Infiltration Analgesia Research Articles

Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance.

Background: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance Imaging (MRI). Methods: A descriptive, observational, cross-sectional study was performed on 126 knee MRIs. The variables studied were age, sex, and distance between different neurovascular structures of the popliteal fossa (tibial nerve, common peroneal nerve, and vascular bundle). Data were analyzed for normality (Kolmogorov-Smirnov) and variance homogeneity (Levène). A value of p < 0.05 and a confidence interval of 9% were considered statistically significant for all comparisons. Student's t-test was used to compare the means between independent samples. Results: We observed statistically significant differences between the sexes regarding EP-EPS (external plateau-external popliteal sciatic nerve (common peroneal)), EP-IPS (external plateau-internal popliteal sciatic nerve (tibial)), and IP-PA (internal plateau-popliteal artery) measurements. The average distance between both nerves, EPS-IPS (external popliteal sciatic nerve and internal popliteal sciatic nerve), was 25.96 mm in females, while the value obtained in males was 29.93 mm, but this difference was not statistically significant. Conclusions: The average distance from the posterior capsule to the EPS and IPS nerves is greater in males than in females, despite no statistical differences. The presence of a lateralized arteriovenous bundle reduces the infiltration area of the external compartment. Regarding the safety area, infiltration of the internal compartment is safe since the volume diffuses into the muscle mass of the internal gastrocnemius upon injection. To infiltrate the external compartment, the needle must move at least 2 cm from the midline toward the external side (to exceed the maximum displacement of the neurovascular bundle established at 1.82 cm), and not advance beyond 0.76 cm (minimum distance at which we located the common peroneal nerve in the external compartment).

Long-Term Outcomes of Breast Cancer Patients Receiving Levobupivacaine Wound Infiltration or Diclofenac for Postoperative Pain Relief.

Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year (P = 0.022). The most significant predictor of the 5-year outcome was HGS (P = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. P = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival (P = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study-trial number NCT05829707.

Efficacy of Local Infiltration of Analgesics via Intra-articular Epidural Catheter vs Adductor Canal Block in Primary Total Knee Arthroplasty Surgery.

Pain is believed to be a poorly understood phenomenon, which is mostly regulated by neural, cellular, hormonal &amp; emotional components. Epidural analgesia is used for pain relief in patients undergoing primary total knee arthroplasty, though provides good pain control, many a time is associated with side effects such as hypotension, urinary retention and impaired mobility. The purpose of the current study is to compare the efficacy of ACB to local infiltration of analgesics by Intraarticular Epidural Catheter for primary total knee arthroplasty by comparing visual analog scale, knee flexion, and active SLRT on the day of surgery (POD-0), POD1-3, day of discharge, and 4 weeks after surgery. This study is prospectively randomized, the cases undergoing primary knee replacement were divided into two groups, which includes a minimum of 36 cases in each group.Group-1(36) patients received local infiltration of analgesics via IAECand Group-2(36) patients received single shot ACB. As far as age, sex, BMI(kg/m2), pre-op VAS, mean pre-op flexion, mean pre-operative varus, mean preop KSS(Knee society score), duration of surgery and hospital stay is concerned no significant difference was noticed between the two groups.Group-1(LIA via IAEC) had significantly lower VAS on a postoperative day (POD) 1-3, lower tramadol consumption, better ROM (atPOD1-3), superior quadriceps recovery(active SLRT), earlier mobilization day, better KSS (at 4weeks) postoperatively, compared to Group-2(single shot ACB).LIAby IAEC for patients undergoing primary TKA is a better option compared to single shot ACB concerning to pain levels, narcotic usage, range of motion, quadriceps recovery and KSS (Knee society score).

The Effect of Intraoperative Transversus Abdominis Plane Blocking on Postoperative Pain After Laparoscopic Transabdominal Pre-peritoneal (TAPP) Groin Hernia Repair.

BackgroundManaging postoperative pain even after laparoscopic groin hernia repair still remains an interesting challenge for clinicians especially for patients of high risk. Plenty of operative techniques and analgesic methods have been proposed in order to minimize postoperative pain after laparoscopic groin hernia repair. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain.MethodsPatients that underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) groin hernia repair in a high-volume university hospital were included. Patients were divided in two groups depending on the analgesic method used. Pain was assessed using Visual Numerical Scale (VNS) score.ResultsThirty patients were included. Intraoperative TAP-block seemed to be superior in terms of decreasing pain at the hernia area and at the trocar insertion site (p < 0.05) compared to local analgesic infiltration at the trocar insertion site at 6, 12 and 24 h after surgery (p < 0.05). In addition, pain reduction was more effective in rest rather than in motion for both analgesic methods.ConclusionIntraoperative TAP-block under direct vision seems to be an effective, fast and easy technique in order to reduce postoperative pain after laparoscopic groin hernia repair, but more studies are required to validate these results in a prospective and randomized context.

Dexamethasone as a ropivacaine adjuvant to pre-emptive incision-site infiltration analgesia in pediatric craniotomy patients: A prospective, multicenter, randomized, double-blind, controlled trial.

Dexamethasone added to incision-site infiltration has been routinely used to reduce pain after tonsillectomy in children. However, this has not been studied in pediatric craniotomy patients yet. We hypothesized that incision-site infiltration with a combination of ropivacaine and dexamethasone might provide superior analgesia to ropivacaine alone in pediatric craniotomy patients. In this multicenter, double-blind, randomized, controlled trial, children aged 2-12years, scheduled for craniotomy, were prospectively enrolled at two study centers, from September 2, 2019, to July 5, 2020. Eighty children were randomly assigned (1:1) to either ropivacaine plus dexamethasone group who received pre-emptive incision-site infiltration with 0.2% ropivacaine plus 0.025% dexamethasone, or ropivacaine group who received 0.2% ropivacaine alone. Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 24h postoperatively. Primary analysis was performed using the modified intention-to-treat principle. Pre-emptive incision-site infiltration with ropivacaine plus dexamethasone had a reduced pain score of 2.0, compared with the pain score of 2.9 in the ropivacaine group, at 24h postoperatively (mean difference -0.9, 95% confidence interval [CI], -1.7 to -0.2; p=.019). Estimated median of the time of first rescue analgesic demand was 24h in the ropivacaine plus dexamethasone group and 8.5h in the ropivacaine group [hazard ratio 0.43, 95% CI 0.24 to 0.08; Log-rank p=.0025]. No adverse events related to incision-site infiltration with dexamethasone were observed in this study. Dexamethsone reduces the local production of pro-inflammatory factors after tissue damage and as a ropivacaine adjuvant for incision-site infiltration reduced the pain scores by 31% at 24 h postoperatively. The results were similar to several prior studies on to tonsillectomy patients. However, this changes on pain scores might has limited clinical significance. The addition of dexamethasone to ropivacaine for preoperative incision-site infiltration has better postoperative analgesic effect than ropivacaine alone in pediatric craniotomy patients.

Comparison of the efficacy of ultrasound guided adductor canal block versus intra-articular infiltration in providing post-operative analgesia after arthroscopic anterior cruciate ligament repair surgery

Ultrasound guided adductor canal block (ACB) is a modality for providing analgesia after arthroscopic anterior cruciate ligament repair surgery. Intra-articular infiltration of analgesics in the knee joint acts on the free nerve endings at the operative site and provides analgesia. We aim to compare the analgesic efficacy and opioid consumption between these two modalities.Sixty patients were randomized to receive either ACB under ultrasound guidance (group A) or intra-articular infiltration (group B). Post-operatively time of rescue analgesia and opioid consumption were noted. Quality of analgesia was assessed every 2 hours until 6 hours, then every 6 hours until 24 hour post-operative period between the two groups. Data was analysed statistically and P value &amp;#60; 0.05 was considered significant.: Time of rescue analgesia was comparable in both the groups (p value 0.4317). NRS scores in ACB group and intra-articular infiltration group were comparable till first 6 hours (p value 0.4519) but increased in intra-articular infiltration group at 12 hour (p value &amp;#60;0.0001) and 18 hour (p value &amp;#60;0.0117) as compared to group receiving ACB. The opioid consumption was more in intra-articular infiltration group than ACB group although not statistically significant (p value 0.6319).ACB is a better modality for postoperative analgesia after arthroscopic anterior cruciate ligament repair surgery as analgesia of intra-articular infiltration wears off in 12-24 hour period which is crucial for early ambulation and from rehabilitation point of view.

Commentary-LIAT: Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements.

Commentary-LIAT: Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements.

Yellow flag on prognostic factors for non-specific chronic low back pain patients subjected to mini-invasive treatment: a cohort study.

Research was conducted to study the efficacy of analgesic infiltration treatment in a well-selected population of patients with non-specific drug-resistant chronic low back pain. It studied the pain on a numeric rating scale and the physical and mental condition of patients using a short-form health survey-36, before and six months after invasive pain treatment. This is a prospective observational single center cohort study. The study took place in the Multimodal Pain Therapy Unit of the IRCCS Institute of Neurological Sciences in Bologna, Italy. Four hundred and thirteen out of a total 538 patients admitted to the unit with non-specific drug-resistant chronic low back pain were enrolled in the study. Patients were enrolled with written consent between April 2017 and November 2018. The study assessed NRS, BDI and SF-36 scores before and six months after mini-invasive treatment. There is an inverse correlation between Mental Component Scale (MCS) and Physical component scale as measured by SF-36. Older patients in a worse physical condition but with a more positive outlook on their quality of life were more likely to improve after invasive treatment (p < 0.001). The BDI scale is more effective in the diagnosis of depression than MCS. The prognostic value of MCS given to the patient before mini-invasive treatment could lead physicians to adopt a multimodal approach that includes consideration of the psychological features of pain and possibly antidepressant therapy.

The Efficacy of Peritubal Analgesic Infiltration in Postoperative Pain Following Percutaneous nephrolithotomyNephrolithotomy

The Efficacy of Peritubal Analgesic Infiltration in Postoperative Pain Following Percutaneous nephrolithotomyNephrolithotomy

Implementation of an Evidence Based Practice (EBP) Project Using an External Vibratory Device to Decrease Patient Pain With Analgesic Infiltration

Implementation of an Evidence Based Practice (EBP) Project Using an External Vibratory Device to Decrease Patient Pain With Analgesic Infiltration

A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial

Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.

The effect of ultrasound-guided nerve block on the prognosis of patients undergoing laparoscopic cholecystectomy

Objective To investigate the effhect of ultrasound-guided nerve block on the prognosis of patients undergoing laparoscopic cholecystectomy. Methods A total of 150 cases undergoing elective laparoscopic cholecystectomy in our hospital was used as the research object, and randomly divided into control (n=75) and observation (n=75) groups. The control group used punctured local infiltration analgesia, and observation group used the transversus abdominis plane block (TAP) combined with local infiltration analgesia hole. The postoperative awake time, hemodynamic changes, pain score, and analgesic use were compared between two groups. Results The recovery time was significantly reduced in the observation group (9.7±2)minutes compared to the control group (23.9±2.4)minutes. The additional total dose of analgesics and average additional times were significantly lower in the observation group compared to the control group (P 0.05). Conclusions Ultrasound-guided nerve block can obviously reduce postoperative pain, reduce drug use frequency and dosage, significantly improve postoperative outcomes, and does not increase the incidence of adverse drug reactions. It is worthy of clinical reference. Key words: Ultrasonography; Nerve block; Cholecystectomy, laparoscopic; Anesthesia

Efficacy of continuous infiltration analgesia after total knee arthroplasty

Efficacy of continuous infiltration analgesia after total knee arthroplasty

Anterior vs Posterior Periarticular Multimodal Drug Injections: A Randomized, Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty

BackgroundCurrently, various techniques are used to overcome postoperative pain after total knee arthroplasty. A local analgesic infiltration with periarticular multimodal drug injection (PMDI) is favorable because of its simplicity, safety, and efficacy. The present study compared the efficacy of a PMDI at the anterior vs posterior compartments. MethodsForty-six patients were randomized to receive the PMDI at either the anterior or posterior compartment, with the contralateral knee receiving the PMDI at the opposite compartment. The PMDI injected to the posterior capsule, medial and lateral meniscal remnant, was defined as the posterior compartment injection, whereas the injection to the medial retinaculum, quadriceps muscle, pes anserinus, and retropatellar fat pad was defined as the anterior compartment injection. Pain scores at rest, knee flexion angle, quadriceps function, and drainage blood loss were evaluated in both groups. ResultsThe anterior PMDI group had significantly lower pain scores at rest during 96 hours postoperatively. On the day of discharge, 19 patients (41.3%) favored the knee with the anterior PMDI, which was superior to 9 patients (19.6%) who favored the knee with the posterior PMDI. The anterior PMDI demonstrated a superior recovery of quadriceps function during the same period, but there was no significant difference in terms of other parameters. ConclusionThe PMDI at the anterior compartment can reduce pain after total knee arthroplasty with potentially better quadriceps function compared with that in the PMDI at the posterior compartment. We recommend infiltrating the anterior compartment with a greater amount of PMDI than the posterior compartment.

Adductor Canal Block Combined with Sciatic Nerve Block Vs. Local Analgesic Infiltration for Pain Control after Total Knee Arthroplasty

Background: A combined adductor canal block (ACB) and sciatic nerve block (SNB) is new different way to achieve an efficient postoperative analgesia after total knee replacement (TKR) that spares the weakness of quadriceps femoris muscle. This prospective randomized controlled trial aimed to evaluate the efficiency and safety of the combined adductor canal with sciatic nerve blocks versus local analgesic infiltration alone for pain control after total knee replacement.Patients and methods: Forty patients (ASA II, and III), undergoing unilateral total knee replacement, were randomly and allocated to two groups (20 patients each), block group (ACB+SNB): the patient received US- guided adductor canal block combined with sciatic nerve block, local group (LAI): patient received local analgesic injection (LAI) to entire of the knee joint. The primary outcomes were postoperative visual analogue scale (VAS) at rest and with movement, first request of analgesics and 24 h total consumption of morphine. Secondary outcome measures included sedation score and side effects associated with morphine consumption like nausea, vomiting.Results: There was a significant reduction in postoperative morphine consumption, VAS, nausea and vomiting and sedation at 12 h in local group. There were no complications attributable to the ACB or SNB blocks.Conclusion: Combined adductor canal with sciatic nerve blocks could significantly reduce VAS scores, morphine consumption, and first request for analgesia in comparison with local analgesic infiltration alone following TKA. Additionally, there is a lower incidence of sedation, nausea and vomiting in the combined blocks group.

Peri-articular/intra-articular infiltration analgesia with local anaesthetic versus nerve block for postoperative pain and function in patients receiving major knee surgery

Reason for withdrawal from publication This protocol has been withdrawn due to the full review not meeting the quality standards and expectations of Cochrane and the PaPaS review group.

Do anesthesiologists need epidural anesthesia and do surgeons need an anesthesiologist?

Presented paper reviews up-to-date often contradictive concepts about the role of epidural anesthesia in anesthesiological support of patients undergone major surgery. The author performed critical analysis of the arguments of the opponents of the wide use of epidural analgesia who propose to substitute the epidural anesthesia with minimally invasive techniques in particular infiltration analgesia with local anesthetics. The article includes convincing evidence in favour of continuous epidural anesthesia remains the method of choice for open major thoracic and abdominal surgery especially in patients from high risk groups.

Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty.

To evaluate the effect of the local infiltration of analgesics for pain after total knee arthroplasty in patients treated with femoral and sciatic peripheral nerve blocks. The secondary objective was to detect differences in analgesic consumption as well as blood loss after local infiltration of analgesics. Prospective randomized double-blinded study in patients who underwent a TKA for knee osteoarthritis under spinal anesthesia and treated with femoral and sciatic nerve blocks. This study compared 50 patients treated with local infiltration with ropivacaine, epinephrine, ketorolac and clonidine and 50 patients treated with a placebo with the same technique. The visual analogic score was registered postoperatively at 2, 6, 12, 24, 36, 48 and 72h after surgery. Analgesic consumption was also registered. Both groups of patients were treated with the same surgical and rehabilitation protocols. A significant difference of one point was found in the visual analogic pain scores 12h after surgery (0.6±1.5 vs. 1.7±2.3). There were no significant differences in the visual analogic pain scores evaluated at any other time between 2 and 72h after surgery. No significant differences were found in the required doses of tramadol or morphine in the postoperative period. Postoperative hemoglobin and blood loss were also similar in both groups. Adding local infiltration of analgesics to peripheral nerve blocks after TKA surgery only provides minimal benefit for pain control. This benefit may be considered as non-clinically relevant. Moreover, the need for additional analgesics was the same in both groups. Therefore, the use of local infiltration of analgesics treatment in TKA surgery cannot be recommended if peripheral nerve blocks are used. I.

Continuous wound infiltration versus epidural analgesia after pancreatic- and hepatobiliary surgery (POP-UP): A multicentre, randomised controlled, open-label, non-inferiority trial

Continuous wound infiltration versus epidural analgesia after pancreatic- and hepatobiliary surgery (POP-UP): A multicentre, randomised controlled, open-label, non-inferiority trial

The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy - A prospective randomized controlled study.

ABSTRACTObjective:To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access.Patients and Methods:A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand.Results:The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012).Conclusion:The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access.