Optimizing Pain and Rehabilitation After Knee Arthroplasty: A Two-Center, Randomized Trial

Choi, Stephen; O’Hare, Turlough; Gollish, Jeffrey; Paul, James; Kreder, Hans J.; Thorpe, Kevin E.; Katz, Joel; Mamdani, Muhammad; Moisiuk, Peter; McCartney, Colin J. L.

doi:10.1213/ane.0000000000001469

Cited by 24 publications

(18 citation statements)

References 37 publications

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“…The reason for this is due to the multimodal analgesia including PCA pump and LIA which make patients in an acceptable range of pain, thus resulting in a similar degree of pain relief. As for all kinds of peripheral nerve block, LIA has similar pain relief compared with single femoral nerve block [26,27], continuous femoral nerve block [27,28], and single sciatic nerve block [18,20]. However, currently, few studies focus on the comparison between local infiltration analgesia with combined femoral and sciatic nerve block and do not reach a consensus.…”

Section: Discussionmentioning

confidence: 99%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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Background: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.

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Section: Discussionmentioning

confidence: 99%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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“…Among available data in TKR, Lisi [ 29 ] reported a NRS value under 3, at POD 2 in a mininvasive protocol for TKR, Snyder [ 30 ] a mean NRS value ranging between 3.24 (POD 0) and 4 (POD 3), and Gerbershagen [ 31 ] a mean maximum pain at POD 1 of 5.56. Rakel [ 32 ] reported a median resting pain NRS intensity of 4 at POD 2, and Choi [ 33 ] reported a mean NRS value of 4.6 in patients who underwent TKR and were treated with FNB at POD 2. Castorina, [ 34 ] comparing a fast track protocol versus a standard protocol in TKR, reported a level of Visual Analogic Scale (VAS) pain at POD 3 of 3.38 and 4.40, respectively.…”

Section: Discussionmentioning

confidence: 99%

Pain monitoring and management in a rehabilitation setting after total joint replacement

Luca

Ciccarello²,

Martorana

et al. 2018

Medicine

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Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.

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“…The majority of studies (27/31) utilised two or more pain outcomes. The most commonly used outcome measures were numerical grading of pain/numerical reporting scale (NRS) out of 10 (16 studies) [ 12 , 17 , 20 – 24 , 27 – 29 , 32 – 35 , 38 , 40 ], opioid consumption (16 studies), and visual analogue scale 10 cm (VAS; 12 studies) [ 13 – 16 , 25 , 26 , 31 , 36 , 37 , 39 , 41 , 42 ]. Other than reporting total opioid consumption, analgesia usage was also measured with the following outcomes: nonopioid analgesic requirement [ 14 , 16 , 32 , 33 , 36 ], total supplementary analgesic requirement [ 34 , 35 ], and cumulative opioid consumption [ 26 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Postoperative Pain Outcome Measurements Utilised in Regional Anesthesia Randomized Controlled Trials

Pushpanathan

Setty

Carvalho

et al. 2018

Anesthesiology Research and Practice

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Introduction Regional anesthesia is a rapidly growing subspecialty. There are few published meta-analyses exploring pain outcome measures utilised in regional anesthesia randomized controlled trials (RCTs), which may be due to heterogeneity in outcomes assessed. This systematic review explores postoperative pain outcomes utilised in regional anesthesia RCTs. Methods A literature search was performed using three databases (Medline, Embase, and CINAHL). Regional anesthesia RCTs with postoperative pain as a primary outcome were included if written in English and published in one of the top 20 impact factor journals between 2005 and 2017. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias. Results From the 31 included articles, 15 different outcome measures in total were used to assess postoperative pain. The most commonly (16/31) used outcome measures were verbal numerical grading of pain out of 10, total opioid consumption, and visual analogue scale 10 cm (VAS). The need for analgesia was used as an outcome measure where studies did not use a pain rating score. Ten studies reported pain scores on activity and 27/31 studies utilised ≥2 pain outcomes. Time of measurement of pain score also varied with a total of 51 different time points used in total. Conclusion Analysis of the articles demonstrated heterogeneity and inconsistency in choice of pain outcome and time of measurement within regional anesthesia studies. Identification of these pain outcomes utilised can help to create a definitive list of core outcomes, which may guide future researchers when designing such studies.

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Optimizing Pain and Rehabilitation After Knee Arthroplasty: A Two-Center, Randomized Trial

Abstract: Our findings suggest no clinically significant differences between cFNB, LIA, and sFNB for pain during physiotherapy on POD 2 after TKA. Secondary analyses suggest that cFNB and LIA are superior to sFNB for early analgesic outcomes (NRS on POD 1) after TKA.

Cited by 24 publications

References 37 publications

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

Pain monitoring and management in a rehabilitation setting after total joint replacement

A Systematic Review of Postoperative Pain Outcome Measurements Utilised in Regional Anesthesia Randomized Controlled Trials

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