block resulted in significantly less morphine consumption during the first postoperative 24 hours (MD = -6.56; 95% CI -11.26 to -1.86; P = 0.006). To conclude, this meta-analysis suggests that saphenous nerve block has an advantage in pain relief both at an active flexion of knee and at rest after knee surgery. Further studies are still wanted to validate these conclusions.
| S-EPMC4358462 | biostudies-literature
Project description:BACKGROUND Methods of pain management that have less effect on motor function after total knee arthroplasty (TKA) are needed to ensure early mobilization. We investigated whether the distal femoral triangle and distal adductor canal blocks are superior to the femoral nerve block regarding motor blockade at early postoperative hours. MATERIAL AND METHODS Patients scheduled for TKA under spinal anesthesia were blindly assigned into 2 groups. One group received the distal femoral triangle and distal adductor canal blocks and the other group received the femoral nerve block. In both groups, at 3, 6, 24, and 48 h after surgery motor blockade was evaluated with the Bromage scale. Secondary outcomes such as pain control efficacy and patient satisfaction were evaluated at 6, 24, and 48 h postoperatively using either the VAS scale or a 10-point scale. RESULTS We analyzed the outcomes of 77 patients. Better motor function at 3 and 6 h after TKA was observed in the distal femoral triangle and the distal adductor canal blocks group (37.7% vs 23.4%, p=0.032 and 49.4% vs 32.5%, p=0.002, respectively). At 24 h after the surgery, patients from the femoral nerve block group consumed significantly more rescue opioid analgesics (p=0.016). We found no significant differences in pain intensity and patient satisfaction at any timepoints after the surgery. CONCLUSIONS The distal femoral triangle and distal adductor canal blocks resulted in significantly better motor function at the first 3 and 6 h after total knee arthroplasty. At 24 h after surgery, rescue opioid doses in the femoral nerve block group were significantly higher.
| S-EPMC8518512 | biostudies-literature
Project description:BackgroundPeripheral nerve blocks (PNBs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. Peripheral nerve blocks aim to decrease overall perioperative pain and lower systemic analgesic requirements. Short-acting anesthetic agents are commonly given as single-injection PNBs for pain relief, typically lasting less than 24 hours. Liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection PNB and may allow patients to recover postoperatively with a lower need for opioid analgesics.ObjectivesThis study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus PNB for hand surgery.MethodsA retrospective review of patients who underwent a long-acting PNB using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between July 2020 and May 2023 in Florida, USA. Patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics.ResultsOne hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). Patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the PNB to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. Nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used NSAIDs postoperatively.ConclusionsLiposomal bupivacaine PNBs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. Patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. Given these results, long-acting PNBs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.
| S-EPMC10998466 | biostudies-literature
Project description: Not available
| S-EPMC6485776 | biostudies-literature
Project description:IntroductionThe objective of the present feasibility study was to investigate the use of a new treatment modality-percutaneous peripheral nerve stimulation (PNS)-in controlling the often severe and long-lasting pain following total knee arthroplasty (TKA).MethodsFor patients undergoing a primary, unilateral TKA, both femoral and sciatic open-coil percutaneous leads (SPR Therapeutics, Cleveland, OH) were placed up to seven days prior to surgery using ultrasound guidance. The leads were connected to external stimulators and used both at home and in the hospital for up to six weeks total.ResultsIn six of seven subjects (86%), the average of daily pain scores across the first two weeks was <4 on the 0-10 Numeric Rating Scale for pain. A majority of subjects (four out of seven; 57%) had ceased opioid use within the first week (median time to opioid cessation for all subjects was six days). Gross sensory/motor function was maintained during stimulation, enabling stimulation during physical therapy and activities of daily living. At 12 weeks following surgery, six of seven subjects had improved by >10% on the Six-Minute Walk Test compared to preoperative levels, and WOMAC scores improved by an average of 85% compared to before surgery. No falls, motor block, or lead infections were reported.ConclusionsThis feasibility study suggests that for TKA, ultrasound-guided percutaneous PNS is feasible in the immediate perioperative period and may provide analgesia without the undesirable systemic effects of opioids or quadriceps weakness induced by local anesthetics-based peripheral nerve blocks.
| S-EPMC6339601 | biostudies-literature
Project description:BackgroundContinuous peripheral nerve blocks (CPNB) provide an opioid-free alternative for pain control after orthopaedic surgery. However, postdischarge ambulatory patient care and follow-up concerns have prevented CPNB use at home.ObjectiveTo address physicians' concerns about the outpatient use of CPNB.DesignProspective, cohort, observational study.SettingSingle centre, teaching private hospital in Santiago, Chile, between July 2016 and March 2020.PatientsWe included patients aged at least 18 who underwent orthopaedic surgery using CPNB for postoperative pain management. Patients scheduled simultaneously for non-orthopedic surgery on the same event were excluded.Main outcome measuresPain scores, opioid use, and complication rates at both in-hospital and at-home sites.ResultsCPNB were provided as an analgesia plan in 497 patients who met inclusion criteria, and 387 (77.87%) were discharged home with this continuous analgesia. At 48 h, 70% of the patients reported no-worse-than-mild pain. Less than 3.1% of patients reported an episode of severe pain, and less than 13% of the patients required opioid rescue medication. Transient neurological symptoms were observed in 13% (95% confidence interval (CI), 10.4 to 16.1) of the patients. No long-term or severe complications were observed. High rates of satisfaction were reached among patients.ConclusionIn-hospital and at-home use of CPNB supervised by a pain service team provides a feasible and safe alternative after orthopaedic surgery, pain control with a low requirement of opioids.
| S-EPMC11798377 | biostudies-literature
Project description: Not available
| S-EPMC6457974 | biostudies-literature
Project description:BackgroundVarious nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017.ObjectivesThis review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards.Search methodsFor the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles.Selection criteriaWe included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture.Data collection and analysisTwo review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach.Main resultsWe included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I2 = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P < 0.00001). Based on seven trials with 676 participants, we did not find a difference in the risk of acute confusional state (risk ratio (RR) 0.69, 95% CI 0.38 to 1.27; I2 = 48%; very low quality of evidence). Three trials with 131 participants reported decreased risk for pneumonia (RR 0.41, 95% CI 0.19 to 0.89; I2 = 3%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 72; moderate quality of evidence). We did not find a difference in risk of myocardial ischaemia or death within six months, but the number of participants included was well below the optimal information size for these two outcomes. Two trials with 155 participants reported that peripheral nerve blocks also reduced time to first mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I2 = 52%; moderate quality of evidence). One trial with 75 participants indicated that the cost of analgesic drugs was lower when they were given as a single shot block (SMD -3.48, 95% CI -4.23 to -2.74; moderate quality of evidence).Authors' conclusionsHigh-quality evidence shows that regional blockade reduces pain on movement within 30 minutes after block placement. Moderate-quality evidence shows reduced risk for pneumonia, decreased time to first mobilization and cost reduction of the analgesic regimen (single shot blocks).
| S-EPMC6481480 | biostudies-literature