Efficacy of Liposomal Bupivacaine Compared with Multimodal Periarticular Injections for Postoperative Pain Control following Total Knee Arthroplasty

This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider. We compared 22 patients who were treated with LB intraoperatively (LBG) with 41 matched controls who were treated with HC periarticular injection (HCG). These cases were retrospectively reviewed at 0 to 6, 6 to 12, 12 to 24, 24 to 48, and 48 to 72 hours. We reviewed pain scores and opioid use per the preceding time period, total opioid use, length of stay (LOS), and wound complications between the two groups. The two groups showed no statistical difference in total opioids used. In both the 6- to 12-hour and 12- to 24-hour intervals, the LBG required significantly more opioids than the HCG, with p-values of 0.0039 and 0.0061, respectively. Pain scores were not significantly different for any time period. We found no difference in LOS. The LBG tended to have lower doses of antiemetics than the HCG. No significant difference was found in postoperative pain scores and total opioid use between LB and multimodal periarticular intraoperative injections in TKA. Our data demonstrated decreased opioid consumption in the HC group compared with the LB group in both the 6- to 12-hour ...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

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Conclusion: The decision-to-delivery interval was ≤ 15 min in most women, suggesting that optimised organisation ensures short decision-to-delivery interval independently of the anaesthetic technique performed. As general anaesthesia was associated with worse neonatal outcomes, our results support the early insertion of an epidural catheter whenever there is any potential concern that an emergency caesarean section may be required.
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Authors: Osman BM, Shapiro FE Abstract There has been an exponential increase in plastic surgery cases over the last 20 years, surging from 2.8 million to 17.5 million cases per year. Seventy-two percent of these cases are being performed in the office-based or ambulatory setting. There are certain advantages to performing aesthetic procedures in the office, but several widely publicized fatalities and malpractice claims has put the spotlight on patient safety and the lack of uniform regulation of office-based practices. While 33 states currently have legislation for office-based surgery and anesthesia, 17 states h...
Source: Archives of Plastic Surgery - Category: Cosmetic Surgery Tags: Arch Plast Surg Source Type: research
Publication date: Available online 23 May 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Daniel C. Menezes, Edison I.O. Vidal, Cesar M. Costa, Glenio B. Mizubuti, Anthony M.H. Ho, Guilherme A.M. Barros, Fernanda B. FukushimaAbstractBackgroundPostoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
AbstractPurpose of ReviewTo provide an overview of the adductor canal block (ACB), with specific discussion on its scope of practice in regional anesthesia for total knee arthroplasty (TKA).Recent FindingsACB is emerging as a viable alternative to femoral nerve block (FNB) as a purely sensory blockade providing comparable postoperative analgesia after TKA. There is growing evidence that it is non-inferior to FNB in terms of pain control, opioid consumption, and earlier ambulation without the risk of quadriceps muscle weakness.SummaryThe saphenous nerve can be effectively blocked at the adductor canal and, in conjunction wi...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
AbstractPurpose of ReviewUnderstanding the etiologies of the complications associated with regional anesthesia and implementing methods to reduce their occurrence provides an opportunity to foster safer practices in the delivery of regional anesthesia.Recent FindingsNeurologic injuries following peripheral nerve block (PNB) and neuraxial blocks are rare, with most being transient. However, long-lasting and devastating sequelae can occur with regional anesthesia. Risk factors for neurologic injury following PNB include type of block, injection in the presence of deep sedation or general anesthesia, presence of existing neur...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
Publication date: Available online 22 May 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Hala S. Abdel-Ghaffar, Amani H. Abdel-Wahab, Mohammed M. Roushdy, Amira M.M. OsmanAbstractObjectivesThe administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2 mg.kg−1) administered 30 min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5 mg.kg−1) and saline placebo.MethodsOne hun...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
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Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
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Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
(Reg Anesth Pain Med. 2018;43:502–508) As the use of neuraxial anesthesia is potentially broadening, an increased understanding and prevention of postdural puncture headache (PDPH) is needed. While numerous studies have examined either needle gauge or design, there has not been a comprehensive study analyzing individual technical and patient-related factors. This meta-analysis aimed to examine the association between spinal needle characteristics and PDPH.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research
(Lancet. 2018;392:662–672) While pethidine (meperidine) is widely used for pain relief during labor, there are unfavorable side effects, such as nausea/vomiting, maternal sedation, and possible neonatal depression. In addition, more than a third of women receiving pethidine ultimately request epidural labor analgesia. Remifentanil is a potential alternative to pethidine for labor pain relief. Its rapid onset and short duration of action provide some benefits although its short duration requires administration via intravenous (IV) patient controlled analgesia (PCA). It is not commonly used in maternity units in the U...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Anesthesia and Analgesia: Alternative Methods of Analgesia Source Type: research
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