Are Continuous Femoral Nerve Catheters Beneficial for Pain Management After Operative Fixation of Tibial Plateau Fractures? A Randomized Controlled Trial

Cooke, Margaret E.; Welch, Tyler; Gusakov, Oleg; Tornetta, Paul

doi:10.1097/bot.0000000000001594

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…FIB and femoral nerve block provided similar analgesia after femoral fracture surgery [ 23 ]. Femoral nerve blocks for tibial plateau fractures operations demonstrated a similar pain relief compared with patients controlled analgesia (PCA), as reported by Cooke et al [ 24 ]. In our study, the FIB group presented immediate analgesia effects after retrograde nailing and got the same level of pain relief at postoperative 3 months.…”

Section: Discussionsupporting

confidence: 57%

Retrospective Comparison of Postoperative Fascia Iliaca Block and Multimodal Drug Injection on Early Function of the Knee in Femoral Fractures Using Retrograde Intramedullary Nailing

Luo

Yu-hu

et al. 2022

Pain Research and Management

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Introduction. There is a common concern about the pain and rehabilitation of the knee after femoral retrograde intramedullary nailing. It is essential for early postoperative knee function required for physical self-maintenance in daily life. And a favorable rehabilitation of the knee usually promotes the quality of life. However, early rehabilitation is absent or insufficient for many patients in postoperative management. This retrospective study aims to evaluate the effect of early knee function improvement in comparison to postoperative fascia iliaca blocking (FIB) and multimodal drug injection (MDI). Patients and Methods. A retrospective analysis of 41 patients receiving femoral fracture treatment with retrograde intramedullary nailing, was performed during 2018–2020. 19 patients were treated with MDI as postoperative analgesia, and 22 patients were treated with FIB. Rehabilitation started on the first postoperative day and lasted for 3 months. Visual analog scale (VAS), the range of motion (ROM) of the knee, and single assessment numeric evaluation (SANE) were assessed. Results. There was no significant difference shown in any of the demographic, fracture types, and operative time. All patients performed regular and voluntary knee rehabilitation and weight-bearing at home following the instruction from the orthopedic staff. Pain in the FIB group at postoperative 1-day was milder (1.7 ± 1.1), compared with that in the MDI group (2.8 ± 1.3, p = 0.038 ). There was a significant difference in VAS between two groups at postoperative 1-month ( p = 0.031 ), with a peak score in the FIB group (3.3 ± 0.9). At postoperative 3-month, both groups had pain relief with similar VAS ( p = 0.465 ). The ROM of the knee in both groups was continuously improved during the first three months. The SANE in the MDI group was significantly different compared with FIB at 1-month ( p = 0.026 ). However, scores of SANE were similar in both groups at 3 months ( p = 0.541 ). All patients were identified as fractures union at 9-month or 12-month follow-up. Conclusion. The knee pain was commonly experienced in this series of retrograde femoral nailings. Both MDI and FIB provided immediate and effective pain control after femoral fracture surgery. MDI was more beneficial to continuous pain control and knee rehabilitation in the early follow-up. The extent of pain relief and knee function improvement reached the same level at postoperative 3-month.

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Section: Discussionsupporting

confidence: 57%

Retrospective Comparison of Postoperative Fascia Iliaca Block and Multimodal Drug Injection on Early Function of the Knee in Femoral Fractures Using Retrograde Intramedullary Nailing

Luo

Yu-hu

et al. 2022

Pain Research and Management

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“…Given that our institution administers opioids as needed according to patient comfort, this reduction in opioid consumption during the early postoperative period likely reflects superior pain relief with RA. Cooke et al 23 previously conducted an RCT examining the efficacy of continuous femoral nerve blockade in reducing pain and narcotic intake after surgical management of tibial plateau fractures and found no difference in pain relief or narcotic use in patients with and without RA. The authors speculated that the femoral nerve blockade alone might not sufficiently relieve pain as the articular branch of the sciatic nerve also supplies the knee.…”

Section: Discussionmentioning

confidence: 99%

Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery

Cunningham

LaRose

Zhang

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Regional anesthesia (RA) has been used to reduce pain and opioid usage in elective orthopedic surgery. The hypothesis of this study was that RA would be associated with decreased opioid demand in tibial plateau fracture surgery. METHODS: Inpatient opioid consumption and 90-day outpatient opioid prescribing in all patients ≥18 years of age undergoing tibial plateau fracture surgery from July 2013 to July 2018 (n = 264) at a single, level I trauma center were recorded. The presence or absence of perioperative RA was noted. Of 60 patients receiving RA, 52 underwent peripheral nerve blockade (PNB) with single-shot sciatic-popliteal (40.0%; n = 24), femoral (26.7%; n = 16), adductor canal (18.3%; n = 11), or fascia iliaca (1.7%; n = 1) block with ropivacaine. Ten patients received epidural analgesia (EA) with either single-shot spinal (11.7%; n = 7) blocks or continuous epidural (5.0%; n = 3). Additional baseline and treatment characteristics were recorded, including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery. Statistical models, including multivariable generalized linear models with propensity score weighting to adjust for baseline patient and treatment characteristics, were used to assess perioperative opioid demand with and without RA. RESULTS: RA was associated with reduced inpatient opioid usage from 0 to 24 hours postoperatively of approximately 5.2 oxycodone 5-mg equivalents (0.74 incident rate ratio [IRR]; 0.63–0.86 CI; P < .001) and from 24 to 48 hours postoperatively of approximately 2.9 oxycodone 5-mg equivalents (0.78 IRR; 0.64–0.95 CI; P = .014) but not at 48 to 72 hours postoperatively. From 1 month preoperatively to 2 weeks postoperatively, RA was associated with reduced outpatient opioid prescribing of approximately 24.0 oxycodone 5-mg equivalents (0.87; 0.75–0.99; P = .044) and from 1 month preoperatively to 90 days postoperatively of approximately 44.0 oxycodone 5-mg equivalents (0.83; 0.71–0.96; P = .011), although there was no significant difference from 1 month preoperatively to 6 weeks postoperatively. There were no cases of acute compartment syndrome in this cohort. CONCLUSIONS: In tibial plateau fracture surgery, RA was associated with reduced inpatient opioid consumption up to 48 hours postoperatively and reduced outpatient opioid demand up to 90 days postoperatively without an associated risk of acute compartment syndrome. RA should be considered for patients undergoing tibial plateau fracture fixation.

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“…i) The time of operation and intraoperative blood loss of patients in the two groups were recorded and compared. ii) Visual analogue pain score (VAS) (10) was evaluated before and 6 months after surgery of patients in both groups. iii) The Karnofsky (KPS) (11) scores before and 6 months after surgery of patients in the two groups were compared.…”

Section: Methodsmentioning

confidence: 99%

Effects of surgery and radiofrequency ablation in the treatment of spinal metastases and analysis of the influencing factors of prognosis

Zhang

2019

Exp Ther Med

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Effects of surgery and radiofrequency ablation in the treatment of spinal metastases were explored to analyze the influencing factors of prognosis. A total of 132 patients with spinal metastases admitted to Weifang People's Hospital were selected, 67 patients who underwent simple surgery were selected as the control group, and 65 patients who underwent radiofrequency ablation assisted surgery were the research group. The time of operation and intraoperative blood loss of patients in the two groups were recorded and compared. The visual analogue pain score (VAS), Karnofsky (KPS) score, Frankel spinal cord injury grading, and complications within 6 months after surgery were compared. The patients were followed up for 36 months and the survival rates were analyzed. Cox regression model was used to analyze the factors affecting the prognosis of patients. The time of operation and blood loss in the research group was significantly lower than that in the control group (P<0.05). The VAS, KPS scores, and Frankel grading of patients in the two groups after treatment were significantly improved compared with those before treatment, but the VAS and KPS scores of patients in the research group were significantly improved compared with those in the control group (P<0.05). The incidence rate of complications and 3-year recurrence rate in the research group were lower than those in the control group, and the 3-year survival rate was significantly higher than that in the control group (P<0.05). The number of pathological cones, visceral metastasis, malignant degree, and radiofrequency ablation therapy are independent risk factors for poor prognosis of patients. Radiofrequency ablation assisted surgery can effectively improve the clinical efficacy of patients with spinal metastases, reduce postoperative complications and recurrence rate of patients, and prolong the survival time of patients compared with simple surgical treatment. It is worthy of clinical application.

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Are Continuous Femoral Nerve Catheters Beneficial for Pain Management After Operative Fixation of Tibial Plateau Fractures? A Randomized Controlled Trial

Cited by 7 publications

References 14 publications

Retrospective Comparison of Postoperative Fascia Iliaca Block and Multimodal Drug Injection on Early Function of the Knee in Femoral Fractures Using Retrograde Intramedullary Nailing

Retrospective Comparison of Postoperative Fascia Iliaca Block and Multimodal Drug Injection on Early Function of the Knee in Femoral Fractures Using Retrograde Intramedullary Nailing

Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery

Effects of surgery and radiofrequency ablation in the treatment of spinal metastases and analysis of the influencing factors of prognosis

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