Enhanced recovery pathways in orthopedic surgery

Kaye, Alan D.; Urman, Richard D.; Cornett, Elyse M.; Hart, Brendon M.; Chami, Azem A.; Gayle, Julie; Fox, Charles J.

doi:10.4103/joacp.joacp_35_18

Cited by 83 publications

(28 citation statements)

References 24 publications

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“…Perioperative regional analgesia with ultrasound-guided peripheral nerve blocks has been reported to improve patients' satisfaction with post-operative pain management and facilitate early rehabilitation [32,33]. Therefore, perineural analgesia is currently favoured for UEFS and post-operative pain management as part of the MMA regimen [18,20,21]. Multiple randomised controlled trials have consistently demonstrated that peripheral nerve block provides superior analgesia compared with general anaesthesia in the setting of upper extremity surgery [34].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, multimodal analgesia (MMA), which aims to reduce opioid use, has been shown to provide satisfactory perioperative pain relief with an opioid-sparing effect [16][17][18][19]. Epidural analgesia, either continuous or patient controlled; peripheral nerve blocks, either single injection or continuous; acetaminophen; nonsteroidal anti-inflammatory drugs (NSAIDs); gabapentin and ketamine have all been used for this purpose [20]. Many studies have applied MMA in upper extremity trauma surgery and reported good outcomes [21,22], but few have included DS.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

Zheng

Yeh

et al. 2022

Pain Ther

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Introduction:Patients undergoing upper extremity fracture surgery (UEFS) commonly suffer from unbearable acute pain. Opioids remain the mainstay of moderate to severe pain alleviation, although there is a growing concern regarding the increasing trend in misuse and abuse. This study aimed to observe the safety and efficacy of dinalbuphine sebacate (DS), a novel extended-release analgesic, along with multimodal analgesia (MMA) for post-UEFS pain control.Methods: We retrospectively reviewed the records of patients undergoing UEFS between August 2020 and January 2021. Eligible patients were included and divided into two groups, depending on the analgesic regimen. In the DS group, 150 mg DS was administered intramuscularly at least 12 h pre-operatively, while in the conventional analgesia (CA) group, 40 mg parecoxib was given within 3 h before surgery. Intraoperative fentanyl administration was guided by the Analgesia Nociception Index System in both groups. For breakthrough pain, fentanyl was used as rescue medicine in the

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

Zheng

Yeh

et al. 2022

Pain Ther

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“…In 1997, Kehlet rst introduced the concept of enhanced recovery after surgery (ERAS) to promote quick patient recovery, restore normal activity levels, and reduce the length of hospital stay after surgery, leading to a decrease in complication rates and hospitalization costs [15]. Subsequently, many specialties have adopted ERAS programs, which have become the standard of care for several surgical procedures [16][17][18][19][20][21][22][23][24], as con rmed by various systematic reviews and meta-analyses [25][26][27][28][29][30][31][32][33]. However, to the best of our knowledge, no studies have evaluated the impact of ERAS focusing solely on patients undergoing bula ap surgery [34].…”

Section: Introductionmentioning

confidence: 99%

ERAS for Free Fibula Flap Surgery: Effects on Postoperative Recovery and Complications

Hsiao

Tai

2023

Preprint

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This study aimed to evaluate the effects of the enhanced recovery after surgery (ERAS) program on postoperative recovery of patients who underwent free fibula flap surgery.This retrospective study enrolled 188 patients who underwent free fibula flap surgery between January 2018 and December 2022; after propensity score matching, the ERAS and non-ERAS groups included 36 patients each. The primary outcome was the length of intensive care unit stay; the secondary outcomes were flap complications, unplanned reoperation, 30-day readmission, postoperative ventilator use length, surgical site infections, lower-limb comorbidities, and morbidity parameters.There were no significant differences in the demographic characteristics of the patients. However, the ERAS group showed lower length of intensive care unit stay (ERAS vs non-ERAS: 8.66 ± 3.90 days vs. 11.64 ± 5.42 days, P = 0.027) and post-operative ventilator use days (ERAS vs non-ERAS: 1.08 ± 0.28 days vs. 2.03 ± 1.05 days, P < 0.001). Other secondary outcomes were not significantly different between the two groups. Additionally, patients in the ERAS group had lower postoperative morbidity parameters, such as postoperative nausea, vomiting, urinary tract infections, and pulmonary complications (P = 0.044).The ERAS program could be beneficial and safe for patients undergoing free fibula flap surgery, thereby improving their recovery and not increasing flap complications and 30-day readmission.

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“…Multimodal analgesia combines analgesics from ≥2 drug classes that employ different mechanisms of action, targeting different (i.e., peripheral or central) pain pathways, thus achieving a synergistic effect at lower analgesic doses 5,9 . Nowadays, non-opioid medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly given as multimodal analgesic regimens to enhance pain control and minimize the need for opioids 6,10 .…”

mentioning

confidence: 99%

“…Traditionally, opioids have been the pillar of postoperative TKA pain control management 1,5 . Although they provide potent analgesia, opioids can lead to serious side effects such as respiratory depression, confusion, constipation, nausea, vomiting, pruritus, and urinary retention that may increase hospital length of stay, cost of care, and drug addiction 4,6 .…”

mentioning

confidence: 99%

Opioid-Sparing Multimodal Analgesia Efficacy in Hispanic Patients Undergoing Total Knee Arthroplasty

et al. 2023

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Background:Adequate pain control after total knee arthroplasty (TKA) has been associated with improved patient mobility and satisfaction, and is a task that has historically relied on opioids. Multimodal analgesic regimens can be considered a therapeutic alternative for postoperative pain control to avoid opioid consumption and its adverse side effects. This study aimed to evaluate the use of a multimodal analgesia protocol based on nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as an alternative to reduce opioid consumption in Hispanic patients undergoing primary TKA.Methods:An institutional review board-approved, randomized controlled trial evaluated postoperative pain control after TKA in a Hispanic population. The experimental opioid-sparing group received 30-mg ketorolac intravenously every 6 hours and 1-g acetaminophen orally every 6 hours as the patient requested. The experimental group had the option to use morphine and oxycodone combined with acetaminophen as a rescue therapy. The control group received opioids in the form of 0.1-mg/kg morphine intravenously every 6 hours and/or oxycodone combined with acetaminophen (2.5 and 325 mg), 2 tablets orally every 6 hours, as the patient requested. Sociodemographic, operative, and immediate postoperative data and pain intensity measurements according to the numerical rating scale (NRS) were compared between groups. Analgesic efficacy was assessed according to the NRS scores at 12, 24, and 48 hours postoperatively.Results:Eighty-one Hispanic patients met inclusion criteria: 42 patients in the experimental group and 39 patients in the control group. None of the patients in the experimental group requested oxycodone combined with acetaminophen as a rescue therapy. Only 2 patients in the experimental group used a mean of 3.0 ± 1.4 mg of rescue morphine; in comparison, the control group consumed a mean of 28.0 ± 7.9 mg of morphine and 64.8 ± 26.0 mg of oxycodone per patient. A pain intensity decrease was observed in the experimental and control groups, with no postoperative evaluation differences at 12 hours (6.7 ± 2.9 compared with 5.9 ± 2.8; p = 0.209), 24 hours (6.2 ± 2.0 compared with 6.1 ± 2.2; p = 0.813), and 48 hours (4.7 ± 2.1 compared with 4.6 ± 1.7; p = 0.835).Conclusions:The use of a multimodal analgesic regimen based on intravenous ketorolac and oral acetaminophen was adequate in reducing postoperative pain and opioid consumption in Hispanic patients undergoing TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Enhanced recovery pathways in orthopedic surgery

Cited by 83 publications

References 24 publications

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

ERAS for Free Fibula Flap Surgery: Effects on Postoperative Recovery and Complications

Opioid-Sparing Multimodal Analgesia Efficacy in Hispanic Patients Undergoing Total Knee Arthroplasty

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