Low-level Laser Acupuncture Reduces Postoperative Pain and Morphine-related Side Effects in Patients With Total Knee Arthroplasty:

2019 ◽  
Author(s):  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Laser Acupuncture ◽  
Low Level ◽  
Low Level Laser ◽  
Level Laser ◽  
Total Knee

Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after total knee arthroplasty

2017 ◽  
Vol 16 (1) ◽  
pp. 176-176
Author(s):  
M.B. Jensen ◽  
M.M. Andersen ◽  
B. Boesen ◽  
M.B. Jørgensen ◽  
O. Simonsen
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Treatment ◽  
Combined Treatment ◽  
Consecutive Series ◽  
Superior Effect ◽  
Total Knee ◽  
Postoperative Pain Treatment

Abstract Background Gabapentin (GAB) has recently been introduced for postoperative pain treatment in orthopedic surgery. As persistent postoperative pain is still a major problem in total knee arthroplasty (TKA), studies on the effect and side effects of Gabapentin in addition to the commonly used morphine (MOR), Oxynorm (OXY) and Norspan (NOR) are highly warranted. In the present study, four relevant treatment algorithms, gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm (GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm and Norspan (GAB/OXY/NOR) were examined. Patients and methods A total of 241 patients were followed systematically during one month following TKA in four consecutive series: 60 patients were treated with GAB/MOR, 62 patients with GAB/OXY, 59 patients with OXY, and 60 patients with GAB/OXY/MOR. On the day before surgery and on postoperative day 1, 14, and 30, pain during rest, pain during walking and side effects (constipation, dizziness, and nausea) were reported (VAS). Results After 30 days, pain greatly decreased in all groups, with a superior effect of GAB/OXY/NOR for pain during rest and only slightly more side effects at day 1. Conclusions In management of postoperative pain following TKA, data indicated that GAB/OXY/NOR was superior, compared to GAB/MOR, GAB/OXY, and OXY.

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.

Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 73-78
Author(s):  
William G. Hamilton ◽  
Jeanine M. Gargiulo ◽  
Nancy L. Parks
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Genetic Variants ◽  
Control Group ◽  
Ongoing Research ◽  
Pain Scores ◽  
Pain Medications ◽  
Total Knee

Aims The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine. We further sought to determine if changing the multimodal programme based on these results would improve pain control or reduce side effects. Methods In this pilot study, buccal samples were collected from 31 primary TKA patients. Pharmacogenetics testing examined genetic variants in genes OPRM1, CYP1A2, CYP2B6, CYP2C19, CYP3A4, CYP2C9, and CYP2D6. These genes affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and opioids. We examined the frequency of genetic variants to any of the medications we prescribed including celecoxib, hydrocodone, and tramadol. Patients were randomized to one of two groups: the control group received the standard postoperative pain regimen, and the study group received a customized regimen based on the pharmacogenetic results. For the first ten postoperative days, patients recorded pain scores, medication, and side effects. Results Genetic variants involving one or more medications in the multimodal pain protocol occurred in 13 of the 31 patients (42%). In total, eight patients (26%) had variants affecting more than one of the medications. For the 25 patients who recorded pain and medication logs, the mean pain levels and morphine equivalents (MEQs) consumed in the first ten days were higher in the control group than in the custom-guided group (p = 0.019 for pain and p = 0.655 for MEQ). Conclusion Overall, 42% of patients had a variant involving one of the pain medications prescribed in our perioperative pain program for TKA. Ongoing research will help determine if using these data to modify a patient’s medication will improve outcomes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):73–78.

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

2018 ◽  
Vol 32 (01) ◽  
pp. 111-116 ◽  
Author(s):  
John Barrington ◽  
Ryan Hansen ◽  
Belinda Lovelace ◽  
Elaine Böing ◽  
Morad Chughtai ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Lengths Of Stay ◽  
Oral Group ◽  
Total Knee

AbstractPostoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.

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.

The Effect of Preoperative Video Based Pain Training on Postoperative Pain and Analgesic Use in Patients Undergoing Total Knee Arthroplasty: A Non-randomized Control Group Intervention Study

2020 ◽  
pp. 105477382098336
Author(s):  
Ceyda Su Gündüz ◽  
Nurcan Çalişkan
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Group Intervention ◽  
Intervention Study ◽  
Intervention Group ◽  
Control Group ◽  
Total Knee ◽  
Randomized Control ◽  
Analgesic Use

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.

scholarly journals Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanuel Noel ◽  
Luca Miglionico ◽  
Mickael Leclercq ◽  
Harold Jennart ◽  
Jean-François Fils ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multimodal Analgesia ◽  
Sublingual Tablet ◽  
Randomized Controlled ◽  
Total Knee ◽  
Median Pain

Abstract Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3

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