Remote transmission monitoring for postoperative perineural analgesia after major orthopedic surgery: A multicenter, randomized, parallel-group, controlled trial

2022 ◽  
Vol 77 ◽  
pp. 110618
Author(s):  
Xavier Capdevila ◽  
Philippe Macaire ◽  
Nathalie Bernard ◽  
Philippe Biboulet ◽  
Philippe Cuvillon ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Remote Transmission ◽  
Parallel Group ◽  
Major Orthopedic Surgery

scholarly journals Antifibrinolytic Therapy and Perioperative Blood Loss in Cancer Patients Undergoing Major Orthopedic Surgery

2003 ◽  
Vol 98 (2) ◽  
pp. 337-342 ◽  
Author(s):  
David Amar ◽  
Florence M. Grant ◽  
Hao Zhang ◽  
Patrick J. Boland ◽  
Denis H. Leung ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cancer Patients ◽  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Caproic Acid ◽  
Double Blind ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements ◽  
Major Orthopedic Surgery ◽  
Duration Of Surgery

Background Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse. Methods Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n = 23), bolus of 2 x 10(6) kallikrein inactivator units (KIU), followed by an infusion of 5 x 10(5) KIU/h, or EACA (n = 22), bolus of 150 mg/kg, followed by a 15 mg/kg/h infusion or saline placebo (n = 24) during surgery. Our goal was to determine whether prophylactic EACA or aprotinin therapy would reduce perioperative blood loss (intraoperative + first 48h) >30% when compared to placebo. Results The mean age of the study population was 52 +/- 17 yr. The groups did not differ in age, duration of surgery, perioperative blood loss or number of packed erythrocyte units transfused. When compared to the placebo group, the two treated groups had a significantly lower D-Dimer level immediately after surgery, P < 0.01. Conclusions Under the conditions of this study, we were unable to find a clinical benefit to using aprotinin or EACA to reduce perioperative blood loss or transfusion requirements during major orthopedic surgery in cancer patients.

scholarly journals Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Hong ◽  
Da-Zhi Zhang ◽  
Mo Li ◽  
Geng Wang ◽  
Sai-Nan Zhu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Adverse Events ◽  
Sleep Quality ◽  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Median Difference ◽  
Randomized Controlled ◽  
Link Type ◽  
Major Orthopedic Surgery ◽  
Intravenous Analgesia

Abstract Background Dexmedetomidine promotes normal sleep architecture; the drug also improves analgesia. We therefore tested the hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in older patients recovering from orthopedic surgery. Methods In this double-blinded randomized controlled trial, we enrolled 712 older (aged 65–90 years) patients scheduled for major orthopedic surgery. Postoperative analgesia was provided by patient-controlled intravenous sufentanil, supplemented by randomly assigned dexmedetomidine (1.25 μg/mL) or placebo, for up to three days. The primary outcome was the incidence of delirium assessed twice daily with the Confusion Assessment Method. Among secondary outcomes, pain severity was assessed twice daily and sleep quality once daily, each with an 11-point scale where 0 = no pain/the best possible sleep and 10 = the worst pain/the worst possible sleep. Results The incidence of postoperative delirium was 7.3% (26 of 354) with placebo and 4.8% (17 of 356) with dexmedetomidine; relative risk 0.65, 95% CI 0.36 to 1.18; P = 0.151. Dexmedetomidine reduced pain both at rest (median difference -1 to 0 points, P ≤ 0.001) and with movement (-1 points, P < 0.001) throughout the first 5 postoperative days; it also improved subjective sleep quality during the first 3 postoperative days: day one median difference -1 point (95% CI -1 to 0), P = 0.007; day two 0 point (-1 to 0), P = 0.010; and day three 0 point (-1 to 0), P = 0.003. The incidence of adverse events was similar in each group. Conclusions Supplementing sufentanil intravenous analgesia with low-dose dexmedetomidine did not significantly reduce delirium, but improved analgesia and sleep quality without provoking adverse events. Trial registration www.chictr.org.cn: ChiCTR1800017182 (Date of registration: July 17, 2018); ClinicalTrials.gov:NCT03629262 (Date of registration: August 14, 2018).

scholarly journals Combination of gabapentin and celecoxib for analgesia after major orthopedic surgery: a randomized, controlled trial

2011 ◽  
Vol 5 (1) ◽  
pp. 101-110 ◽  
Author(s):  
Waraporn Waikakul ◽  
Theerawat Chalachewa ◽  
Nuj Tantisirin ◽  
Pet-eng Suranutkarin ◽  
Nadhaporn Saengpetch
Keyword(s):  
Pain Score ◽  
Orthopedic Surgery ◽  
Controlled Trial ◽  
Patient Controlled Analgesia ◽  
Randomized Controlled ◽  
Post Operative Pain ◽  
Major Orthopedic Surgery ◽  
Intravenous Morphine ◽  
Sparing Effect ◽  
Double Blinded

Abstract Background: The use of analgesics with different mechanism of action enhances post-operative pain relief by opioids. Both celecoxib and gabapentin have opioid-sparing effect, but it is unclear whether combination of the two drugs accentuates postoperative analgesia and further reduced opioid requirement. Objective: Determine whether the perioperative use of celecoxib in combination with gabapentin reduces the amount of post-operative opioid consumption in comparison to celecoxib alone or gabapentin alone in patients that have major orthopedic surgery. Materials and methods: Randomized double-blinded placebo controlled trial was done in 99 patients underwent major orthopedic surgery. They were randomly allocated into four groups. One to two hours before anesthesia, they received midazolam 7.5 mg plus study drugs. Group P received placebo plus placebo at 12 and 24 hours later. Group C received celecoxib 400 mg plus celecoxib 200 mg at 12 and 24 hour later. Group G received gabapentin 400 mg plus gabapentin 300 mg at 12 and 24 hour later. Finally, group CG received celecoxib 400 mg + gabapentin 400 mg plus celecoxib 200 mg + gabapentin 300 mg at 12 and 24 hour later. The patients underwent surgery under general anesthesia. Post-operative pain was treated by intravenous morphine patient-controlled analgesia. Results: Median morphine consumption (minimum-maximum) in twenty-four hours was 18.0, 15.0, 15.5, and 8.0 mg, in group P, C, G, and CG, respectively. The group CG significantly consumed less morphine (41%) in 24 hour than group G, but not significantly less (38%) than group C. Pain score, sedation score, and nausea/vomiting at postoperative hour 1, 4, 8, 12, 16, 20, and 24 was not significantly different. Conclusion: Combination of celecoxib and gabapentin further accentuated post-operative analgesia by morphine comparing to celecoxib or gabapentin alone without change in pain score and other side effects of the medications.

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