Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine

Shlaifer, Amir; Sharfman, Zachary T.; Martin, Hal David; Amar, Eyal; Kazum, Efi; Warschawski, Yaniv; Paret, Matan; Brill, Silviu; Drexler, Michael; Rath, Ehud

doi:10.1016/j.arthro.2016.07.026

Cited by 23 publications

(33 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…T he idea of preemptive analgesia was first proposed by Woolf in Harvard Medical School 8 , with the purpose to block the pain sensation center before harmful stimulation occurs, to inhibit the center sensitization and to raise the threshold of pain sensation. Recently, there have been many studies published on the preoperative use of local anesthesia agents, including opiates and NSAIDS [9][10][11][12] , but the value of preemptive analgesia is still controversial [13][14][15] . It has been proved that synthesis of COX-2 increases after inflammatory stimulation, and increases the production of prostaglandins, which induces inflammatory pain.…”

Section: Discussionmentioning

confidence: 99%

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Bian

Wang

Qian

et al. 2018

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective Total knee arthroplasty (TKA) is an established surgical technique and is the standard treatment for degenerative knee joint diseases. However, severe pain after TKA makes it difficult for many patients to perform early postoperative rehabilitation and functional exercise, which might result in subsequent unsatisfactory recovery of knee joint function and great reduction in patients’ satisfaction and quality of life. Orthopaedic surgeons have tried a large variety of analgesics and analgesic modes to relieve patients’ pain after TKA. There are many analgesic regimens available in clinical practice but all have some deficiencies. Parecoxib sodium, a highly selective inhibitor of cyclooxygenase‐2 (COX‐2), can reduce the synthesis of peripheral prostaglandin to exert the effect of analgesia, and relieve inflammation and prevent central sensitization through inhibition of peripheral and central COX‐2 expression. In addition, it can be used as a preemptive analgesic without affecting platelet aggregation. However, there does seem to be conflicting evidence in the current research as to whether parecoxib sodium can be used successfully as a preemptive analgesic; the effect of preemptive analgesia with parecoxib sodium in multimodal analgesia is still controversial. This research investigated the effects of parecoxib sodium in a preemptive multimodal analgesic regimen. Methods Eighty‐eight patients were randomized into two groups. The experimental group received parecoxib (46 patients) and the control group received saline (42 patients), administered 30 min before the initiation of the surgical procedure. A patient‐controlled analgesia (PCA) pump was applied within 48 h after surgery. The visual analogue scale (VAS), drug consumption through the PCA pump, use of salvaging analgesia, range of motion (ROM) of the knee joints, and postoperative complications were observed. Results The VAS score in the post‐anesthesia care unit (PACU) of the parecoxib group was significantly lower than that of the control group (P = 0.039). There was no significant difference in the demographic profiles, duration of operation, hemorrhage in surgery, postoperative hemorrhage, postoperative drainage, VAS at different time points, function of knee joints, length of hospital stay, use of salvaging analgesia, and postoperative drug consumption through the PCA between the two groups (P > 0.05). Conclusion In preemptive multimodal analgesia regimens, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain shortly after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug in the perioperative analgesic management for TKA.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Bian

Wang

Qian

et al. 2018

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…It also provides a method of pain control for the patient and has been used to perform opioid-free anesthesia in patients with breast cancer undergoing modified radical mastectomy ( 33 , 34 ). Similarly, bupivacaine is commonly used for pain control in orthopaedic surgery to decrease opioid consumption after surgery ( 35 ). Pain due to cancer is a significant problem and decreasing opioid use in this patient population can have multiple benefits while decreasing the complications associated with opioid use ( 36-38 ).…”

Section: Discussionmentioning

confidence: 99%

Antiproliferative effect of bupivacaine on patient-derived sarcoma cells

et al. 2020

View full text Add to dashboard Cite

Sarcomas are rare tumors with limited treatment options. Although chemotherapy is standard for certain subtypes, overall survival has not improved in several decades. Bupivacaine has been shown to induce apoptosis and prevent cell growth in multiple different types of malignancies but has not been studied in sarcoma. The current study evaluated the effects of bupivacaine on multiple patient-derived sarcoma cells and a commercial sarcoma cell line. Multiple patient-derived sarcoma cell subtypes and a commercial synovial cell sarcoma cell line were exposed to bupivacaine for different durations and at different concentrations. The patient-derived cells included a high-grade conventional osteosarcoma, a high-grade undifferentiated pleomorphic sarcoma of bone, and a high-grade synovial sarcoma. Flow cytometry and an MTT assay were used to evaluate whether a treatment effect was observed. Treatment of all the subtypes of sarcomas in this study with bupivacaine demonstrated a time- and dose-dependent increase in apoptosis and decrease in cell viability. A cell viability assay demonstrated that the IC 50 was between 0.04 and 0.05% and that the treatment effect occurred at clinically relevant doses in vitro . Bupivacaine was toxic to both the patient-derived cells and the commercial cell line at doses commonly used in the clinical setting. These findings provide a foundation for further in vivo studies to evaluate whether these effects will translate to the clinical setting. Although further research is necessary, bupivacaine shows promise as not only an adjunct for pain management but as a treatment modality for sarcoma.

show abstract

“…During the closing stages, both groups received an additional 20 ml intra-articular injection of 0.5% bupivacaine. The two different LIA groups had similar post-operative pain with the periacetabular group having improved pain at 30 min and 18 h compared with the intra-articular group [ 29 ]. The analgesic effect of intra-articular or periacetabular LIA is difficult to quantify as no control group was included in the study design.…”

Section: Discussionmentioning

confidence: 99%

Extracapsular local infiltration analgesia in hip arthroscopy patients: a randomized, prospective study

Philippi

Kahn

Adeyemi

et al. 2018

Journal of Hip Preservation Surgery

View full text Add to dashboard Cite

Hip arthroscopy patients can experience significant post-operative pain. Many strategies to combat this pain have been explored including nerve blocks, which can be costly. An alternative option for pain management is local infiltration analgesia (LIA) which has been studied in hip and knee arthroplasty, but its ability to decrease pain in the setting of hip arthroscopy remains uncertain. A prospective randomized controlled trial of 74 patients who underwent hip arthroscopy at a single medical center was performed. Thirty-seven patients received a 20-ml extracapsular injection of 0.25% bupivacaine-epinephrine under direct arthroscopic visualization after capsular closure while 37 from the control group received no injection. Primary outcome measures were both maximum and discharge numeric rating scale (NRS) pain scores while in the post-anesthesia care unit (PACU). The LIA group had a statistically significant decrease in the maximum PACU NRS score (6.16 versus 7.35, P = 0.009), however this did not reach the level of minimal clinically important difference of 1.5. There was an insignificant difference in discharge PACU pain scores. This is the first randomized controlled trial studying extracapsular LIA in hip arthroscopy. While LIA offers an uncomplicated and low-cost approach to post-operative pain management, this specific technique did not reduce pain to a clinically significant level.

show abstract

Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine

Cited by 23 publications

References 26 publications

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Antiproliferative effect of bupivacaine on patient-derived sarcoma cells

Extracapsular local infiltration analgesia in hip arthroscopy patients: a randomized, prospective study

Contact Info

Product

Resources

About

Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine

Cited by 23 publications

References 26 publications

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double‐blinded Controlled Trial

Antiproliferative effect of bupivacaine on&nbsp;patient-derived sarcoma cells

Extracapsular local infiltration analgesia in hip arthroscopy patients: a randomized, prospective study

Contact Info

Product

Resources

About

Antiproliferative effect of bupivacaine on patient-derived sarcoma cells