The Impact of Analgesic Modality on Early Ambulation Following Total Knee Arthroplasty

Perlas, Anahi; Kirkham, Kyle R.; Billing, Rajeev; Tse, Cyrus; Brull, Richard; Gandhi, Rajeev; Chan, Vincent

doi:10.1097/aap.0b013e318296b6a0

Cited by 146 publications

(119 citation statements)

References 17 publications

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“…1 Therefore, effective pain management is essential to facilitate proper rehabilitation and acceleration of the return to functional capability. 2 Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits.…”

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confidence: 99%

“…opioids like morphine, buprenorphine, pethidine, hydromorphone, fentanyl, sufentany and tramadol. 1,3 Other classes of drugs such as epinephrine, midazolam, neostigmine, ketamine, magnesium and clonidine have been added to the intrathecal local anaesthetics to prolong the analgesic effect and to reduce the incidence of adverse events. [4][5][6][7] These opioids produce satisfactory analgesia for 24hours postoperatively, but are frequently associated with side effects like respiratory depression, itching, nausea, vomiting and urinary retention.…”

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confidence: 99%

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Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Chandra¹,

Krishna

Singh

2017

Int Surg J

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Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

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confidence: 99%

mentioning

confidence: 99%

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Chandra¹,

Krishna

Singh

2017

Int Surg J

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“…7,8 Lorsqu'il est ajouté à une infiltration locale périarticulaire, le BCA procure une analgésie de qualité tout en favorisant une ambulation et un congé rapides. 9 Ceci étant dit, le BCA n'est pas sans défaut; en effet, certaines publications font état d'une faiblesse au niveau du quadriceps 10 ainsi que de BNS partiel non voulu. 11 En outre, le BCA doit être réalisé avec soin étant donné que le site d'injection est proche de vaisseaux majeurs, ce qui augmente le risque de toxicité systémique.…”

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“…7,8 When used in addition to periarticular local infiltration, ACB provides quality analgesia and rapid ambulation and home discharge. 9 Nevertheless, ACB is not without its shortcomings; indeed, reports of quadriceps weakness 10 and unwanted partial SNB 11 have been published. In addition, ACB must be performed with care since the injection site is close to major vessels (increasing the risk of systemic toxicity).…”

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confidence: 99%

Narrowing the blockade field: development of an optimal postoperative analgesia regimen for total knee arthroplasty

Tsui

2016

Can J Anesth/J Can Anesth

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Total knee arthroplasty (TKA) is associated with significant postoperative pain. Pain management for TKA is complex, and even with administration of multiple nerve blocks, highquality postoperative analgesia cannot always be achieved. Multiple regional approaches, including femoral nerve block (FNB), fascia iliaca block, conventional or three-in-one (i.e., inguinal paravascular) lumbar plexus block, and adductor canal block (ACB) (with or without periarticular infiltration), have been attempted to minimize knee pain following the procedure with variable success. 1,2Historically, FNB has been the most commonly performed regional technique. Although FNB provides substantial coverage of the operative area, it may spare areas innervated by other inferior branches of the lumbar plexus, including the lateral femoral cutaneous and obturator nerves, resulting in inadequate analgesia. Since branches of the sciatic nerve also innervate the knee, various studies have examined whether supplementing FNB with sciatic nerve block (SNB) provides superior analgesia following TKA. In this issue, Abdallah et al. discuss their meta-analysis of several recent randomized-controlled trials, which they performed in an attempt to address the effectiveness of a combined FNB and SNB approach. 3 The authors show that, although individual studies provide mixed results, overall trends suggest that combining SNB and FNB can reduce opioid consumption and alleviate knee pain postoperatively compared with FNB alone.As Gaston Labat, the father of modern regional anesthesia, stated in his classic textbook, ''Anatomy is the foundation upon which the entire concept of regional anesthesia is built.'' 4 Thus, a comprehensive understanding of anatomy is critical in order to select the appropriate block for the procedure and to provide effective analgesia. Branches from the lumbar (femoral and obturator nerves) and sacral (tibial and common peroneal nerves) plexuses provide innervation to the knee joint, and the saphenous nerve, a branch of the posterior division of the femoral nerve, provides some sensory supply to the medial aspect of the knee. The involvement of multiple nerves highlights the complexity of providing quality analgesia following knee surgery. In theory, a combination of lumbar plexus block and proximal SNB would provide the most effective analgesia; however, this approach would be complicated technically and would likely result in extensive motor block of the entire lower extremity. Although FNB is generally considered the gold standard for TKA analgesia, it has declined in popularity in favour of approaches that block a narrower region proximal to the knee. Indeed, one reason FNB has gradually fallen out of favour is its propensity for prolonged motor blockade. This attribute can cause quadriceps weakness and a delay in patient mobilization and rehabilitation, which raises concerns about delayed discharge from the hospital. Since proximal SNBs (which were the only approaches included in the Abdallah et al. meta-analysis) target the sc...

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“…1 Multimodel drug analgesia as well as regional techniques have been the most common practice to treat perioperative pain but no method has been identified as yet to specifically block nociception without associated side effects. 2 Intrathecal block is preferred technique because it is simple and easy to administer, quite economical, has a rapid onset of action with less failure rates and superior level of blockade.…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Intrathecal Use of two Different Doses of Dexmedetomidine Along with Bupivacaine in Lower Abdominal Surgeries

Bansal¹,

Khatri²

2016

IOSR

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Abstract:Introduction: group B 11.6±1.12, group D5 5.84±2.02, group D10-4.92±1.23 (p <0.001). Total duration of sensory block was (in minutes) group B 172.61±24.68, group D5 268.34±28.42, group D10 346.28±44.8 (p <0.001). Total duration of motor block (in minutes) group B 150.66±18.64, group D5 268.44±24.85, group D10 322.9±49.68 (p <0.001). Duration of analgesia (in minutes) -group B 124.01±8.552, group D5 194.68±18.44, group D10 290.48±20.64 (p <0.001). Conclusion: dexmedetomidine added to hyperbaric bupivacaine intrathecally has a dose dependent favourable effect on the onset and regression of motor and sensory block.

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The Impact of Analgesic Modality on Early Ambulation Following Total Knee Arthroplasty

Abstract: Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.

Cited by 146 publications

References 17 publications

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Narrowing the blockade field: development of an optimal postoperative analgesia regimen for total knee arthroplasty

Comparative Evaluation of Intrathecal Use of two Different Doses of Dexmedetomidine Along with Bupivacaine in Lower Abdominal Surgeries

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