Toward Outpatient Arthroplasty

McGraw, Robert P.; Ilfeld, Brian M.

doi:10.1097/aia.0b013e3182101124

Cited by 15 publications

(2 citation statements)

References 92 publications

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“…172,187 A second goal of ambulatory infusion eventually developed: using improved pain control to allow patientswho would be expected to remain in the hospital-to be instead discharged earlier than otherwise possible. 188,20,175 Theoretical benefits include improved patient satisfaction, decreased risk of nosocomial infection and health care provider error, and decreasing health care-related costs. 170,189,190 Although multiple RCTs demonstrate that ambulatory CPNB reduces the time until discharge readiness, 1 only 2 have demonstrated a shortening of actual hospitalization duration.…”

Section: Ambulatory Perineural Infusionmentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

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282

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A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim. Novel insertion sites include the adductor canal, interpectoral, quadratus lumborum, lesser palatine, ulnar, superficial, and deep peroneal nerves. Noteworthy new indications include providing analgesia after traumatic rib/femur fracture, manipulation for adhesive capsulitis, and treating abdominal wall pain during pregnancy. The preponderance of recently published evidence suggests benefits nearly exclusively in favor of catheter insertion using ultrasound guidance compared with electrical stimulation, although little new data are available to help guide practitioners regarding the specifics of ultrasound-guided catheter insertion (eg, optimal needle-nerve orientation). After some previous suggestions that automated, repeated bolus doses could provide benefits over a basal infusion, there is a dearth of supporting data published in the past few years. An increasing number of disposable infusion pumps does now allow a similar ability to adjust basal rates, bolus volume, and lockout times compared with their electronic, programmable counterparts, and a promising area of research is communicating with and controlling pumps remotely via the Internet. Large, prospective studies now document the relatively few major complications during ambulatory CPNB, although randomized, controlled studies demonstrating an actual shortening of hospitalization duration are few. Recent evidence suggests that, compared with femoral infusion, adductor canal catheters both induce less quadriceps femoris weakness and improve mobilization/ambulation, although the relative analgesia afforded by each remains in dispute. Newly published data demonstrate that the incidence and/or severity of chronic, persistent postsurgical pain may, at times, be decreased with a short-term postoperative CPNB. Few new CPNB-related complications have been identified, although large, prospective trials provide additional data regarding the incidence of adverse events. Lastly, a number of novel, alternative analgesic modalities are under development/investigation. Four such techniques are described and contrasted with CPNB, including single-injection peripheral nerve blocks with newer adjuvants, liposome bupivacaine used in wound infiltration and peripheral nerve blocks, cryoanalgesia with cryoneurolysis, and percutaneous peripheral nerve stimulation.

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Section: Ambulatory Perineural Infusionmentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

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282

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“…Although knee replacement surgery is a major operation, the length of hospitalisation has declined in recent decades, from 10-14 days to approximately 2-3 days (33,(42)(43)(44)(45)(46)(47)(48)(49). This tendency seems to remain, and some go further, suggesting same-day admission and discharge of patients (39,50,51). Preoperative education is usually offered to patients and their relatives 1-4 weeks prior to the surgery and is organised in most departments as group sessions (33,43,52).…”

Section: The Trajectory Of Surgical Treatment and Carementioning

confidence: 99%

Investigation and Identification of Patients with Enhanced Care Needs after Knee Replacement Surgery

Buus¹

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Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults

Guay

Johnson

Kopp

2017

Cochrane Database of Systematic Reviews

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Compared to systemic analgesia alone, there is moderate-quality evidence that peripheral nerve blocks reduce postoperative pain, low-quality evidence that patient satisfaction is increased and very low-quality evidence for reductions in acute confusional status, pruritus and hospital length of stay .We found moderate-quality evidence that peripheral nerve blocks reduce pruritus compared with neuraxial blocks.The 11 ongoing studies, once completed, and the three studies awaiting classification may alter the conclusions of the review once assessed.

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Toward Outpatient Arthroplasty

Cited by 15 publications

References 92 publications

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Investigation and Identification of Patients with Enhanced Care Needs after Knee Replacement Surgery

Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults

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