Functional recovery after knee arthroplasty with regional analgesia

Osinski, Thomas; Bekka, Samir; Regnaux, Jean‐Philippe; Fletcher, Dominique; Martinez, Valéria

doi:10.1097/eja.0000000000000983

Cited by 11 publications

(7 citation statements)

References 44 publications

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“…14 Meta-analyses indicate that local infiltration of analgesia during hip arthroplasty procedures is associated with greater postoperative pain relief and improved range of motion throughout recovery following TKA, relative to patients receiving general anesthesia. 15,16 In a recent study, patients exposed to regional anesthetics reported improved sleep up to 3 days after hip arthroplasty compared with patients receiving general anesthesia exclusively. 17 However, this study did not model postoperative pain and sleep outcomes simultaneously.…”

mentioning

confidence: 99%

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Giordano

Kent

Andersen

et al. 2021

The Clinical Journal of Pain

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Objectives: Despite substantial research showing the bidrectional relationship between sleep and pain, there remains a dearth of research examining the role of perioperative pain management interventions in mitigating postoperative sleep disturbances. This secondary analysis of a prospective observational multisite study examined the association between peripheral nerve block (PNB) use during total knee or total hip arthroplasty (TKA/THA) procedures and postoperative pain and sleep outcomes.Materials and Methods: Adult patients undergoing TKA or THA procedures were recruited from 2 tertiary care facilities. Average pain and sleep disturbance scores were collected preoperatively and at 1-and 2-week postoperatively. Participants were not randomized to receive PNB. Postoperative outcomes were compared based on receipt of PNB during surgery. Structural equation modeling path analysis was utilized to model multiple co-occurring relationships, including mediation pathways between perioperative pain management approaches, pain, and postoperative sleep outcomes.Results: Of the 197 participants, 53% received PNB. Mediation analyses indicated that PNB was indirectly associated with 1-week sleep disturbance via its effects on 1-week pain intensity (β = −0.02, 95% confidence interval [CI] −0.04, −0.001, P = 0.04). In addition, PNB was indirectly associated with 2-week sleep disturbance, via its effects on 1-week pain intensity and 1-week sleep disturbance (β = −0.04, 95% CI −0.07, −0.02, P = 0.04). Lastly, PNB was indirectly associated with 2-week pain intensity via its effects on 1-week pain intensity (β = −0.10, 95% CI −0.19, −0.02, P = 0.02).Conclusions: Receipt of PNB during TKA or THA was found to be associated with improved 1-week postoperative pain intensity, which in turn was found to be associated with lower sleep disturbances at both 1-and 2-week postoperative time points. Multimodal opioid sparing pain management interventions, capable of improving postoperative sleep, are vital to improving recovery and rehabilitation following arthroplasty.

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mentioning

confidence: 99%

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Giordano

Kent

Andersen

et al. 2021

The Clinical Journal of Pain

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show abstract

“…The analysis of 1246 patients by Osinski et al evaluated the effect of the type of anesthesia with analgesic peripheral nerve block employed in the course of unilateral TKA. The mean postoperative hospitalization time was shorter by 0.9 day in patients who received regional anesthesia as compared to general anesthesia and were able to achieve better knee flexion by a mean value of 10 degrees by postoperative day 4 16 , 20 . In our procedures, all patients received regional anesthesia with analgesic peripheral nerve block.…”

Section: Discussionmentioning

confidence: 89%

“…The ERAS protocol reduced the postoperative time of hospitalization following TKA an average of 3 days, similar to our study. The observation is illustrated by the meta-analysis addressing the years 1990–2015 presented by Osinski et al 16 . Similarly, in Gotland’s hospitals in the period of 2011–2015 the postoperative hospitalization time of 6374 patients following TKA was shortened from 5 to 3 days (patients classified ASA I and II score, irrespectively of age) 17 .…”

Section: Discussionmentioning

confidence: 95%

Pre-emptive analgesia with methylprednisolone and gabapentin in total knee arthroplasty in the elderly

Liszka

Zając

Gądek

2022

Sci Rep

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The aim of this study is to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). One hundred seventy patients above 65 years were qualified for the study, with exclusion of 10 patients due to clinical circumstances. One hundred sixty patients were randomly double-blinded into two groups: the study group (80 patients) and the control group (80 patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral (PO) gabapentin and 125 mg intravenous (IV) methylprednisolone, while the control received a placebo. All patients received opioid and non-opioid analgesic agents perioperatively calculated for 1 kg of total body weight. We measured (1) pain intensity level at rest (numerical rating scale, NRS), (2) life parameters, (3) levels of inflammatory markers (leukocytosis, C reactive protein CRP), and (4) all complications. Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia, the NRS score at rest was calculated at 6, 12 (p < 0.000001), 18 (p < 0.00004) and 24 (p = 0.005569) h postoperatively. Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p = 0.000006). The duration time of analgesia was significantly longer in study group (p < 0.000001), with CRP values lower on all postoperative days (1, 2 days—p < 0.00001, 3 days—p = 0.00538), and leukocytosis on day 2 (p < 0.0086) and 3 (p < 0.00042). No infectious complications were observed in the first postoperative days; in the control group, one patient manifested transient ischemic attack (TIA). The use of gabapentin and methylprednisolone as a single dose decreased the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, and the level of inflammatory parameters without infectious processes.

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“…The ERAS protocol reduced the postoperative time of hospitalization following TKA the average until 3 days, similarly as in our material. The observation is illustrated by the meta-analysis addressing the years 1990-2015 presented by 17 . Similarly, in Gotland's hospitals in the period of 2011-2015 the postoperative hospitalization time of 6374 patients following TKA was shortened from 5 days to 3 days (patients classi ed ASA I and II score, irrespectively of age) 18 .…”

Section: Discussionmentioning

confidence: 96%

“…The analysis of 1246 patients by Osinski et al (2019) evaluated the effect of the type of anesthesia with analgesic peripheral block employed in the course of unilateral TKA, the mean postoperative hospitalization time was shorter by 0,9 day in patients who received regional anesthesia as compared to general anesthesia, up to day 4 postoperatively achieved better exion movement in the implanted knee joint, by the mean value of 10 17,21 . In our material, all patients received regional anesthesia with analgesic peripheral block, we observed 2 patients in the study and control groups with di culties in achieving satisfactory exion of the operated joint.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

Liszka

Zając

Gądek

2021

Preprint

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Background The aim of the study was to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). Material and Methods One hundred seventy, above 65 years old patients were qualified for the study, and 10 patients were excluded due to clinical situation. One hundred sixty patients were double-blind randomized into two groups: the study (eighty patients) and controls (eighty patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral gabapentin and 125 mg intravenous methylprednisolone, while the others placebo. Perioperatively, all the patients received opioid and nonopioid analgesic agents calculated for 1 kg of body weight. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein - CRP), pain intensity level at rest (numerical rating scale - NRS), the life parameters and all complications. Results Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia CRP values being lower on all postoperative days ( 1, 2 days - p<0,00001, 3 day – p=000538), leukocytosis on day 2 (p<0,0086) and 3 (p<0,00042), the NRS score at rest 6, 12 (p<0,000001), 18 (p<0,00004) and 24 (p=0,005569) hours postoperatively . Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p=0,000006). The duration time of analgesia was significantly longer in study group (p<0,000001). No infectious complications were observed; in the control group, one patient manifested transient ischaemic attack (TIA). Conclusion The use of gabapentin and methylprednisolone at a single dose decreases the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, the level of inflammatory parameters without infectious processes.

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Functional recovery after knee arthroplasty with regional analgesia

Cited by 11 publications

References 44 publications

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Pre-emptive analgesia with methylprednisolone and gabapentin in total knee arthroplasty in the elderly

The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

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