Functional outcome after major orthopedic surgery

Bernucci, Francisca; Carli, Francesco

doi:10.1097/aco.0b013e328357a3d5

Cited by 17 publications

(12 citation statements)

References 36 publications

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“…Furthermore, we found no group differences in satisfaction, pain experience, or opioid consumption. Since patients' own perceptions regarding their functional ability and physical status may differ greatly from their actual performance outcomes when measured, our data reinforce the need for both performance-based and self-reported outcomes when assessing the progress of TKA patients' postoperative rehabilitation [ 27 ].…”

Section: Discussionmentioning

confidence: 67%

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Mudumbai

Kim

Howard

et al. 2016

Korean J Anesthesiol

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BackgroundAdductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients' physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation.MethodsWe conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status.ResultsData from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = –2.6; 95% CI: –4.5, –0.8, P = 0.01) with R2 = 0.1.ConclusionsAdductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.

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Section: Discussionmentioning

confidence: 67%

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Mudumbai

Kim

Howard

et al. 2016

Korean J Anesthesiol

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“…In this context, the possible beneficial role of prehabilitation in THA and TKA in length of stay requirements needs to be reassessed with the fast-track methodology (Gill and McBurney 2013, Villadsen et al 2014). The same applies to different analgesic interventions (Bernucci and Carli 2012, Lunn and Kehlet 2013) or type of in-hospital physiotherapy and possibilities for early postoperative strength training (Bandholm and Kehlet 2012). Also, organizational factors such as the weekday of operation or waiting for a transfusion need to be considered (Husted et al 2008, Husted 2012).…”

Section: Discussionmentioning

confidence: 99%

Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty

Holm¹,

Bandholm²,

Lunn³

et al. 2014

Acta Orthopaedica

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Background and purpose The concept of fast-track surgery has led to a decline in length of stay after total hip arthroplasty (THA) and total knee arthroplasty (TKA) to about 2–4 days. However, it has been questioned whether this is only achievable in selected patients—or in all patients. We therefore investigated the role of preoperative pain and functional characteristics in discharge readiness and actual LOS in fast-track THA and TKA.Methods Before surgery, hip pain (THA) or knee pain (TKA), lower-extremity muscle power, functional performance, and physical activity were assessed in a sample of 150 patients and used as independent variables to predict the outcome (dependent variable)—readiness for hospital discharge —for each type of surgery. Discharge readiness was assessed twice daily by blinded assessors.Results Median discharge readiness and actual length of stay until discharge were both 2 days. Univariate linear regression followed by multiple linear regression revealed that age was the only independent predictor of discharge readiness in THA and TKA, but the standardized coefficients were small (≤ 0.03).Interpretation These results support the idea that fast-track THA and TKA with a length of stay of about 2–4 days can be achieved for most patients independently of preoperative functional characteristics.

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“…[3] Delayed postoperative mobilization caused by pain reduces quality of life and delays return to normal daily activities. [45]…”

Section: Introductionmentioning

confidence: 99%

Effects of preincisional analgesia with surgical site infiltration of ketamine or levobupivacaine in patients undergoing abdominal hysterectomy under general anesthesia; A randomized double blind study

2017

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Context:Postoperative pain management remains a cornerstone in patient's management to ensure a better quality of life. Preemptive analgesia is reported to inhibit the persistence of postoperative pain.Aims:The aim of this study is to assess the analgesic effectiveness of preincisional infiltration of ketamine following elective abdominal hysterectomy as compared to levobupivacaine.Settings and Design:This was a prospective, randomized, double-blind study.Subjects and Methods:This study included 48 patients undergoing abdominal hysterectomy under general anesthesia. They were randomized into two equal groups; Group K received subcutaneous infiltration of 20 ml containing ketamine 2 mg/kg and Group L received subcutaneous infiltration of 20 ml of levobupivacaine 0.25% along the Pfannenstiel incision 5 min before incision. Postoperative pain was assessed using visual analog scale (VAS) at rest and on coughing with evaluation of additional opioid analgesic requirements.Statistical Analysis Used:Numerical variables were presented as mean and standard deviation or median and range as appropriate. The intergroup differences were compared using the independent-sample Student's t-test or Mann–Whitney test for numerical variables.Results:VAS score decreased significantly in Group L from 10 to 24 h and in Group K from 8 to 24 h as compared to the immediate postoperative reading. VAS score in ketamine group was significantly lower than that in the levobupivacaine group 8, 10, and 24 h postoperatively. Ketamine group showed delayed request of additional opioid analgesia (P < 0.001) with significantly less opioid consumption (P < 0.001) as compared to levobupivacaine. The total dose of meperidine consumed during the 24 postoperative h was significantly smaller in ketamine group (P < 0.001).Conclusion:Surgical site infiltration of ketamine is a promising preemptive analgesic method in the lower abdominal surgery with minimal sedation and adverse effects.

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Functional outcome after major orthopedic surgery

Abstract: In order to establish the role of regional anesthesia in functional outcome after major orthopedic surgery, assessment of pain control is no longer sufficient. New clinically relevant outcomes must be introduced and used for procedure-specific studies.

Cited by 17 publications

References 36 publications

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty

Effects of preincisional analgesia with surgical site infiltration of ketamine or levobupivacaine in patients undergoing abdominal hysterectomy under general anesthesia; A randomized double blind study

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