scholarly journals Does ischemic preconditioning preoperatively reduce postoperative pain and analgesic requirement in total knee arthroplasty?

2019 ◽  
Vol 5 (6) ◽  
pp. 1000
Author(s):  
Rajiv Ranjan Dubey ◽  
Bhabani Shankar Behera ◽  
Manish Prasad
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Sample Size ◽  
Knee Arthroplasty ◽  
Ischemic Preconditioning ◽  
Vas Score ◽  
Patient Reported ◽  
Total Knee ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Osteoarthritis of knee is one of the most commonly affecting condition affecting the activities of daily living in the middle age group Indian and Asian population. Total knee arthroplasty (TKA) performed for pain relief and improvement in mobility of individuals is associated with significant post-operative pain. Ischemic preconditioning is one of the non-pharmacologic methods of reduction in postoperative pain using variable periods of tourniquet induced ischaemia which has limited data in literature.</p><p class="abstract"><strong>Methods:</strong> Sample size (n=30) was taken. A standard automatic pneumatic tourniquet was used while performing ischemic preconditioning of the limb prior to TKA and during surgery. Statistical analysis was performed with p values &lt;0.05 considered significant. Standard postoperative analgesia as per hospital protocol was given to patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean 6 hour postoperative and 48-hr postoperative visual analogue scale (VAS) score at rest is significantly higher compared to mean preoperative VAS score at rest (p&lt;0.01 for both). The distribution of mean preoperative and 24 hour postoperative VAS score at rest did not differ significantly (p&gt;0.05). The mean % change in postoperative period compared to preoperative VAS at rest was 47.06%.</p><p class="abstract"><strong>Conclusions:</strong> In this study, the effect of preconditioning over postoperative pain relief was not consistent. Although the patient reported pain scores were low at 6th and 24th postoperative hour, the effect at 48th postoperative hour was not satisfactory. Studies with larger sample size required for better understanding of ischemic preconditioning.</p>

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 Review of patient-reported outcomes in periprosthetic distal femur fractures after total knee arthroplasty: a plate or intramedullary nail?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Dustin Rinehart ◽  
Tyler Youngman ◽  
Junho Ahn ◽  
Michael Huo
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Distal Femur ◽  
Non Union ◽  
Femur Fractures ◽  
Patient Reported ◽  
Total Knee ◽  
The Mean

Abstract Purpose This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty. Methods A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05. Results The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05). Conclusion Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.

scholarly journals Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253641
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Sung Cheol Yang ◽  
Yong In
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Readmission Rate ◽  
Postoperative Pain Control ◽  
Vas Score ◽  
Total Knee ◽  
One Year

Background The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following total knee arthroplasty (TKA). Methods Among 944 patients, 290 (30.7%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated. Results There was no significant difference in pain VAS score, WOMAC Pain and Function score, at each time point between before and after surgery (all p>0.05). Fifteen (9.8%) patients in the opioid group and six (4.4%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p>0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p>0.05). There was no difference in the incidence of side effects between the two groups (p>0.05). Conclusion Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA. Although large-scale randomized controlled trials are still required to further confirm the side effects of duloxetine, it can be considered as an alternative to opioid for postoperative pain control following TKA.

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