Abstract:
BACKGROUND:Previously, we have demonstrated that extending a continuous femoral nerve block (cFNB) from overnight to 4 days after total knee arthroplasty (TKA) provides clear benefits during the infusion, but not subsequent to catheter removal. However, there were major limitations in generalizing the results of that investigation, and we subsequently performed a very similar study using a multicenter format, with many health care providers, in patients on general orthopedic wards, thus greatly improving inference of the results to the general population. Not surprisingly, the perioperative/short-term outcomes differed greatly from the first, more limited study. We now present a prospective follow-up study of the previously published, multicenter, randomized controlled clinical trial to investigate the possibility that an extended ambulatory cFNB decreases long-term pain, stiffness, and functional disability after TKA, which greatly improves inference of the results to the general population. METHODS:Subjects undergoing TKA received a cFNB with ropivacaine 0.2% from surgery until the following morning, at which time patients were randomized to continue either perineural ropivacaine (n=28) or normal saline (n=26). Patients were discharged with their catheter and a portable infusion pump, and catheters were removed on postoperative day 4. Health-related quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index preoperatively and then at 7 days, as well as 1, 2, 3, 6, and 12 months after surgery. This index evaluates pain, stiffness, and physical functional disability. For inclusion in the analysis, we required a minimum of 4 of the 6 time points, including day 7 and at least 2 of months 3, 6, and 12. RESULTS:The 2 treatment groups had similar Western Ontario and McMaster Universities Osteoarthritis scores for the mean area-under-the-curve calculations (point estimate for the difference in mean area under the curve for the 2 groups [overnight infusion group - extended infusion group]=3.8; 95% confidence interval, -3.8 to +11.3; P=0.32) and at all individual time points (P>0.05). CONCLUSIONS:This investigation found no evidence that extending an overnight cFNB to 4 days improves (or worsens) subsequent pain, stiffness, or physical function after TKA in patients of multiple centers convalescing on general orthopedic wards.
journal_name
Reg Anesth Pain Medjournal_title
Regional anesthesia and pain medicineauthors
Ilfeld BM,Shuster JJ,Theriaque DW,Mariano ER,Girard PJ,Loland VJ,Meyer S,Donovan JF,Pugh GA,Le LT,Sessler DI,Ball STdoi
10.1097/aap.0b013e3182052505subject
Has Abstractpub_date
2011-03-01 00:00:00pages
116-20issue
2eissn
1098-7339issn
1532-8651journal_volume
36pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Neosaxitoxin (NeoSTX) is a potent site-1 sodium-channel blocker being developed as a local anesthetic. Doses of 100 μg have been used by local infiltration in anesthetized adult humans without adverse effect. We hypothesized that similar doses could cause significant respiratory, neuromuscular, and cardiovas...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e3182424566
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:S(-)-Bupivacaine has the pharmacotoxicological advantage over its antipode and racemate. The interaction with lipid membranes was compared between S(-)-, R(+)- and racemic bupivacaine. METHODS:The bupivacaine-induced changes in membrane property were determined by turbidity and fluorescence p...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2007.05.011
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The typical blind insertion of a catheter into the epidural space risks catheter misplacement into the intrathecal space. The epidural stimulation test is designed to confirm the correct epidural location of a catheter but may also detect unintended intrathecal catheter placement by evaluating...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/aap.0b013e3181bfbe1e
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Peripheral nerve and spinal cord stimulation techniques have been used for many years. However, electrical stimulation methods rarely have been used to confirm epidural catheter placement. This study examines the practicality of this technique to confirm epidural catheter placement in obstetri...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s1098-7339(99)90160-8
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The aim of this study is to examine the effects of head-up tilt (70 degrees ) 30 minutes after right or left stellate ganglion block (SGB) on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QT dispersion (QTcD) using computerized meas...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2004.03.009
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The benefit of adding sciatic nerve block (SNB) to femoral nerve block to improve analgesia after total knee arthroplasty (TKA) is uncertain. We hypothesized that the effective duration of single-injection SNB is too short to improve postoperative analgesia and that this contributes to conflic...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0000000000000076
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Gabapentin is an anticonvulsant that has been shown to be effective in the treatment of neuropathic and inflammatory pain in animal and human studies. The analgesic effect of its perioperative use has not been fully elucidated. METHODS:This systematic review (meta-analysis) included 12 random...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,meta分析
doi:10.1016/j.rapm.2006.01.005
更新日期:2006-05-01 00:00:00
abstract:INTRODUCTION:The posterior lumbar plexus block (LPB) has been used for decades to provide acute pain management after hip surgery. Unfamiliarity with the technique and its perceived difficulty, potential risks, and possible adverse effects such as quadriceps weakness have limited broader use. The quadratus lumborum blo...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2020-101915
更新日期:2021-02-01 00:00:00
abstract::High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dos...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0000000000000416
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Accurate needle control during ultrasound (US)-guided nerve blocks may be an elusive goal for the anesthesiologist. Despite modifications to increase echogenicity, needle visibility still requires precise alignment within the transducer beam. In this study, we evaluated a magnetically guided u...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0000000000000390
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Dorsal root ganglion stimulation is an emerging therapy in the treatment of chronic pain. Compared with traditional spinal cord stimulation, it allows a discretely targeted stimulation profile and may act via differing mechanisms of action. Despite these advantages, little is known about the c...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2018-000007
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective w...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/j.rapm.2007.12.010
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Spontaneous intracranial hypotension is a postural headache syndrome unrelated to dural puncture. Due to the apparent failure of epidural blood patch to relieve headache in spontaneous intracranial hypotension, we investigated the epidemiologic features and treatment outcomes of this condition...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1053/rapm.2001.28275
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVES:The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compressi...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1016/j.rapm.2004.01.012
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-gui...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e318228d1c0
更新日期:2011-09-01 00:00:00
abstract::The blood-brain barrier (BBB) describes the unique properties of endothelial cells (ECs) that line the central nervous system (CNS) microvasculature. The BBB supports CNS homeostasis via EC-associated transport of ions, nutrients, proteins and waste products between the brain and blood. These transport mechanisms also...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2020-101403
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Numerous factors are considered in the academic promotion of pain medicine physicians. In this study, we investigated the importance of research productivity, career duration, leadership, and gender on attaining professorship in chronic pain medicine fellowship programs in the USA. METHODS:We identified 98 ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2019-101139
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Despite ultrasound (US) guidance, sciatic nerve block (SNB) remains among the least performed peripheral blocks. By targeting the tissue plane between the gluteus maximus and quadratus femoris muscles, the US-guided subgluteal space technique may facilitate the performance of US-guided SNB. We...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0000000000000016
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Paresthesia occasionally occurs during dural puncture or injection of local anesthetic for spinal anesthesia. Although the incidence of neurologic complications after spinal anesthesia is extremely low, the significance of paresthesia is unknown. The influence of known lumbar spine pathology o...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/s1098-7339(98)90081-5
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVE:We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. CASE REPORT:A 36-year-old man underwent ultrasound-guided interscalene nerve blockade before shoulder incision and drainage. On postoperative day 1, he exhibi...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/aap.0b013e3181e8a35f
更新日期:2010-07-01 00:00:00
abstract::Abrupt cessation of intrathecal baclofen (ITB) administration can cause a life-threatening withdrawal syndrome that requires prompt diagnosis and urgent treatment. The current therapy for this condition is administration of propofol, benzodiazepines, paralytics and supportive care. This study reports a 53-year-old pat...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1097/AAP.0b013e3181b4cc6b
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Adenosine is an endogenous compound that may have analgesic effects. Results from clinical trials are not consistent, however, and there is a need for large-scale, randomized, placebo-controlled studies to clarify the role of adenosine in the treatment of pain states, including acute nocicepti...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/rapm.2001.22256a
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Pregabalin is often used as a perioperative analgesic adjunct; some studies show benefit, but others do not. Adverse effects, such as confusion and sedation, have been attributed to perioperative use of pregabalin. We tested the hypothesis that pregabalin, when used as part of a multimodal ana...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31824c6846
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Several studies have evaluated the effect of pectoral nerve blocks to improve postoperative analgesia following breast cancer surgery resulting in contradictory findings. The aim of this study was to examine the effect of Pecs blocks on postoperative analgesia in women following mastectomies. ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1136/rapm-2019-100658
更新日期:2019-08-09 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The American College of Obstetricians & Gynecologists has opposed postpartum tubal ligation (PPTL) in patients whose pregnancies have been complicated by a medical condition, including hypertension. A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL i...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1053/rapm.2000.0250170
更新日期:2000-03-01 00:00:00
abstract::The development of chronic pain is a complex mechanism that is still not fully understood. Multiple somatic and visceral afferent pain signals, when experienced over time, cause a strengthening of certain neural circuitry through peripheral and central sensitization, resulting in the physical and emotional perceptual ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1136/rapm-2020-101273
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. CASE REPORT:We managed ...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章
doi:10.1016/s1098-7339(99)90015-9
更新日期:1999-09-01 00:00:00
abstract::Conventional opioids are widely used for acute pain management in the postoperative setting. However, a primary concern with conventional opioids is their therapeutic window-the range between doses that produce the desired therapeutic effect (analgesia) and doses that produce unwanted opioid-related adverse events (OR...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,评审
doi:10.1136/rapm-2018-000010
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Whether patients titrate themselves to an individualized blood or plasma opioid concentration (the so-called minimum effective concentration or [MEC]) has been debated extensively. Nevertheless, there is consistent opinion that during patient controlled analgesia (PCA) patients balance accepta...
journal_title:Regional anesthesia and pain medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s1098-7339(00)90008-7
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Recent clinical trials suggest that subfascial (sometimes termed subepineural) injections result in faster block onset and success compared with conventional techniques. This prospective, randomized, observer-blinded study measured and compared the 3-dimensional spread pattern and volume of pe...
journal_title:Regional anesthesia and pain medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/AAP.0b013e31826af511
更新日期:2012-11-01 00:00:00