Local Infiltration Anesthesia Group Research Articles

A retrospective study of the safety and efficacy of peritoneal dialysis catheter placement under combined local infiltration anesthesia and monitored anesthesia care

ObjectiveGiven the lack of global consensus on anesthesia selection for peritoneal dialysis catheter (PDC) placement via open surgery, this study investigates the safety and efficacy of combining local infiltration anesthesia (LIA) with monitored anesthesia care (MAC) in patients with end-stage renal disease (ESRD).MethodsThis retrospective analysis of ESRD patients who underwent open surgical placement of PDC in the Department of Nephrology, the First Affiliated Hospital of the Army Medical University from 1 August 2020 to 31 May 2022. Patients were categorized into two groups based on anesthesia method: LIA group and LIA + MA group. MA was defined as preoperative sedation (0.2–0.7 µg/kg/h) with dexmedetomidine injection (Huidrican trade name, DEX), and intraoperative analgesia with dexrazoxane injection (Garonin trade name, DEZ) as appropriate according to the patients’ pain scores. We compared the general clinical data of the two groups of patients, the changes in blood pressure and heart rate during the whole operation, the intraoperative and postoperative pain, the total duration of the operation and the immediate postoperative complications.ResultsThe study included 123 patients (59 in the LIA + MAC group and 64 in the LIA group). The LIA + MA group exhibited lower pain scores measured by Visual Analogue Scale(VAS) during surgery (skin incision, subcutaneous adipose tissue dissection, anterior fascia, muscle traction, posterior fascia, peritoneum, and catheterization) compared to the LIA group(p<0.05). In terms of surgical incisions, to intraoperative pain scores (VRS), the LIA + MA group showed higher score level I and lower score level II compared to the LIA group (p = 0.002, 0.004, respectively). The LIA + MA group experienced lower postoperative resting pain (NRS) and VAS than the LIA group (p = 0.001,0.003, respectively). The surgical duration for the LIA + MA group was shorter than that of the LIA group (p<0.001). Preoperative systolic and diastolic blood pressures (SBP and DBP) were higher in the LIA + MA group compared to the LIA group (p<0.001,<0.001, respectively). Postoperative heart rate and DBP were lower in the LIA + MA group (p<0.001, 0.004, respectively). The LIA + MA group exhibited greater changes in heart rate, SBP, and DBP during and after surgery compared to the LIA group (p = 0.009, <0.001,<0.001, respectively). In terms of immediate postoperative complications, the proportion of patients requiring analgesics within 24 h post-surgery was significantly lower in the LIA + MA group (p = 0.031).ConclusionOpen surgery for PDC placement under LIA + MAC is both safe and effective.

Intraoperative local infiltration anesthesia effect on post-operative pain after total knee replacement

Background: Pain following TKA renders rehabilitation difficult. Local infiltration anesthesia (LIA) could significantly decrease post-operative pain. Aim was to assess the effect of peri-articular intraoperative LIA during primary TKA on post-operative pain. Methods: This prospective, randomized and double-blind study included 150 patients, aged 65-74 years, of both sexes with stage 4 knee osteoarthritis who were assigned for primary TKA at Queen Alia Military hospital, Amman-Jordan, during the period May 2022–December 2022. Patients were divided into two groups. LIA group (GI, n=75) received a single peri-articular LIA during surgery. The cocktail comprised 75 mg diclofenac sodium, 100 mg bupivacaine, and 0.5 mg adrenaline. The cocktail was diluted in 100 ml of normal saline and split into two syringes, 50 ml each. Patients in control group (GII, n=75) received only 100 ml of normal saline. When patients had pain postoperatively, 1 mg morphine was given intravenously at 15-minute intervals. Primary outcomes were verbal analog scale (VAS) pain score from day 1 to 6 after surgery and overall morphine administration. Results: On day 1 after surgery, the average VAS was 4.19 in the LIA group vs. 6.08 in group II (p&lt;0.002), while it was 4.01 versus 4.78 (p&gt;0.05) on day 6. Overall morphine requirement and pain scores from day 1 to day 6 after surgery were less in the LIA group than in the other group, 13.06 mg versus 20.75 mg (p&lt;0.004). Conclusions: Peri-articular LIA during TKA significantly improve post-operative pain and decreases morphine use.

Combined application of adductor canal block and local infiltration anesthesia in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials

Perioperative pain after total knee arthroplasty (TKA) may seriously affect the rapid recovery of patients. The purpose of this study was to assess whether the combined use of adductor canal block (ACB) and local infiltration anesthesia (LIA) can further reduce postoperative pain and improve early functional recovery. PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) comparing ACB + LIA and LIA alone in primary TKA. The primary outcomes were visual analog scale (VAS) scores at rest and walking, morphine consumption, range of motion (ROM) at 24 and 48h postoperatively and distance walked. The secondary outcomes were the length of stay, the incidence of nausea and vomiting, and the total complications. Subgroup analyses were performed on the VAS at rest and walking, morphine consumption, and distance walked at 24, 48, and 72h postoperatively. A total of 10 RCTs involving 797 patients were enrolled in this meta-analysis. The results demonstrated that the combined application of ACB + LIA had a lower resting VAS at 24h postoperatively (p = 0.02) and the walking score at 24 (p = 0.0002) and 48h (p = 0.02) postoperatively compared with LIA alone. Similarly, the combined ACB + LIA group also had less morphine consumption at 48h postoperatively (p = 0.0005) and had a higher ROM score at 24h (p = 0.01) postoperatively compared to the LIA group. There were no statistical differences in length of stay, distance walked, and incidence of nausea and vomiting. The current meta-analysis showed that ACB + LIA significantly reduced postoperative walking pain and morphine consumption and promoted rapid recovery in the early postoperative period. There is no statistical difference in the length of stay and ROM after 72h in the two groups.

Feasibility research of remifentanil combined with propofol on ureteral stent removal under patient's sober state

Objective To investigate feasibility of remifentanil combined with propofol on ureteral stent removal under outpatient's sober state. Methods From October 2015 to April 2017, 60 outpatients with ureteral stent removal were selected in hospital(considering urethral physiologic characteristics of male patients, the research selected all patients as male), who were randomly divided into two groups, 30 cases in each group. Group A was remifentanil-propofol-lidocaine group. Group B was local infiltration anesthesia group. Changes of vital signs during the operation in two groups were observed, such as heart rate (HR), mean arterial pressure (MAP) , oxygen saturation (SPO2) at different time points of pre-anaesthesia (T1), post injection (T2), cystoscopy (T3), double-J tube (T4), 3 minutes after operation (T5). Operation time, postoperative left ventricular time, anesthesia effect, visual analogue score of pain, postoperative patients' satisfaction were compared between two groups. Results Patients in two groups were able to remove ureteral stent successfully. Hemodynamics in group A were more stable than group B. Anesthesia effect in group A was better than group B. VAS score in group A was lower than group B(P 0.05). There was no significant difference in operation time between two groups(P>0.05). Conclusions Remifentanil-propofol-lidocaine compound solution can be used safely in ureteral stent removal of outpatients, which has great clinical value. Key words: Ureter; Stents; Fentanyl; Propofol

Pain management after total knee arthroplasty: A prospective randomized study

IntroductionTotal knee arthroplasty (TKA) is a common procedure for improving mobility and quality of life in patients with osteoarthritis. Postoperative pain control management after TKA is still a concern as it relates to patients satisfaction and functional recovery.Many anesthetic regimens and techniques have been explored to decrease postoperative pain and enhance the fast recovery after TKA. The aim of this study was to evaluate the best anesthetic treatment in pain control after TKA. Methods51 patients were included in a randomized prospective study and distributed in three groups. The first group (CG) in which no analgesic protocol was implemented (control group). The second group (LIA group) received an intraoperative local infiltration anesthesia (LIA) (60 ml mixture of two ropivacaine 75mg/10 mL + adrenaline 100μg/10 mL + physiological solution). The third group (FNB group) had only a femoral nerve block (FNB). Continuous outcomes including visual analogue scale (VAS) at 5,24,48 h and at 1 week, morphine consumption and range of motion (ROM) at 1,2,7 days. ResultsThere was significant difference between all groups (p < 0,001) in terms of the VAS score: at 5h after surgery (4.55,2.15,1.82); at 24h (4.15,2.65,3.36); at 48h (3.85,2.45,2.73); at 1 week (2.95,1.80, 1.64), respectively for groups CG, LIA, FNB.ROM was better in LIA and FNB groups than CG: at 1 die after surgery (44°,50°,54°); at 3 dies (69°,70°,71°); at 7 dies (91°,98°,98°), respectively for groups CG, LIA, FNB (p < 0,001). DiscussionLIA and FNB groups both showed a significant reduction at VAS score, better range of motion and less morphine consumption than CG (control group). LIA group has obtained a constant pain control in the postoperative days; FNB group had a good pain control in the hours after surgery, with a decrease in efficacy in the following days. ConclusionFurther studies are still needed in order to define LIA as the reference pain management in TKA.

Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis

BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA).MethodsIn December 2017, a systematic computer-based search was conducted in Pubmed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared LIA versus EPA for postoperative pain control in TKA were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12, 24 and 48, and 72 h. The secondary outcomes were the range of motion, the length of stay, and the occurrence of infection and nausea. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSeven clinical studies with 251 patients (LIA = 124, EPA = 127) were included in the meta-analysis. There was no significant difference between LIA and EPA group in terms of the VAS score with rest at 12 and 24 h. LIA was associated with a reduction of the VAS score with rest at 48 and 72 h than EPA (P < 0.05). There was no significant difference between the LIA group and EPA group in terms of the VAS with mobilization at 24, 48, and 72 h (P > 0.05). And LIA was associated with an increase of the range of motion at 24 and 48 h (P < 0.05) and a reduction of the length of hospital stay (P < 0.05). What is more, LIA was associated with a reduction of the occurrence of the nausea.ConclusionsLIA has equivalent efficacy as EPA for pain control after TKA and shows an increase of the range of motion and a reduction of the occurrence of nausea and length of hospital stay. Due to the limited number of the included studies, more high-quality RCTs are still needed to identify the long-term effects of LIA for pain control after TKA.

Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA.

Adductor canal block (ACB) and local infiltration anesthesia (LIA) are both widely accepted techniques for postoperative pain control without quadriceps weakness after total knee arthroplasty (TKA). However, the above techniques are insufficient in efficacy or duration. The aim of our study was to address whether ACB plus posterior capsular infiltration (PCI) result in improved analgesia compared with ACB or LIA in patients underwent TKA during 48h after operation. Sixty patients were included: ACB group (group A, ACB with 0.375% ropivacaine 30ml, n=20), ACB+PCI group (group B, ACB same as group A, PCI with 0.2% ropivacaine 50ml, n=20), LIA group (group C, local infiltration with 0.2% ropivacaine 100ml, n=20). VAS pain scores, rescue analgesic tramadol consumption, nausea and vomiting occurrence, and patient satisfaction were recorded at 4, 8, 24, and 48h post-operation. Group B, versus group A, had lower pain scores (at rest and during mobilization) at 4 to 8h post-operation (P<0.017). As compared with group C, only at 24h post-operation, group B had statistically decreased rest and active pain scores (p=0.016 and 0.014, respectively). There were no statistical differences in total tramadol consumption and nausea and vomiting occurrence among the three groups. However, there was improved patient satisfaction in group B. Overall, as compared with ACB or LIA, ACB plus PCI appeared to provide more ideal analgesia and patient satisfaction in the first 24h after operation.

Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials.

BackgroundThe purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration anesthesia (LIA) after total knee arthroplasty (TKA).MethodsThe electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their inception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were eligible for this meta-analysis. This systematic review and meta-analysis was performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) score with rest at 12, 24, and 48 h, which represents the pain control after TKA. Data regarding active knee flexion, length of hospital stay, anesthesia time, and morphine use at 24 and 48 h were also compiled. The complications of postoperative nausea and vomiting (PONV) and fall were also noted to assess the safety of morphine-sparing effects. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modeling when necessary.ResultsSeven clinical trials with 615 patients were included in the meta-analysis. The pooled results indicated that SNB was associated with a lower VAS score at 12 h (MD = −6.96; 95% CI −8.36 to −5.56; P < 0.001) and 48 h (MD = −2.41; 95% CI −3.90 to −0.91; P < 0.001) after TKA. There was no significant difference between the SNB group and the LIA group in terms of the VAS score at 24 h (MD = 0.67; 95% CI −0.31 to 1.66; P = 0.182). The anesthesia time in the LIA group was shorter than in the SNB group, and the difference was statistically significant (MD = 4.31, 95% CI 1.34 to 7.28, P = 0.004). There were no significant differences between the groups in terms of active knee flexion, length of hospital stay, morphine use, PONV, and the occurrence of falls.ConclusionsSNB may provide earlier anesthesia effects than LIA when combined femoral nerve block (FNB); however, there were no differences in morphine use, active knee flexion, and PONV between the groups. The LIA group spent less time under anesthesia, suggesting that LIA may offer a practical and potentially safer alternative to SNB.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-016-0495-6) contains supplementary material, which is available to authorized users.

Pain Control After Total Knee Arthroplasty: A Prospective Study Comparing Local Infiltration Anesthesia and Epidural Anesthesia

Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. The purpose of this study was to compare the local infiltration anesthesia technique with epidural anesthesia, which has been the most widely used technique in Sweden.Eighty-five patients received either local infiltration anesthesia or epidural anesthesia for postoperative pain relief. Postoperative morphine consumption, range of motion, walking ability, patient satisfaction, hospital stay, and time in the recovery room were measured. The groups were followed equally. The patients in the local infiltration anesthesia group were mobilized 24 hours earlier. On postoperative day one, 22 of 33 patients in the local infiltration anesthesia group could get in and out of bed without assistance. Only 1 of 31 patients in the epidural anesthesia group could manage this. On postoperative day two, 28 of 33 patients in the local infiltration anesthesia group could walk without assistance, compared to 5 of 31 in the epidural anesthesia group. Seventy-six percent of the local infiltration anesthesia patients were "very satisfied" with their postoperative pain control method, compared to 40% of the epidural anesthesia patients.The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study.