Efficacy of Surgical-Site, Multimodal Drug Injection Following Operative Management of Femoral Fractures

Koehler, Daniel M.; Marsh, J. Lawrence; Karam, Matthew D.; Fruehling, Catherine; Willey, Michael

doi:10.2106/jbjs.16.00733

Cited by 33 publications

(28 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the results from this study and the previous studies on PMDI in hip fracture. Our findings on the additional benefits of PMDI are comparable to the results of previous studies by Kang et al [23] and Koehler et al [24]. In 2013, Kang et al presented a singleblinded randomized controlled trial (RCT) that studied the effect of multimodal pain management in 82 elderly hip fracture patients undergoing bipolar hemiarthroplasty by comparing between those who received combined preemptive medication (10 mg oxycodone SR and 200-mg celecoxib) with intraoperative periarticular injection (100 mL cocktail solution of 300 mg ropivacaine, 10 mg morphine sulfate, 30 mg ketorolac, 300 -mcg epinephrine, 1000 mg cefmetazole, and physiologic saline) (n = 43) and those who did not receive (n = 39).…”

Section: Cas Pmdi Group (N = 12)supporting

confidence: 92%

Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT

Orapin¹,

Sutantavibul²,

Chulsomlee³

et al. 2020

Cureus

View full text Add to dashboard Cite

Introduction Recently, periarticular multimodal drug injection (PMDI) has demonstrated the ability to significantly reduce early postoperative pain with hip fractures in the elderly. Nonetheless, data on PMDI without non-steroidal anti-inflammatory drugs (NSAIDs) in these patients are still doubtful. The current study has evaluated the effect of PMDI with NSAIDs in elderly femoral neck fractures (FNFs) underlying bipolar hip arthroplasty (BHA). Materials and methods A prospective triple-blinded randomized controlled trial (RCT) was conducted in 28 elderly FNFs undergoing BHA. They were randomized into two groups: PMDI group (n=14), which received intraoperative PMDI (50-mL solution of 100-mg bupivacaine, 10-mg morphine, 300mcg epinephrine, and 750-mg cefuroxime), and a placebo group (n=14), which received only saline solution. The primary outcome was a 10-point visual analog scale (VAS). Secondary outcomes were morphine consumption and cumulative ambulatory score (CAS), postoperative complications, and functional outcomes as a timed up-and-go (TUG) test and Harris hip score (HHS) at two, six, and 12 weeks postoperatively.

show abstract

Section: Cas Pmdi Group (N = 12)supporting

confidence: 92%

Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT

Orapin¹,

Sutantavibul²,

Chulsomlee³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…O'Neill 15 reported that continuous ropivacaine infiltration in the first 48 hours achieved better analgesia, with fewer side effects and a shorter hospitalization duration after cesarean delivery. Koehler 16 conducted a randomized controlled trial and concluded that surgical-site injection alleviated postoperative pain and reduced opioid utilization on the first day postoperatively without major adverse events in femoral fracture patients undergoing surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Luo

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Poor postoperative pain control impairs patient recovery and lengthens the duration of hospitalization after various surgeries. Local infiltration analgesia(LIA) has become an effective method for managing postoperative pain. This study aimed to investigate the efficacy of LIA with ropivacaine for postoperative pain control after cervical laminoplasty. In total, 68 patients undergoing cervical laminoplasty were included for retrospective review and divided into ropivacaine and control groups. The visual analogue scale (VAS) score, postoperative analgesic consumption, operative duration, intraoperative blood loss volume, incision length, hospitalization duration and incidence of complications were analyzed. In the ropivacaine group, the VAS score was 3.2 ± 1.4 at 4 hours postoperatively, which was lower than that of the control group(4.0 ± 1.4, P = 0.024). At 8, 12 and 24 hours after surgery, a significant difference was detected in the VAS score between the two groups(P ≤ 0.015). Sufentanil consumption was less in the ropivacaine group than in the control group in the first 4 hours postoperatively (25.6 ± 6.3 µg vs 32.2 ± 6.8 µg, P < 0.001), and similar results were observed in the first 8, 12, 24, 48 and 72 hours postoperatively(P < 0.001). Fewer patients required rescue analgesia in the ropivacaine group(8/33 vs 18/35 at 4-8 hours, P = 0.021; 9/33 vs 21/35 at 8-12 hours, P = 0.007). The hospitalization duration and time to ambulation were shorter in the ropivacaine group(8.5 ± 1.4 vs 9.6 ± 1.6 for postoperative duration, P = 0.002; 2.9 ± 0.7 vs 3.5 ± 0.8 for time to ambulation, P = 0.001). The incidence of nausea and vomiting was lower in the ropivacaine group than in the control group(30.3% vs 54.3%, P = 0.046). In conclusion, LIA with ropivacaine could effectively reduce postoperative pain, and postoperative analgesic consumption, and promote recovery after cervical laminoplasty. Cervical laminoplasty has been used widely and achieved satisfactory outcomes in treating multilevel cervical lesions, including cervical spondylotic myelopathy(CSM), congenital cervical stenosis(CCS), and ossification of the posterior longitudinal ligament(OPLL) 1-3. However, surgical treatment often results in serious pain, which can impair patient recovery and lengthen the hospitalization duration. Recently, local infiltration analgesia (LIA) has emerged as a good choice for postoperative analgesia due to its simplicity and low-cost 4,5. LIA has been used in various surgeries with favorable outcomes and without major side effects 6. The benefits of LIA in spinal surgery are also well known; however, its use has been limited to lumbar decompression and discectomy, and spinal fusion surgery 7,8. Few studies have focused on the effect of LIA on postoperative pain control in cervical laminoplasty. Therefore, we conducted this clinical study to retrospectively evaluate the efficacy of LIA with ropivacaine for managing postoperative pain after cervical laminoplasty.

show abstract

“… 23 24) Although various pain control protocols have evolved over recent years for patients with musculoskeletal trauma, surgical-site, multimodal drug injection has been reported to be progressing recently as a new analgesic method after the surgical treatment for musculoskeletal trauma. 22 25 26 27) To the best of our knowledge, this investigation is the first study to assess the effect and safety of the surgical-site multimodal drug injection on the mid-shaft clavicular fractures, along with the evaluation of stress biomarkers.…”

Section: Discussionmentioning

confidence: 99%

“… 22) The SI can preserve motor functions, which may enable early mobilization and limit the side effects associated with systemic narcotics. 27) The preservation of the motor functions with the SI technique may lead to a decreased prevalence of in-hospital falls as compared to that occurring from peripheral nerve blocks. 27) …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

et al. 2018

View full text Add to dashboard Cite

BackgroundSurgical-site, multimodal drug injection has recently evolved to be a safe and useful method for multimodal pain management even in patients with musculoskeletal trauma.MethodsFifty consecutive patients who underwent plating for mid-shaft and distal clavicular fractures were included in the study. To evaluate whether surgical-site injections (SIs) have pain management benefits, the patients were divided into two groups (SI and no-SI groups). The injection was administered between the deep and superficial tissues prior to wound closure. The mixture of anesthetics consisted of epinephrine hydrochloride (HCL), morphine sulfate, ropivacaine HCL, and normal saline. The visual analogue scale (VAS) pain scores were measured at 6-hour intervals until postoperative hour (POH) 72; stress biomarkers (dehydroepiandrosterone sulfate [DHEA-S], insulin, and fibrinogen) were measured preoperatively and at POH 24, 48, and 72. In patients who wanted further pain control or had a VAS pain score of 7 points until POH 72, 75 mg of intravenous tramadol was administered, and the intravenous tramadol requirements were also recorded. Other medications were not used for pain management.ResultsThe SI group showed significantly lower VAS pain scores until POH 24, except for POH 18. Tramadol requirement was significantly lower in the SI group until POH 24, except for POH 12 and 18. The mean DHEA-S level significantly decreased in the no-SI group (74.2 ± 47.0 µg/dL) at POH 72 compared to that in the SI group (110.1 ± 87.1 µg/dL; p = 0.046). There was no significant difference in the insulin and fibrinogen levels between the groups. The correlation values between all the biomarkers and VAS pain scores were not significantly different between the two groups (p > 0.05).ConclusionsAfter internal fixation of the clavicular fracture, the surgical-site, multimodal drug injection effectively relieved pain on the day of the surgery without any complications. Therefore, we believe that SI is a safe and effective method for pain management after internal fixation of a clavicular fracture.

show abstract

Efficacy of Surgical-Site, Multimodal Drug Injection Following Operative Management of Femoral Fractures

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 33 publications

References 48 publications

Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT

Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT

Efficacy of local infiltration analgesia with ropivacaine for postoperative pain management in cervical laminoplasty: a retrospective study

Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

Contact Info

Product

Resources

About