Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia

Adams, Hans Anton; Saatweber, P.; Schmitz, Christoph; Hecker, Hans Ulrich

doi:10.1017/s0265021502001084

Cited by 39 publications

(23 citation statements)

References 22 publications

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“…[12][13][14][15] . [12,13,15] [14] Single injection femoral nerve block [25][26][27][28][29][30][31][32] . [26,29,30] fl [25,27,28] NS [31,32] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

“…[12,13,15] [14] Single injection femoral nerve block [25][26][27][28][29][30][31][32] . [26,29,30] fl [25,27,28] NS [31,32] . [27,28,30] fl [26] NS [25,29,32] n ⁄ a Continuous infusion femoral nerve block [25,[33][34][35][36] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

“…[49][50][51] NS [34] n ⁄ a Postoperative (± pre-operative) lumbar epidural LA [31,47,48] . [48] NS [31,47] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

“…[49][50][51] NS [34] n ⁄ a Postoperative (± pre-operative) lumbar epidural LA [31,47,48] . [48] NS [31,47] . [47] fl [48] n ⁄ a Postoperative (± before end of surgery) lumbar epidural opioid [18,[44][45][46] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

See 3 more Smart Citations

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

Fischer¹,

Simanski²,

Sharp³

et al. 2008

Anaesthesia

264

218

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SummaryThe PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence‐based consensus recommendations for the effective management of postoperative pain are then developed from these systematic reviews, incorporating clinical practice observations, and transferable evidence from other relevant procedures. We present the results of a systematic review of pain and other outcomes following analgesic, anaesthetic and surgical interventions for total knee arthroplasty (TKA). The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression techniques, should be supplemented with paracetamol and conventional non‐steroidal anti‐inflammatory drugs or COX‐2‐selective inhibitors, plus intravenous strong opioids (high‐intensity pain) or weak opioids (moderate‐ to low‐intensity pain).

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“…[12][13][14][15] . [12,13,15] [14] Single injection femoral nerve block [25][26][27][28][29][30][31][32] . [26,29,30] fl [25,27,28] NS [31,32] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

“…[49][50][51] NS [34] n ⁄ a Postoperative (± pre-operative) lumbar epidural LA [31,47,48] . [48] NS [31,47] .…”

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

Section: Pharmacological Agents and Techniquesmentioning

confidence: 99%

See 2 more Smart Citations

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

Fischer¹,

Simanski²,

Sharp³

et al. 2008

Anaesthesia

264

218

View full text Add to dashboard Cite

show abstract

“…Diz artroplastisi yapılan hastalarda intravenöz HKA, 3-1 blok ve epidural anestezi tekniklerinin karşılaştırıldığı bir araştırmada tüm grupların ağrı skorları benzer olmasına ve yeterli analjezi sağlanmasına rağmen en iyi stres yanıt kontrolü epidural anestezi grubunda sağlanmıştır (22). Beyazıt ve ark.…”

Section: Discussionunclassified

Investigation of Effects of Epidural Anaesthesia Combined with General Anaesthesia on the Stress Response in Patients Undergoing Hip and Knee Arthroplasty

Sağlık¹,

Yazicioglu²,

Çiçekler³

et al. 2015

Turk J Anesth Reanim

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Objective: To investigate the effects of general anaesthesia and general+epidural anaesthesia on the stress response which was evaluated with the adrenocorticotrophic hormone (ACTH), cortisol, insulin, and glucose levels and the haemodynamic parameters.Methods: Forty two, American Society of Anesthesiologists physiologic status I-II, patients undergoing hip and knee arthroplasty were randomized into two groups; general anaesthesia (Group G) and general anaesthesia+epidural anaesthesia (Group E). Epidural anaesthesia: patients in Group E received epidural anaesthesia with 0.5% bupivacaine, a lumbar epidural catheter was placed and after achieving sensorial block at T10 dermatome, general anaesthesia was commenced. General anaesthesia was standardized in both groups. Further, plasma ACTH, cortisol, insulin and glucose levels were determined at preoperative=t1, after the surgical incision=t2, postoperative 2 nd hour=t3 and postoperative 24 th hour=t4. Perioperative heart rate, blood pressures, pain scores and morphine consumption were also determined. . The insulin levels were higher compared with the baseline values at t3, and glucose was higher at t3 and t4 in both groups. Haemodynamic parameters were stable in Group E, and pain scores and morphine consumption were higher in Group G than in Group E. Results Conclusion:Our results suggest that general anaesthesia combined with epidural anaesthesia suppressed the stress response, which was evaluated with ACTH, cortisol levels and haemodynamic parameters; however, this method was ineffective to attenuate the increase in glucose and insulin levels.Keywords: ACTH, arthroplasty, epidural anaesthesia, cortisol, insulin, stress response Amaç: Genel anestezi ve genel anestezi ile birlikte uygulanan epidural anestezinin, adrenokortikotropik hormon (ACTH), kortizol, glukoz ve insülin düzeylerinin yanı sıra hemodinamik değişiklikler ile değerlendirilen stres yanıt üzerindeki etkilerinin araştırılmasıdır.Yöntemler: Kalça ve diz artroplastisi yapılan, Amerikan Anestezistler Derneği fizyolojik durumu I-II olan, 42 hasta rastgele genel anestezi (Grup G) ve genel anestezi+epidural anestezi (Grup E) gruplarına ayrıldı. Epidural anestezi; Grup E'deki hastalara %0,5 bupivakain ile uygulandı, lomber epidural kateter yerleştirildi. Duyu bloğunun T10 seviyesine ulaştığı tespit edildikten sonra hastalara genel anestezi uygulandı. Genel anestezi; her iki grupta da standardize edildi. Plazma ACTH, kortizol insülin ve glukoz düzeyleri, preoperatif=t1, cerrahi insizyondan sonra=t2, postoperatif 2. saat=t3 ve 24. saat=t4'te ölçüldü. Hastaların perioperatif kalp hızı, kan basınçları ve postoperatif ağrı skorları ve morfin tü-ketimleri tespit edildi. Bulgular: ACTH, Grup G'de, Grup E'den yüksekti [Grup G, t2: 71,4±39,9 pg mL -1 ve t3: 578,6±566,1 pg mL -1, Grup E'de t2: 20,2±16,2 pg mL -1 , t3: 56,3±73,6 pg mL -1 (p<0,001)]. Kortizol, Grup G'de, Grup E'den yüksekti [Grup G, t3: 33 Her iki grupta da insülin postoperatif 24. saatte ve glukoz postoperatif 2 ve 24. saatlerde preoperatif düzeylere ...

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2014

Cochrane Database of Systematic Reviews

164

112

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Background Total knee replacement (TKR) is a common and o en painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Objectives To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web of Science, dissertation abstracts and reference lists of included studies. The date of the last search was 31 January 2013. Selection criteria We included randomized controlled trials (RCTs) comparing FNB with no FNB (intravenous patient-controlled analgesia (PCA) opioid, epidural analgesia, local infiltration analgesia, and oral analgesia) in adults a er TKR. We also included RCTs that compared continuous versus single-shot FNB. Data collection and analysis Two review authors independently performed study selection and data extraction. We undertook meta-analysis (random-e ects model) and used relative risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) or standardized mean di erences (SMDs) for continuous outcomes. We interpreted SMDs according to rule of thumb where 0.2 or smaller represents a small e ect, 0.5 a moderate e ect and 0.8 or larger, a large e ect. Main results We included 45 eligible RCTs (2710 participants) from 47 publications; 20 RCTs had more than two allocation groups. A total of 29 RCTs compared FNB (with or without concurrent treatments including PCA opioid) versus PCA opioid, 10 RCTs compared FNB versus epidural, five RCTs compared FNB versus local infiltration analgesia, one RCT compared FNB versus oral analgesia and four RCTs compared continuous versus single-shot FNB. Most included RCTs were rated as low or unclear risk of bias for the aspects rated in the risk of bias Femoral nerve blocks for acute postoperative pain a er knee replacement surgery (Review)

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Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia

Cited by 39 publications

References 22 publications

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

Investigation of Effects of Epidural Anaesthesia Combined with General Anaesthesia on the Stress Response in Patients Undergoing Hip and Knee Arthroplasty

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

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