The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

Goyal, Nitin; McKenzie, James C.; Sharkey, Peter F.; Parvızı, Javad; Hozack, William J.; Austin, Matthew S.

doi:10.1007/s11999-012-2596-9

Cited by 52 publications

(55 citation statements)

References 34 publications

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“…YaDeau et al [48] reported decreased postoperative cognitive dysfunction in patients who received a single-shot femoral nerve block immediately before TKA (2.5% versus 0%), while Marino et al [34] found decreased postoperative cognitive dysfunction with the use of continuous lumbar or femoral block as compared to IV PCA alone (0%, 1.3%, and 10.7%, respectively). In contrast, intraarticular infusion of bupivacaine after TKA was not found to change the incidence of postoperative cognitive dysfunction as compared to placebo [15]. When narcotic medications were used, morphine and meperidine appeared to be associated with an increased risk of postoperative cognitive dysfunction, irrespective of the mode of administration (IV, intramuscular [IM], or epidural).…”

Section: Multimodal Anesthetic Techniquesmentioning

confidence: 98%

“…However, of those studies, only nine of 21 (43%) explicitly reported blinding of patients, clinicians, and/or assessors to the participants' treatment arm allocation [4,12,15,20,24,27,29,47,48]. Only nine of 21 (43%) reported performing an a priori power calculation for the outcome of postoperative cognitive dysfunction [4,16,24,27,29,34,38,39,48], with one of these studies failing to recruit a sufficient number of patients [38].…”

Section: Study Designs and Populationsmentioning

confidence: 99%

“…This included eight studies of patients who underwent either TKA or THA [7,12,17,18,20,24,36,47], eight studies of patients who underwent unilateral TKA [15,19,26,35,39,41,45,48], two studies of patients who underwent unilateral THA [16,34], and one study of patients who underwent bilateral TKA [46]. The remaining nine studies encompassing 2426 patients investigated postoperative cognitive dysfunction in a mixed major noncardiac surgical population, which included patients who underwent elective joint arthroplasty.…”

Section: Study Designs and Populationsmentioning

confidence: 99%

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The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

Zywiel

Prabhu

Perruccio

et al. 2014

Clinical Orthopaedics &Amp; Related Research

104

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Background Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction.Questions/purposes We systematically reviewed the English-language literature to assess the influence of the following anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction in patients undergoing elective joint arthroplasty: (1) general versus regional anesthesia, (2) different parenteral, neuraxial, or inhaled agents within a given type of anesthetic (general or regional), (3) multimodal anesthetic techniques, and (4) different postoperative pain management regimens. Methods A systematic search was performed of the MEDLINE 1 and EMBASE TM databases to identify all studies that assessed the influence of anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction after elective joint arthroplasty. Twenty-eight studies were included in the final review, of which 21 (75%) were randomized controlled (Level I) trials, two (7%) were prospective comparative (Level II) studies, two (7%) used a case-control (Level III) design, and three (11%) used retrospective comparative (Level III) methodology.

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Section: Multimodal Anesthetic Techniquesmentioning

confidence: 98%

Section: Study Designs and Populationsmentioning

confidence: 99%

Section: Study Designs and Populationsmentioning

confidence: 99%

See 1 more Smart Citation

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

Zywiel

Prabhu

Perruccio

et al. 2014

Clinical Orthopaedics &Amp; Related Research

104

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“…Mobile bearing TKA [16], sex-specific TKA [6], high-flexion TKA [40,55], and refinements in the design of cruciate-retaining (CR) and posterior-stabilized (PS) TKA [4,14,33,64] have all been introduced in recent years. In addition, improvements in perioperative management, including more limited incisions [62] and multimodal pain management [23,44], have been instituted to speed the recovery process and potentially improve the ultimate patient outcome and satisfaction with TKA.…”

Section: Introductionmentioning

confidence: 99%

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Barrack¹,

Ruh²,

Chen³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

144

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Background Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known. Questions/purposes We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients. MethodsWe surveyed 661 patients (average age, 54 years; range, 18-60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest. One of the authors certifies that he (RLB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Smith & Nephew, Inc, and an amount of more than USD 1,000,001 from Stryker Orthopaedics. One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc, and an amount of USD 10,000 to 100,000 from Innomed, Inc (Savannah, GA, USA). One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc.One of the authors certifies that he (JP) has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of USD 10,000 to 100,000 from 3 M, an amount of USD 10,000 to 100,000 from Cadence Pharmaceuticals, Inc (San Diego, CA, USA), an amount of USD 10,000 to 100,000 from CeramTec (Laurens, SC, USA), an amount of USD 10,000 to 100,000 from Pfizer (New York, NY, USA), an amount of USD 10,000 to 100,000 from Salient Surgical (Minneapolis, MN, USA), an amount of USD 10,000 to 100,000 from TissueGene (Rockville, MD, USA), and an amount of USD 10,000 to 100,000 from Zimmer Inc. One of the authors certifies that he (CDV) has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Biomet Inc, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of less than USD 10,000 from ConvaTec (Skillman, NJ, USA), and an amount of less than USD 10,000 from CD Diagnostics (Wynnewood, PA, USA). One of the authors certifies that he (WGH) has or may receive payments or benefits, during the study period, an amount of USD 100,001 to 1,000,000 from DePuy, a Johnson and Johnson company, and an amount of USD 1...

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“…From these we identified 12 eligible RCTs. [3][4][5][6][7][8][9][10][11][12][13][14] Inter-observer agreement for trial eligibility was good (kappa = 0.75; SE 0.053). Table I reports the characteristics of the included trials and the local anaesthetic protocols used in the trials.…”

Section: Trial Identification and Selectionmentioning

confidence: 95%

Periarticular local anaesthetic in knee arthroplasty: A systematic review and meta-analysis of randomised trials

Gibbins¹,

Kane²,

Smit³

et al. 2016

SA orthop. j.

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IntroductionThe provision of adequate post-operative analgesia in patients undergoing knee arthroplasty presents a significant challenge. A multimodal approach to pain control in these patients has been commonly adopted with regimens including opioids, nonsteroidal anti-inflammatory drugs, adjuncts such as gabapentin or pregabalin, and the use of neuraxial and peripheral nerve blockade. Peri-articular injections and infusion of local anaesthetic holds great attraction as it provides localised analgesia without the side effects often seen with neuraxial or peripheral nerve blockade. This systematic review and meta-analysis aimed to determine whether, in adults undergoing knee arthroplasty, adding peri-articular local anaesthetic to a post-operative pain regimen improved post-operative pain scores. AbstractBackground: This systematic review and meta-analysis aimed to quantify the effect of adding peri-articular local anaesthetic infiltration or infusion to an analgesic strategy in patients undergoing knee arthroplasty.

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The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

Cited by 52 publications

References 34 publications

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Periarticular local anaesthetic in knee arthroplasty: A systematic review and meta-analysis of randomised trials

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