Early Stage Versus Late Stage Periarticular Injection during Unicompartmental Knee Arthroplasty for Postoperative Pain Relief: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Wang Chen ◽  
Jian-Ning Sun ◽  
Zheng-Hao Hu ◽  
Yu Zhang ◽  
Xiang-Yang Chen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Knee Arthroplasty ◽  
Late Stage ◽  
Early Stage ◽  
Drug Dosage ◽  
Rescue Analgesia ◽  
Periarticular Injection ◽  
Injection Group ◽  
The Difference

AbstractControlling postoperative pain after unicompartmental knee arthroplasty (UKA) is essential to improve patient satisfaction and promote early recovery. The purpose of this study was to investigate the difference in clinical efficacy between early and late stage periarticular injection during UKA for postoperative pain relief. Eighty-four patients meeting the inclusion and exclusion criteria were randomly divided into the early stage periarticular injection group and late stage periarticular injection group by using a random number tables method. The difference between the two groups was that the early stage periarticular injection group received superficial injection before the joint incision, while the late stage periarticular injection group received superficial injection after implantation of the prosthesis. Deep injection and other perioperative conditions of the two groups were controlled identically. The primary outcome of the study was the recovery room immediate visual analog scale (VAS) at rest. The secondary outcomes were the postoperative VAS (at rest) at 3, 6, 9, 12, 18, 24, 48, 72, 96, and 120 hours, drug dosage of rescue analgesia, range of motion (ROM), and complications. The recovery room immediate VAS (at rest) in the early stage periarticular injection group was significantly lower than that of the late stage periarticular injection group (21 ± 24 vs. 32 ± 34 mm, p = 0.018), the average difference of the VAS reached the minimal clinically important difference. No statistically significant difference in postoperative drug dosage of rescue analgesia, ROM, and complications. Preemptive analgesia combined with the early stage periarticular injection can better alleviate postoperative pain than the late stage periarticular injection.

scholarly journals Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective, Randomized, Single-blinded Controlled Study

2017 ◽  
Vol 2 (2) ◽  
pp. 51-57
Author(s):  
Meenoti P Potdar ◽  
Ajay Tomar ◽  
Laxmi Kamat
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Adverse Effects ◽  
Epidural Analgesia ◽  
Knee Arthroplasty ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Total Knee ◽  
Postoperative Epidural Analgesia

ABSTRACT Aim The primary aim of the study was to compare epidural ropivacaine with fentanyl and epidural bupivacaine with fentanyl for postoperative epidural analgesia after total knee arthroplasty (TKA). The secondary objective was to assess the outcomes of passive and active mobilizations postoperatively, requirement of rescue analgesia, and adverse effects, such as nausea vomiting, sedation, numbness, motor weakness, hypotension, and respiratory depression. Materials and methods After obtaining hospital ethics committee approval and written informed consent, 100 patients were randomly allocated to two groups of 50 each. Group B received 0.125% bupivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Group R received 0.2% ropivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Patients of American Society of Anesthesiologists (ASA) grades I to II of both sexes undergoing elective TKA and giving written consent were included in the study. Patients with coagulation disorders, history of spine surgery, vertebral deformities, and having contraindications for spinal analgesia were excluded from the study. All patients were preoperatively assessed and clinically evaluated thoroughly. They received conventional combined spinal epidural anesthesia followed by epidural infusion in the postoperative period of ropivacaine fentanyl or bupivacaine fentanyl as per the allocation. The postoperative epidural analgesia was supplemented with intravenous (IV) paracetamol 1 gm TDS, and rescue analgesia, if needed, was given with IV tramadol 50 mg. All patients were monitored for postoperative pain by the visual analog scale (VAS), requirement of rescue analgesia, hemodynamic parameters, sedation scores, and adverse effects. How to cite this article Potdar MP, Tomar A, Kamat L. Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective, Randomized, Single-blinded Controlled Study. Res Inno in Anesth 2017;2(2):51-57.

scholarly journals Percutaneous periarticular analgesic injection at one day after simultaneous bilateral total knee arthroplasty: an open-label randomized control trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takuya Iseki ◽  
Sachiyuki Tsukada ◽  
Motohiro Wakui ◽  
Kenji Kurosaka ◽  
Shinichi Yoshiya ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Medical Information ◽  
University Hospital ◽  
Open Label ◽  
Periarticular Injection ◽  
Injection Group ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Abstract Background The postoperative pain after total knee arthroplasty (TKA) remains a critical issue. The aim of this study was to assess the clinical effectiveness of percutaneous periarticular injection at 1 day following simultaneous bilateral TKA. Methods A total of 88 knees in 44 patients who underwent simultaneous bilateral TKA were randomly assigned to receive a percutaneous periarticular injection at 1 day following surgery (n = 22 patients) or no injection (n = 22 patients). In the additional injection group, we injected a solution including methylprednisolone, ropivacaine, and epinephrine into the muscle belly of the vastus medialis at 1 day after surgery. In both groups, patients received an intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. The primary outcome measure was the postoperative pain at rest using a visual analog scale (VAS) and analyzed with Student’s t test. Results Compared to the no additional injection group, the additional periarticular injection group had significantly lower VAS score at 8:00 PM postoperative day 1, 6:00 AM postoperative day 2, 12:00 PM postoperative day 2, 6:00 AM postoperative day 5, 12:00 PM postoperative day 5, and 8:00 PM postoperative day 5 (p < 0.05). The rate of complication did not differ between groups (p > 0.05). Conclusion Additional percutaneous periarticular injection at 1 day following TKA adding to intraoperative periarticular injection provided better postoperative pain relief. Trial registration Registered at the University Hospital Medical Information Network (registration number: UMIN000029759).

scholarly journals Combined popliteal and saphenous nerve block vs NSAIDS for post operative analgesia in below knee surgery patients: A cross-sectional study

2021 ◽  
Vol 8 (4) ◽  
pp. 556-560
Author(s):  
Amrita Gupta ◽  
Shanu Maheshwari ◽  
Avanish Kumar Saxena ◽  
Sukhdev Mishra ◽  
Aviral Pandey
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Nerve Block ◽  
Saphenous Nerve ◽  
Knee Surgery ◽  
Postoperative Pain Relief ◽  
Ratio Test ◽  
Type I ◽  
Complication Rates ◽  
Rescue Analgesia

Peripheral nerve blocks are becoming increasingly popular to control postoperative pain in orthopaedic limb surgeries. An outstanding feature of nerve block is its lack of adverse effects, reduced requirement of analgesics and better patient satisfaction. To compare the efficacy of combined popliteal and saphenous nerve block with NSAIDS for postoperative pain relief in below knee surgery patients. We performed a prospective randomized study involving seventy patients. All patients underwent an elective orthopaedic procedure below knee under spinal anaesthesia. Thirty five patients had received a combined popliteal and saphenous nerve block and the rest thirty-five received intravenous NSAIDS at the end of surgical procedure. Post operative VAS Score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any were noted.: The statistical power of sample was 80% and type I error (α) of 0.05. The distribution of the data was evaluated using the Shapiro-Wilk test. For data with a non-normal distribution, the Mann-Whitney U test was used in intergroup comparisons. The data were expressed as the median, minimum and maximum (min-max). For comparison of postoperative analgesic use, the chi-square test was used, and complication rates were compared using a cross-ratio test. P-values less than 0.05 were considered to be statistically significant in all the analyses.: Patients with a combined popliteal and saphenous nerve block had significantly less pain at six hours, twelve hours and twenty four hours (p value &#60;0.001) postoperatively. Time for request of rescue analgesia was prolonged. Total diclofenac and anti emetic requirement was also reduced. Also higher level of satisfaction was achieved among this group of patients. : A combined popliteal and saphenous nerve block provides significantly better postoperative pain relief than NSAIDS in patients who underwent below knee surgeries.

Comparison of post-operative analgesic effect between Pregabalin and Gabapentin given as premedication drugs for patients undergoing laproscopic cholecystectomy

2021 ◽  
Vol 8 (2) ◽  
pp. 179-184
Author(s):  
Arun Kumar Balasubramanian ◽  
Rasikapriya Madhanagopal ◽  
Priyanka S Gowda ◽  
Brindha Rathnasabapathy ◽  
R Shankar
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Adverse Events ◽  
Multimodal Analgesia ◽  
Dose Requirement ◽  
College Hospital ◽  
Rescue Analgesia ◽  
Entire Study ◽  
The Difference

Currently most of the anesthetist prefer the usage of multimodal analgesia technique to improve the degree of pain relief without inducing any side effects. Pregabalin and gabapentin when given in higher doses reduces the preoperative anxiety and induce sedation without causing undesirable side effects.To compare and evaluate the effects of premedication drugs Pregabalin or Gabapentin versus placebo for attenuation of postoperative pain among patients undergoing laparoscopic cholecystectomy under general anaesthesia.A prospective comparative study was conducted for a period of 6 months in the department of anesthesiology of our medical college hospital. A total of 90 patients posted for elective laproscopic cholecystectomy in the age group between 20 and 60 years were taken as our study subjects. The entire study subjects were randomized into three groups of 30 each. Group B subjects received 3 tablets of Beplex forte (as placebo), Group G subjects received 3 tablets of Gabapentin 300mg (total 900mg) and Group P subjects received 3 tablets of Pregabalin 50mg (total 150mg). Post-operatively degree of pain, requirement for rescue analgesia, sedation score and adverse events occurred was monitored and analysed between the three groups. Pain score was less in the pregabalin group at all intervals compared to gabapentin and placebo group and the difference was found to be statistically significant. Maximum amount of tramadol requirement as a part of rescue analgesia was seen in the placebo group followed by gabapentin group and minimal dose requirement was needed for pregabalin group and the difference was found to be statistically significant. The occurrence of adverse events such as somnolence and dizziness was almost similar in all the three groups whereas the incidence of nausea and vomiting was less in pregabalin group compared to gabapentin and placebo group. Pregabalin can be effectively used as a part of the multimodal analgesic to prevent acute postoperative pain among patients undergoing elective laproscopic cholecystectomy.

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

2021 ◽  
Vol 15 (10) ◽  
pp. 2622-2624
Author(s):  
Haq dad Durrani ◽  
Rafia Kousar ◽  
Ejaz Iqbal ◽  
Muhammad Abdul Aziz ◽  
Syed Aushtar Abbas Naqvi ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Subcutaneous Tissue ◽  
Difficult Problem ◽  
P Value ◽  
Trial Methodology ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Significant Difference

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

scholarly journals Side-Effect Profiles And Efficacy Of Low Dose Intrathecal Morphine Combine With Periarticular Injection In Elective Primary Unilateral Total Knee Arthroplasty

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0009
Author(s):  
Chompunoot Pathonsamit ◽  
Pruk Chaiyakit ◽  
Ittiwat Onklin
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Side Effect ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Postoperative Pain Control ◽  
Periarticular Injection ◽  
Total Knee

Background: Total knee arthroplasty (TKA) is concerned as a severe postoperative pain procedure. Intrathecal morphine provides good analgesia but has many side effects such as nausea, vomiting, pruritus and respiratory depression. Appropriate postoperative pain control strategy with lower side effect is still challenging. We combined periarticular injection(PI) as a multimodal analgesia with intrathecal morphine in order to decrease intrathecal morphine dosage and lower side effects. Objective: To determine side-effect profiles and efficacy of 0.1 mg and 0.2 mg intrathecal morphine combine with PI in primary unilateral TKA. Material and method: In this prospective, double-blinded, randomized controlled trial. Patients undergoing TKA were recruited from April 2018 to April 2019. All patients were randomized into 3 groups. M 0 (n=32), M 1 (n=36)and M 2 (n=34) represent no intrathecal morphine, 0.1 mg and 0.2 mg intrathecal morphine respectively. All Group received same regimen of PI as a multimodal analgesia and same postoperative pain control protocol. Results: Patients in group M 2 had more nausea or vomiting side effects compared to group M 1 in early postoperative 4 hours(77.1% and 51.4%) with statistical significant(p<0.05) and also required 2 antiemetic drug to relieve symptoms (4.7% and 2.3%) with statistical significant ( p<0.05). No difference in postoperative pain score, rescue analgesic drug consumption ,pruritic score, sedation score, respiratory depression and orthopedic outcomes such as straight leg rising time and maximum active knee flexion between M 1 and M 2 groups. Conclusion: Lower intrathecal morphine dosage (0.1 mg) combine with periarticular injection in primary unilateral total knee arthroplasty provide similar postoperative pain control as standard intrathecal morphine dosage(0.2 mg) combine with periarticular injection with lower rates and severities of nausea and vomiting in first postoperative 4 hours.

Phase Formation and Growth Kinetics of an Interface Layer in Ni/SiC

2008 ◽  
Vol 600-603 ◽  
pp. 631-634
Author(s):  
Kenichiro Terui ◽  
Atsuko Sekiguchi ◽  
Hiroshi Yoshizaki ◽  
Junichi Koike
Keyword(s):  
Growth Rate ◽  
Late Stage ◽  
Growth Kinetic ◽  
Early Stage ◽  
Interface Reaction ◽  
Interface Layer ◽  
Nickel Silicide ◽  
Composition And Structure ◽  
The Difference ◽  
Kinetics Of

The reaction behavior and growth kinetic of reaction layer were investigated in the Ni contact to n-type 6H-SiC. Annealing was performed at temperature in the range between 800 and 1000 °C for 1 to 240 minutes in Ar atmosphere. The interface reaction of Ni/SiC starts with Ni diffusion into SiC. Ni3Si is initially precipitated and subsequently forms the continuous layer of d-Ni2Si. Kirkendall voids are formed at the reaction front. Carbon is segregated in the interface layer of nickel silicide. The growth rate of the interface layer follows a parabolic law, meaning that the growth rate is controlled by diffusion. The growth occurs in two steps at all examined temperatures: a fast growth is followed by a slow growth. In addition, in the late stage, the growth rate changes dramatically below and above 850°C. The observed growth kinetic can be explained by the difference of Ni diffusivity and the required concentration change for phase transition depending on the phase composition and structure. The d-Ni2Si is formed in the early stage, while the e-Ni3Si2 and q-Ni2Si are formed in the late stage below and above 850°C, respectively.

EFFICACY OF INTRAPERITONEAL INSTILLATION OF 0.2% ROPIVACAINE FOR POSTOPERATIVE PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 13-15
Author(s):  
Debottam Gangopadhyay ◽  
Rahul Agarwal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Pain Perception ◽  
Study Drug ◽  
Postoperative Pain Relief ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Intraperitoneal Instillation ◽  
Study Population

INTRODUCTION: Postoperative pain management is one of most important components of adequate postoperative patient care. Poorly treated pain contributes to patient suffering and may prevent rapid recovery and rehabilitation. Laparoscopic operative procedures have revolutionized surgery with many advantages : a smaller and more cosmetic incision, reduced blood loss, reduced postoperative hospital stay and pain, which cut 1 down hospital costs . AIMS AND OBJECTIVES:Aim of the study is to evaluate the efcacy of intraperitoneal instillation of ropivacaine for postoperative pain relief after laparoscopic cholecystectomy surgeries in terms of : Duration of analgesia, 24 hour postoperative analgesic requirement, Postoperative pain assessment, Postoperative hemodynamic changes like pulse rate, blood pressure and Complications (if any). MATERIALS AND METHODS: Study area -Command Hospital (Eastern Command), Alipore, Kolkata (operation theatre and ward). Study population - Patients posted for Elective Laparoscopic Cholecystectomy. Study period -Jan 2017 to June 2018 Study Time– From rst intraoperative intraperitoneal instillation of study drug to next 24 postoperative hours. Sample Size - 80 (40 in each group) RESULTS AND ANALYSIS: In our study, intraperitoneal instillation of Ropivacaine at the end of surgery provided analgesia for 5.54 ± 4.61 hrs. When compared with the saline group, it was about 2.22 ± 2.93 hrs, which was found to be statistically signicant (-0.004). In this study, Injection Tramadol was used for rescue analgesia for postoperative pain relief. SUMMARYAND CONCLUSION: This study has a few limitations. First, eighty study population may be underpowered for the study. Second, the surgeon performing the surgeries is not the same in every case which may alter the postoperative consequences. From this study it may be concluded that intraperitoneal instillation of Ropivacaine is effective for postoperative pain relief after laparoscopic cholecystectomy. From this study we also conclude that, intraperitoneal instillation of Ropivacaine is useful for postoperative pain relief for patients undergoing laparoscopic cholecystectomy in terms of duration of analgesia, rescue analgesic requirement and pain perception.

Transnasal Butorphanol Is Effective for Postoperative Pain Relief in Children Undergoing Myringotomy 

1998 ◽  
Vol 89 (2) ◽  
pp. 385-390 ◽  
Author(s):  
Ruth E. Bennie ◽  
Leigh A. Boehringer ◽  
Stephen F. Dierdorf ◽  
Mark P. Hanna ◽  
Lyn J. Means
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Pain Management ◽  
Face Mask ◽  
Pain Scale ◽  
Tube Placement ◽  
Postoperative Pain Relief ◽  
Controlled Study ◽  
Postanesthesia Care Unit ◽  
Rescue Analgesia

Background More than 70% of children require analgesics after bilateral myringotomy and tube placement (BMT). Because anesthesia for BMT is generally provided by face mask without placement of an intravenous catheter, an alternative route for analgesia administration is needed. Transnasal butorphanol is effective in relieving postoperative pain in adults and children. The effectiveness of transnasal butorphanol for postoperative pain management in children undergoing BMT was studied. Methods This double-blinded, placebo-controlled study compared the postoperative analgesic effects of transnasal butorphanol administered after the induction of anesthesia. Sixty children classified as American Society of Anesthesiologists physical status 1 or 2 who were aged 6 months or older and scheduled for elective BMT were randomized to receive transnasal placebo or 5, 15, or 25 microg/kg butorphanol. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) on arrival in the postanesthesia care unit and at 5, 10, 15, 30, 45, and 60 min. Results The CHEOP scores were significantly less in the 25 microg/kg transnasal butorphanol group compared with controls. Significantly fewer children received rescue analgesia in the 25 microg/kg transnasal butorphanol group compared with controls (n = 1 and 8, respectively; P = 0.02). Conclusions Transnasal butorphanol given in a dose of 25 microg/kg after induction of anesthesia provided adequate postoperative pain relief in children undergoing BMT.

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