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Archives of Orthopaedic and Trauma... Mar 2016Continuous femoral nerve blocks for total knee arthroplasty can cause motor weakness of the quadriceps muscle and thus prevent early mobilisation. Perioperative falls... (Comparative Study)
Comparative Study Randomized Controlled Trial
Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment: a randomised and blinded clinical trial.
INTRODUCTION
Continuous femoral nerve blocks for total knee arthroplasty can cause motor weakness of the quadriceps muscle and thus prevent early mobilisation. Perioperative falls may result as an iatrogenic complication. In this randomised and blinded trial, we tested the hypothesis that a continuous adductor canal block is superior to continuous femoral nerve block regarding mobilisation ('timed up-and-go' test and other tests) after total knee arthroplasty under general anaesthesia.
METHODS
In our study, we included patients scheduled for unilateral knee arthroplasty under general anaesthesia into a blinded and randomised trial. Patients were allocated to a continuous adductor canal block (CACB) or a continuous femoral nerve block (CFNB) for three postoperative days (POD 1-3); with a bolus of 15 ml ropivacaine 0.375%, followed by continuous infusion of ropivacaine 0.2% and patient-controlled bolus administration. Both groups received an additional continuous sciatic nerve block as well as a multimodal systemic analgesic treatment. The primary outcome parameter was mobilisation capability, assessed by 'timed up-and-go' (TUG) test. Analgesic quality, need for opioid rescue and local anaesthetic consumption were also assessed.
RESULTS
Forty-two patients were included and analysed (21 patients per group). No significant difference was noted in respect to mobilisation at POD 3 (TUG [s]: CACB 45, CFNB 51). It is worth saying that pain scores (numeric rating scale, NRS) were similar in both groups at POD 3 {rest [median (interquartile range)]: CACB 0 (0-3), CFNB 1 (0-3); stress: CACB 4 (2-5), CFNB 3 (2-4)}.
CONCLUSIONS
Concerning the mobilisation capability, we did not actually observe a superior effect of CACB compared with CFNB technique in our patients following total knee arthroplasty. Moreover, no difference was observed concerning analgesia quality.
Topics: Accidental Falls; Aged; Amides; Analgesia; Analgesics; Analgesics, Opioid; Anesthesia, Conduction; Anesthetics, Local; Arthroplasty, Replacement, Knee; Double-Blind Method; Early Ambulation; Female; Femoral Nerve; Humans; Male; Middle Aged; Muscle Weakness; Nerve Block; Pain Management; Pain, Postoperative; Physical Therapy Modalities; Pirinitramide; Postoperative Period; Quadriceps Muscle; Ropivacaine; Sciatic Nerve; Thigh; Treatment Outcome
PubMed: 26754752
DOI: 10.1007/s00402-015-2403-7 -
Journal of Perianesthesia Nursing :... Jun 2024Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study compares postoperative hip fracture patients treated with standard pain management with a variety of medications or an approach with only one option in each medication category (nonopioid: acetaminophen; opioid: fentanyl TTS 12,5 mcg/hour; rescue medication: piritramide) to simplify the treatment algorithm for nurses and improve patient well-being.
DESIGN
Double-blind randomized controlled trial.
METHODS
The sample was cognitively intact patients (N = 141) with hip fractures in a tertiary university hospital. Administration of fentanyl 12 mcg/hour transdermal therapeutic system was administered by the nurses in the postanesthesia care unit (PACU) to address basal wound pain to improve patient well-being and patient treatment in the PACU for 24 hours to better control for early complications.
FINDINGS
Well-being was equally increased in both groups in comparison to our preintervention data from 35.7% to over 60% and did not differ significantly between the intervention and control group. No statistically significant differences in numeric rating scale scores, rescue opioid dosage (piritramide i.v.) or in complications were present.
CONCLUSIONS
This one-size-fits-all simplified pain management approach did not improve patient well-being or any other outcome but highlighted the importance of adequate pain management and a sufficient nurse-to-patient ratio.
Topics: Humans; Double-Blind Method; Hip Fractures; Fentanyl; Male; Female; Aged; Pain Management; Pain, Postoperative; Analgesics, Opioid; Aged, 80 and over; Middle Aged; Acetaminophen; Postanesthesia Nursing; Pirinitramide; Recovery Room
PubMed: 38085188
DOI: 10.1016/j.jopan.2023.10.004 -
The British Journal of Dermatology Jul 2015Photodynamic therapy (PDT) using methyl aminolaevulinate (MAL) is an effective treatment for extensive actinic keratosis (AK). However, pain is a major side-effect of... (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial.
BACKGROUND
Photodynamic therapy (PDT) using methyl aminolaevulinate (MAL) is an effective treatment for extensive actinic keratosis (AK). However, pain is a major side-effect of this therapy.
OBJECTIVES
To investigate whether scalp nerve blocks (group 1) provide adequate pain relief during MAL-PDT of the scalp and forehead in 32 men with baldness.
METHODS
The patients received intravenous (IV) analgesia [piritramide 7.5 mg IV, plus oral metamizole (40 drops 30 min prior to PDT)] in combination with cold-air analgesia (group 2; IV analgesia) and cold-air analgesia alone (group 3). Maximum pain was evaluated by means of a visual analogue scale (VAS) during and up to 300 min after PDT. Pain during PDT was further analysed according to a pain perception scale. Furthermore, we measured haemodynamics and investigated stress hormone levels in blood samples at different time points.
RESULTS
Maximum pain during PDT (primary end point) was significantly reduced in the treatment group receiving scalp nerve blocks (VAS 2.1 ± 1.3) compared with the treatment groups receiving IV analgesia (VAS 7.3 ± 1.1) and cold-air analgesia (VAS 8.4 ± 2.0; P < 0.05). No significant difference was found between groups 2 and 3 with regard to pain relief (P = 0.32). The increase in systolic blood pressure during the first 3 min of PDT was significantly lower for group 1 than for groups 2 and 3 (P < 0.001). No correlation between stress hormone levels and pain were found.
CONCLUSIONS
Scalp nerve blocks provide an effective method for pain management during PDT for patients with extensive AK.
Topics: Administration, Oral; Aged; Aminolevulinic Acid; Analgesia; Analgesics, Opioid; Analysis of Variance; Anti-Inflammatory Agents, Non-Steroidal; Cold Temperature; Dipyrone; Facial Dermatoses; Forehead; Hemodynamics; Humans; Injections, Intravenous; Keratosis, Actinic; Male; Middle Aged; Nerve Block; Ophthalmic Nerve; Pain; Pain Measurement; Patient Satisfaction; Photochemotherapy; Photosensitizing Agents; Pirinitramide; Quality of Life; Scalp; Scalp Dermatoses; Trochlear Nerve
PubMed: 25413485
DOI: 10.1111/bjd.13547 -
Acta Anaesthesiologica Belgica 2016Adenotonsillectomy is a frequently performed procedure in pediatric day-case surgery causing significant pain for which adequate analgesia is required. Our aim was to... (Observational Study)
Observational Study
Intraoperative administered tramadol reduces the need for piritramide in the immediate postoperative period in children undergoing adenotonsillectomy: A retrospective observational study.
PURPOSE
Adenotonsillectomy is a frequently performed procedure in pediatric day-case surgery causing significant pain for which adequate analgesia is required. Our aim was to investigate if the intraoperative administration of IV tramadol decreases the need for postoperative pain medication in children. Because tramadol has well-known pro-emetic effects, we also assessed the incidence of postoperative nausea and vomiting (PONV).
METHODS
We performed a retrospective observational study in 314 children aged 1-13 years undergoing elective adenotonsillectomy. We identified 160 children who had received standard pain medication consisting of IV paracetamol and ketorolac and compared them with a group of 154 children who had received in addition a perioperative infusion of tramadol.
RESULTS
32.5% of the patients in the tramadol group versus 83.8% of the patients in the standard group required postoperative administration of piritramide (p < 0.0001). Groups did not differ with respect to the postoperative need for anti-emetics but in the tramadol group more patients had received prophylactic therapy with odansetron or dexamethasone (P < 0.0001).
CONCLUSION
The results of this retrospective study indicate that intraoperative tramadol administration in combination with prophylactic antiemetic therapy decreases the need for piritramide in the immediate postoperative period without increasing the incidence of PONV after tonsillectomy in children.
Topics: Adenoidectomy; Adolescent; Analgesics, Opioid; Antiemetics; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Humans; Infant; Intraoperative Care; Male; Ondansetron; Pain, Postoperative; Pirinitramide; Postoperative Nausea and Vomiting; Retrospective Studies; Tonsillectomy; Tramadol; Treatment Outcome
PubMed: 29873987
DOI: No ID Found