Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Maheshwari, Aditya V.; Blum, Yossef; Shekhar, Laghvendu; Ranawat, Amar S.; Ranawat, Chitranjan S.

doi:10.1007/s11999-009-0728-7

Cited by 284 publications

(192 citation statements)

References 35 publications

(43 reference statements)

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…Overall, pain was not a substantial problem with regard to discharge on the day of surgery or after an overnight stay and this may be related to the pain protocols used at both institutions including preemptive analgesia, spinal anesthesia, and postoperative multimodal pain management. This is in line with contemporary studies demonstrating well-controlled pain with these protocols in place [13,15,17,18].…”

Section: Discussionsupporting

confidence: 90%

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Goyal

Chen

Padgett

et al. 2017

Clinical Orthopaedics &Amp; Related Research

215

203

View full text Add to dashboard Cite

Background Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.Questions/purposes The purpose of this study was to evaluate and compare patients undergoing THA who are discharged on the same day as the surgery (''outpatient,'' less than 12-hour stay) with those who are discharged after an overnight hospital stay (''inpatient'') with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission, One of the authors (AFC) has received research support funding from 3M (Maplewood, MN, USA) and Myoscience (Fremont, CA, USA). One of the authors (WGH) has received research support funding from DePuy (DePuySynthes, New Brunswick, NJ, USA), Biomet (Warsaw, IN, USA), and Nimbic Systems (Stafford, TX, USA). The institution of one or more of the authors (NG, SEP, RHH, WGH) has received, during the study period, funding from the Inova Health System (Falls Church, VA, USA). One of the authors (NG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Cayenne Medical (Scottsdale, AZ, USA) and Stryker Orthopedics (Mahwah, NJ, USA). One of the authors (AFC), or a member of her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from ACI Clinical (Bala Cynwyd, PA, USA). One of the authors (WGH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from DePuy, Biomet, and Nimbic Systems. One of the authors (WJH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker. One of the authors (NG) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Data Trace Publishing Company (Towson, MD, USA) in the amount of USD 10,000 to USD 100,000. One of the authors (AFC) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: SLACK Incorporated (Thorofare, NJ, USA) in the amount of less than USD 10,000. (3) relative work effort for the surgeon's office staff. Methods A prospective, randomized study was conducted at two high-volume adult reconstruction centers between July 2014 and September 2015. Patients who were younger than 75 years of age at surgery, who could ambulate without a walker, who were n...

show abstract

Section: Discussionsupporting

confidence: 90%

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Goyal

Chen

Padgett

et al. 2017

Clinical Orthopaedics &Amp; Related Research

215

203

View full text Add to dashboard Cite

show abstract

“…Preoperatively, patients received 20 mg sustained-release oxycodone (Oxycontin 1 ; Perdue Pharma, Stamford, CT, USA) and 200 mg celecoxib (Celebrex 1 ; Pfizer, New York, NY, USA). Spinal anesthesia with supplemental intravenous sedation was used, as well as a periarticular cocktail injection [19]. The postoperative analgesia protocol included oral acetaminophen, celecoxib, and sustained-release and short-acting oxycodone.…”

Section: Methodsmentioning

confidence: 99%

Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?

Rodríguez

Deshmukh

Rathod

et al. 2013

Clin Orthop Relat Res

Self Cite

195

162

View full text Add to dashboard Cite

Background Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy. Questions/purposes We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement. Methods In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure TM

show abstract

“…The reported efficacy of periarticular analgesic injections after TKA has been inconsistent and plagued by significant heterogeneity among studies with regard to volume and content of local infiltrations [4,11,14]. As an alternative to periarticular administration of analgesics, intraarticular delivery of anesthetics has gained recent attention.…”

Section: Introductionmentioning

confidence: 99%

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Reinhardt

Duggal

Umunna

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Pain management after TKA remains challenging and the efficacy of continuously infused intraarticular anesthetics remains a controversial topic.Questions/purposes We compared the side effect profile, analgesic efficacy, and functional recovery between patients receiving a continuous intraarticular infusion of ropivacaine and patients receiving an epidural plus femoral nerve block (FNB) after TKA. Methods Ninety-four patients undergoing unilateral TKA were prospectively randomized to receive a spinal-epidural analgesic infusion plus a single-injection FNB or a spinal anesthetic plus a continuous postoperative intraarticular infusion of 0.2% ropivacaine. All patients were blinded to their treatment with placebo saline catheters. Blinded coinvestigators collected data concerning side effect profiles (nausea, hypotension), analgesic efficacy (VAS pain scores, narcotic usage), and functional recovery (timed up and go test, quadriceps strength, WOMAC scores, Knee Society scores, early postoperative ambulatory ability, in-hospital falls). All complications and adverse events were recorded. Results The frequency of nausea and hypertension was not different between the study groups. During the first 12 and 24 postoperative hours, the mean maximum VAS pain scores were higher in the ropivacaine group than in the epidural group (first 12 hours: 3.93 versus 1.14, respectively, p \ 0.0001; 12-24 hours: 3.52 versus 1.93, respectively, p = 0.008). After 24 hours, pain scores were similar between groups. Narcotic consumption was significantly higher in the ropivacaine group on the day of surgery, but overall in-hospital narcotic usage was similar between groups. There were no clinically important differences in functional recovery between groups at any time point, but patients in the epidural group were more likely to have knee buckling (32.7% versus 6.7%, p = 0.002) and delayed ambulation (16.3% versus 0.0%, p = 0.006) than patients in the ropivacaine group, though not in-hospital falls. No infections occurred in either group, and the frequency of complications was not different between groups.

show abstract

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Cited by 284 publications

References 35 publications

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Contact Info

Product

Resources

About