Perioperative Pain Management in Hip and Knee Arthroplasty

Gaffney, Christian J.; Pelt, Christopher E.; Gililland, Jeremy M.; Peters, Christopher L.

doi:10.1016/j.ocl.2017.05.001

Cited by 157 publications

(128 citation statements)

References 60 publications

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“…In patients received TKA, 60% experience severe postoperative knee pain and 30% experience moderate pain. Some patients even put off this operation because of the fear of this acute postoperative pain. Furthermore, postoperative pain in TKA inhibits early ambulation and range of motion, risking thromboembolism, and affects rehabilitation, patient satisfaction, and overall outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…In 1996, the American Pain Society declared that pain was “the fifth vital sign”. In an attempt to relieve severe postoperative pain, several routine approaches have been proposed, such as use of preemptive analgesia, opioids, cyclooxygenase‐2 inhibitors, epidural anesthesia, peripheral nerve blockade, local infiltration analgesia, patient‐controlled analgesia, and multimodal analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

218

165

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Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

218

165

View full text Add to dashboard Cite

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“…There are several methods available for postoperative analgesia including systemic opioids, continuous peripheral nerve block, peripheral nerve block, and local infiltration analgesia. Peripheral nerve block (PNB), including different techniques such as femoral nerve block, sciatic nerve block, and adductor canal block (ACB) [7], is the mainstream treatment for postoperative pain following TKA [8]. Local infiltration analgesia (LIA) was introduced to clinical practice in recent years and has been found to be helpful in relieving acute pain after TKA [9,10].…”

Section: Introductionmentioning

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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“…Recent efforts to implement fasttrack total hip arthroplasty programs on a large scale have successfully shortened average hospital stays without modifying the index of risks and complications, patient's satisfaction, or the need for rehabilitation. 17 However, several published series comparing fast-track surgery with traditional recovery protocols found no significant differences in complication rates. 23 In this study, our results showed that the incidence rate of DVT in the study group was lower than in the control group (2.86% vs. 8.57%).…”

Section: Discussionmentioning

confidence: 98%

“…Effective preoperative care and postoperative care help to decrease complications, improve outcomes, and increase patient satisfaction after hip arthroplasty. 17,18 This Note: The data on baseline patient characteristics of each group were compared by v 2 test or t-test.…”

Section: Discussionmentioning

confidence: 99%

Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty

Zhang

Xiao

2020

J Int Med Res

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Objective: To explore the effect of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients treated with total hip arthroplasty (THA). Methods: We enrolled 70 patients diagnosed with avascular necrosis who were treated with a THA. All patients were randomly divided into either a control or a study group. The control group received routine nursing during the perioperative period while the study group received a fast-track surgery combined with a clinical nursing pathway. Results: There was no significant difference in general condition between the two groups, including the Harris hip score and the SF-36 scale of health. At the third week and the third month after the operation, the Harris hip score and the health SF-36 score of the study group increased significantly compared with the control group. In addition, the study group had a lower incidence of total complications and a shorter hospitalization time, as well as higher satisfaction scores for nursing work compared with the control group. Conclusion: Fast-track surgery combined with a clinical nursing pathway can effectively improve the clinical symptoms and self-efficacy of patients undergoing THA, and improve the patients' satisfaction with hospitalization.

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Perioperative Pain Management in Hip and Knee Arthroplasty

Cited by 157 publications

References 60 publications

Postoperative Pain Management in Total Knee Arthroplasty

Postoperative Pain Management in Total Knee Arthroplasty

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

Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty

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