Postoperative Orthopedic Pain Research Articles

Morphine Treatment in Children With Postoperative Orthopedic Pain: A Systematic Review of Clinical Trial

Morphine Treatment in Children With Postoperative Orthopedic Pain: A Systematic Review of Clinical Trial

Effect of Parecoxib on Postoperative Pain Management After Total Knee/Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Total knee arthroplasty (TKA) or total hip arthroplasty (THA) are frequent procedures used to relieve the symptoms of hip or knee joint dysfunction, enhance disease recovery, and boost patients' quality of life. Nevertheless, postoperative pain has been a significant disadvantage since it strongly impacts patients' postoperative recovery. Parecoxib has been demonstrated to be useful in the management of postoperative pain in a variety of surgical procedures. While parecoxib can help with postoperative pain, its analgesic and unfavourable effects in TKA/THA patients have not been well studied. A systematic search of peer-reviewed articles was conducted through the PubMed database, Google Scholar, and Cochrane library to retrieve related studies published in the English language that met inclusion and exclusion criteria. The publication date was restricted to the past 10 years (2012-2022). Results were analyzed using Review Manager software (RevMan version 5.4.1, The Cochrane Collaboration, 2020). The quality of the studies included was assessed using Jadad scores. Risk ratios (RR) standard mean difference (SMD) and 95% confidence intervals (CI) were calculated to analyze the primary and secondary endpoints. Eleven randomized controlled trials covering 1911 patients who underwent TKA/THA were selected. The pooled results indicated that the parecoxib group has lower visual analogue scale (VAS) scores than the placebo group. However, there was no significant difference in the secondary endpoint. The Jadad scores ranged from 3 to 5 and most of the studies were of high quality. The results of our meta-analysis indicate that parecoxib has a better analgesic effect compared to placebo. It alleviates postoperative orthopaedic painwithout raising the risk of adverse events.

Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis.

IntroductionOrthopedic procedures have been associated with increased pain, making perioperative analgesia a major clinical concern. We assessed the efficacy and safety of intravenous parecoxib administration during the perioperative period for postoperative pain relief after orthopedic surgery in adults.MethodsPubMed, Cochrane Library, EMBASE, and clinicaltrial.gov were searched from inception to 23 August 2021 without language restrictions. Randomized controlled trials comparing intravenous parecoxib with placebo or another active treatment for acute postoperative pain in adults after orthopedic surgery were included. The primary outcomes were the pain scores and cumulative morphine consumption. The secondary outcomes included the proportion of patients requiring rescue analgesics and the incidence of adverse events. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered on the International Prospective Register of Systematic Reviews Registration (PROSPERO).ResultsTwenty-seven trials (n = 2840) from more than 20 countries involving six types of orthopedic surgery met the inclusion criteria. Compared with placebo, intravenous parecoxib administration led to reductions in postoperative resting pain scores at 6, 12, 24, and 48 h [mean difference (MD) −0.87, 95% confidence interval [CI] −1.71 to −0.03; MD −0.86, 95% CI −1.26 to −0.46; MD −0.57, 95% CI −0.84 to −0.31; MD −0.40, 95% CI −0.69 to −0.11, respectively], postoperative movement pain scores at 24 and 48 h (MD −0.66, 95% CI −1.14 to −0.19; MD −0.78, 95% CI −1.16 to −0.39, respectively), cumulative morphine consumption (MD −11.30 mg, 95% CI −14.79 to −7.81 mg), and the proportion of patients requiring rescue analgesia (relative risk 0.83, 95% CI 0.77–0.89). There was no difference in the incidence of adverse events between groups.ConclusionLow to moderate evidence indicates that parecoxib might be an effective and safe analgesic in perioperative orthopedic settings. It relieves postoperative orthopedic pain while sparing opioid analgesic consumption without increasing the incidence of adverse events.PROSPERO RegistrationCRD42021274939.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00400-1.

Defined Daily Dose and Appropriateness of Clinical Application: The Coxibs and Traditional Nonsteroidal Anti-Inflammatory Drugs for Postoperative Orthopaedics Pain Control in a Private Hospital in Malaysia.

Introduction: Drug utilization of analgesics in a private healthcare setting is useful to examine their prescribing patterns, especially the newer injectable cyclooxygenase (COX)-2 inhibitors (coxibs). Objectives: To evaluate the utilization of coxibs and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) indicated for postoperative orthopaedic pain control using defined daily dose (DDD) and ratio of use density to use rate (UD/UR). Method: A retrospective drug utilization review (DUR) of nonsteroidal anti-inflammatory drugs (NSAIDs) at an inpatient department of a private teaching hospital in Seremban, Malaysia was conducted. Patients’ demographic characteristics, medications prescribed, clinical lab results, visual analogue scale (VAS) pain scores and length of hospital stay were documented. Orthopaedic surgeries, namely arthroscopy, reconstructive, and fracture fixation, were included. Stratified random sampling was used to select patients. Data were collected through patients’ medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization’s DDD as a benchmark. The inclusion criteria were patients undergoing orthopaedic surgery prescribed with coxibs (celecoxib capsules, etoricoxib tablets, parecoxib injections) and tNSAIDs (dexketoprofen injections, diclofenac sodium tablets). Data were analysed descriptively. This research was approved by the academic institution and the hospital research ethics committee. Result: A total of 195 records of patients who received NSAIDs were randomly selected among 1169 cases. In term of the types of orthopaedic surgery, the ratio of included records for arthroscopy:fracture fixation:reconstructive surgery was 55.4:35.9:8.7. Most of the inpatients had low rates of common comorbidities such as cardiovascular disease as supported by their baseline parameters. The majority were not prescribed with other concomitant prescriptions that could cause drug interaction (74.9%), or gastroprotective agents (77.4%). Overall, DDDs per 100 admissions for all NSAIDs were less than 100, except for parecoxib injections (389.23). The UD/UR for all NSAIDs were less than 100, except for etoricoxib tablets (105.75) and parecoxib injections (108.00). Discussion: As per guidelines, the majority (96.9%) received other analgesics to ensure a multimodal approach was carried out to control pain. From the UD/UR results, the arthroscopy surgery was probably the most appropriate in terms of NSAID utilization. Conclusion: The prescribing pattern of NSAIDs except parecoxib was appropriate based on adverse effect and concurrent medication profile. The findings of this DUR provide insight for a low-risk patient population at a private specialized teaching hospital on the recommended use of NSAIDs for postoperative orthopaedic pain control.

Luaran Terapi Berdasarkan Jenis Pemberian Analgetik pada Pasien Pasca Operasi Ortopedi

Postoperative pain was suffered by 80% of the total patients. One of the many surgical procedures performed is orthopedics. Ketorolac and fentanyl are often used for postoperative orthopedic pain. Appropriate postoperative pain management with adequate analgesic administration will accelerate pain reduction and shorten the patient's hospital stay. This study aims to determine the difference in the effect of continuous fentanyl and intravenous ketorolac on pain targets achievement and Length of Stay (LOS) of patients after orthopedic surgery. This study is a prospective cohort study, involving inpatients after orthopedic surgery in Dr. Sardjito Yogyakarta in July-October 2019. The independent variable is continuous fentanyl and intravenous ketorolac, while the dependent variable is the achievement of pain targets and LOS. The analysis was conducted by Fisher's exact test, Mann Whitney's test, and multivariate analysis to determine the dominance of variables on the research outcomes. There were 59 patients after orthopedic surgery in this study. A total of 34 patients in the continuous fentanyil group and 25 patients in the intravenous ketorolac group. There was no difference in the effect of continuous fentanyl administration and intravenous ketorolac on pain targets achievement (P = 0.711), while there were differences in the effect of continuous fentanyl administration and intravenous ketorolac on the average LOS of patients in the hospital (P = 0,000). Continuous fentanyl and intravenous ketorolac can both produce the achievement of adequate postoperative orthopedic pain targets, but the mean LOS becomes shorter in patients with intravenous ketorolac.

R3 Is TENS a Feasible Non-Pharmacologic Adjunctive Treatment for Post-operative Orthopedic Pain?

R3 Is TENS a Feasible Non-Pharmacologic Adjunctive Treatment for Post-operative Orthopedic Pain?

Cannabinoids and Pain Management: an Insight into Recent Advancements

This review discusses the recent advancements in research on Cannabinoids’ role in pain, including its use in cancer pain, neuropathic pain, fibromyalgia, headache, visceral pain, postoperative and failed back pain management, and concurrent use with opioids. Current research suggests that a potential role exists for medical cannabis in pain management, although research shows varied effectiveness by the type of pain. Moreover, its coadministration with opioids may result in reduced opioid requirements. Patients with neuropathic pain, cancer pain, and migraine headache may benefit from the analgesic effects of a cannabis-based medicine (CBM), but not necessarily patients with chronic abdominal pain. Equivocal results were shown in fibromyalgia and postoperative orthopedic pain. Interestingly, the opioid-sparing properties of CBM make it an attractive option for pain management. However, the scale and quality of studies conducted are limited. Further research is necessary to establish recommendation guidelines for medical cannabis in pain management.

Gabapentin as Premedication for Postoperative Analgesia in Children: A Prospective Randomized Controlled Study

Background: In recent studies, preoperative administration of gabapentin appears to play a role in postoperative pain control. However its use in children is still need further researches. So we aimed to evaluate the effect of gabapentin on management of postoperative orthopedic pediatric pain and consumption of analgesia. Patients and methods: This prospective study was carried out within one year on 80 children patients aged 10-12 years old scheduled for orthopedic surgery in upper and lower limbs. Patients were randomly allocated equally in two groups (40 for each) as follows: Group I: Gabapentin 300 mg was given orally 2 h before induction of anesthesia (Gabapentin capsule). Group II: control group (receive placebo 2 h before induction of anesthesia). Results: There was a significant increase in values of pain score at 0.5 h, 4 h postoperative as (p 0.05) between both groups. There was a significance increase in values of heart rate at 0.5,4 h postoperatively (p 0.05) between both groups. There was a significant increase in values of mean arterial pressure at 0.5 h, 4 h postoperatively as compared group II with group I and there was no statistically significant difference in values of mean arterial pressure at pre-induction and at 1 h, 2 h, 6 h, 12 h, 24 h postoperative as (P>0.05). There was a significant increase in values of postoperative total analgesia consumption in group II (control group) when compared to group I (gabapentin group) as (P<0.05). There was a significance increase in time to first demand of analgesia in group I when compared to group II (P<0.05). Conclusion: Administration of gabapentin preoperatively significantly reduces postoperative pain and postoperative analgesia consumption in children under going orthopedic surgery. It also causes stability in hemodynamic status by decreasing stress response and anxiety.

Anti-nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery-induced pain.

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently, opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA or THA pain. Recently, issues including efficacy, dependence, overdose, and death from opiates have made clinicians and researchers more critical of use of opioids for treating nonmalignant skeletal pain. In the present report, a nonopiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain-induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity and velocity and vertical rearing were continually assessed over a 20 hours day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3, after orthopedic surgery, there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggest that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain after orthopedic surgeries such as TKA or THA.

Initial evaluation of a canine stifle arthrotomy post-operative pain model

Most models of acute post-operative orthopedic pain involve the injection of a clinically irrelevant pro-inflammatory agent. The ideal model should, however, be clinically relevant and allow full functional recovery of enrolled animals after research is completed. This study explored the validity of a model employing arthrotomy and objectively measured limb use. Six purpose-bred Beagles underwent arthrotomies on each stifle with a washout period in between. Using a randomized crossover design, each dog received placebo and an extended-release buprenorphine (ER-Bup) preparation. Static and dynamic ground reaction forces (GRFs) were measured prior to and for 72 h following surgery using a pressure sensitive walkway (PSW). GRFs for each hind limb were compared using difference (delta), and symmetry indices (SI). The effects of surgery and of treatment were analyzed using repeated measures ANCOVA.The results indicated significantly decreased limb use compared to baseline for placebo, and significantly increased limb use in the ER-Bup group over placebo at all times for % bodyweight distribution (%BWdistrib), peak vertical force (PVF) and vertical impulse (VI). There was a significant treatment by time interaction for velocity (P = 0.03) and %BWdistrib (P = 0.01, 0.003). Overall, the data show that reduced limb use was present for at least 72 h following arthrotomy. In addition, the use of the ER-Bup analgesic decreased lameness, confirming the validity of this approach as a model of post-operative pain. Subjective assessments did not detect the pain-inducing effects of arthrotomy or pain-alleviating effects of treatment, and subjective measures of procedural pain in research dogs need to be developed.

Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.

The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain-related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti-nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains.

COMPARISON OF EFFICACY OF MELOXICAM, KETOPROFEN AND CARPROFEN AS POSTOPERATIVE PAIN MANAGEMENT AGENTS IN CLINICAL CANINE ORTHOPAEDIC SURGERY

The present clinical study was carried out on 18 dogs presented to Veterinary College Hospital with various orthopaedic conditions. They were randomly divided into three groups each of 6 animals to compare analgesic efficacy of meloxicam, ketoprofen and carprofen in post-operative orthopaedic pain management. Dogs of group I, received meloxicam @ 0.2 mg/kg b.wt. i/m once followed by oral dose 24 hourly, group II ketoprofen @ 1.5 mg/kg b.wt. i/m once daily and group III carprofen @ 4 mg/kg b.wt. orally 12 hourly, as analgesics for 5 days. Result revealed that in canine orthopaedic cases meloxicam was the best followed by ketoprofen and carprofen.

A Single-Center, Randomized, Double-Blind, Active, and Placebo-Controlled Study of KAI-1678, a Novel PKC-Epsilon Inhibitor, in the Treatment of Acute Postoperative Orthopedic Pain

KAI-1678, a novel inhibitor of the interaction of the epsilon isoform of protein kinase C (εPKC) with its intracellular receptor, has demonstrated activity in countering hyperalgesia in several models of pain. In this controlled randomized trial, KAI-1678 was tested for analgesic activity in an orthopedic acute postoperative pain setting. Following hip or knee replacement surgery, subjects were treated with KAI-1678, ketorolac, or saline. Subjects recorded their pain intensity on a visual analog scale and rated their quality of analgesia. The pain intensity differences between baseline and the evaluations were summed over the first 4 hours. The analysis revealed that, while ketorolac displayed good analgesic activity, KAI-1678 was not significantly different than placebo. Analgesia quality ratings similarly did not show a difference between KAI-1678 and placebo in this pain model. A small excess of infusion site erythema was seen with KAI-1678, but otherwise the drug was safe and well tolerated. We investigated the safety and efficacy of a novel inhibitor of εPKC and provide clinical evidence that inhibition of εPKC with KAI-1678 is not effective in the treatment of acute postoperative orthopedic pain.

Analgesic effects of meloxicam administration on postoperative orthopedic pain in domestic pigeons (Columba livia)

To assess the analgesic effects of 2 doses of meloxicam on the degree of postoperative orthopedic pain in pigeons. 21 domestic pigeons (Columba livia). In each bird, a standardized osteotomy of 1 femur was performed and the fracture was immobilized with an intramedullary pin. Birds were randomly allocated to receive saline (0.9% NaCl) solution (control) or meloxicam (0.5 mg/kg [low dose] or 2.0 mg/kg [high dose]). The first treatment was administered i.m. after surgery was completed. Subsequent treatments were administered p.o. every 12 hours for 9 days. Degree of postoperative pain was assessed for the first 4 days after surgery by use of 3 methods: an electronic perch for assessment of weight-bearing load differential of the pelvic limbs, 4 pain scales, and analysis of video-recorded partial ethograms for bird activity and posture. No significant differences were observed between the control group and the low-dose meloxicam group in any tested variable. The high-dose meloxicam group had a greater degree of weight bearing on the affected limb from the second to the fourth postoperative day as well as lower pain scores for at least the first 2 postoperative days, compared with the other groups. Return to presurgical behavior was achieved faster in pigeons that received high-dose meloxicam than in the other groups. No adverse effects were observed. Administration of meloxicam at 0.5 mg/kg appeared ineffective in minimizing postoperative orthopedic pain in pigeons, but the 2.0 mg/kg dose provided quantifiable analgesia that appeared safe in this species in experimental conditions.

Comparative evaluation of efficacy and safety of etodolac and diclofenac sodium injection in patients with postoperative orthopedic pain

Objective:The objective of this study was to compare the analgesic efficacy of etodolac injection and diclofenac injection in patients with postoperative orthopedic pain.Methods:This was multicentric, randomized, assessor-blind and parallel-group study. A group of 158 patients with moderate to severe pain following orthopedic surgery were randomly assigned to receive either etodolac 400 mg twice a day (n = 78) or diclofenac 75 mg thrice a day (n = 80).Main outcome measures:The primary efficacy outcome measures were pain intensity difference, sum of pain intensity differences and pain relief whereas secondary efficacy variables included maximum fall in pain intensity, number of doses of study medication consumed, number of patients who required rescue medication and overall response to therapy.Results:Mean pain intensity differences assessed on 10 cm VAS were significantly better for etodolac arm compared to diclofenac arm at 4, 8, 20 and 24 hours (p < 0.05). Sum of pain intensity differences over the first 8 hours (−21.31 ± 6.26 for etodolac vs. −19.13 ± 6.98 for diclofenac; p = 0.041) and over the 24 hours (−39.83 ± 10.70 for etodolac vs. −35.25 ± 12.00 for diclofenac; p = 0.012) for the etodolac group was significantly superior than diclofenac group. Assessment of pain relief showed that etodolac injection was significantly more effective than diclofenac injection (p < 0.0001) over the 24 hour assessment period. Maximum fall in pain intensity score, number of doses of study medication consumed and patients’ and investigators’ overall response to the drug at the end of treatment period were also significantly superior in the etodolac arm as compared to the diclofenac arm (p < 0.05). However, the number of patients who were rescued was comparable in both the treatment arms. A change in emotional functioning of the patients was not captured in this study. Both the study medications were well tolerated with no incidence of SAE throughout the study.Conclusion:Etodolac can be considered as an effective alternative to traditional NSAIDS in the treatment of post operative pain.

Recent advances in the treatment of pain

Cancer pain and chronic non-malignant pain can be difficult to manage and may not respond satisfactorily to standard analgesics. Sequential empiric analgesic trials are usually done to manage individual patients. Experimental human pain models have helped to clarify mechanisms of opioid and adjuvant analgesic actions. Combinations of opioids and adjuvant analgesics better relieve pain than either opioids or adjuvant analgesics alone, as demonstrated in randomized controlled trials. The analgesic activity of antidepressants is largely dependent upon norepinephrine reuptake and activation of alpha 2 adrenergic receptors. Corticosteroids reduce postoperative orthopedic incident pain, which may allow patients to ambulate earlier and with less pain. Spinal corticosteroids reduce lower hemibody pain. Gabapentinoids as single high doses reduce postoperative pain and certain acute pain syndromes. Individuals who experience flares of pain while on spinal opioids benefit from intrathecal boluses of levobupivicaine or sublingual ketamine. Interventional approaches to pain management are often necessary due to the limitations of systemic analgesics. Electronics stimulators (peripheral, spinal and motor cortex) improve difficult to manage chronic pain syndromes. Pulsed radiofrequency reduces pain without tissue damage, which could be an advantage over chemical or radiofrequency neurotomy. Botulinum toxin A reduces focal neuropathic pain that is durable. Interventional related successes in relieving pain are operator dependent. Most reported benefits of systemic and regional analgesics and interventional approaches to pain relief are not based on randomized trials and are subject to selection bias, sampling error, and placebo responses, which may over-inflate reported benefits. Randomized controlled trials are needed to confirm reported benefits.

Multicentric, randomized and positive-controlled study to assess the efficacy of an association of chondroitin sulphate, chitosan, l-selenomethionine and epigallocatechin-3-gallate in the control of osteoarthritis and functional postoperative recovery

A multicentric, randomized and positive-controlled study was run to investigate the potential benefits of the association of chondroitin sulphate, chitosan, l-selenomethionine and epigallocatechin-3-gallate (CSCSE) in the control of osteoarthritis and functional recovery after orthopaedic surgery. Forty-two household dogs of any breed, sex and weight, older than 4 months, with hip dysplasia or Anterior Cruciate Ligament (ACL) rupture and admitted for Triple Pelvic Osteotomy (TPO) procedure or ACL surgery by ligamentoplasty, were enrolled in the study. All dogs received one injection of carprofen in the immediate preoperative period. Twenty-four hours after surgery, dogs were randomly assigned to receive either oral carprofen for 4 consecutive days or the CSCSE association for 30 consecutive days. The animals were evaluated by the investigators before surgery, and 6 weeks (W6) and 3 months (M3) after surgery for bodyweight, joint mobility, muscular circumference of the affected limb, pain level and radiographic osteoarthritis score. A pain assessment was also made by the owners during the first 10 days after surgery. No significant differences were found between treatment groups, except for the radiographic osteoarthritis score in dogs operated on for ACL at W6 in favour of the CSCSE association (p = 0.046). No significant differences were found between the radiographic osteoarthritis scores at M3. Evolution over time showed significant differences within treatment groups for all measured parameters, except for joint mobility and osteoarthritis. In conclusion, oral CSCSE association appears to provide some benefit for the treatment of both acute and midterm postoperative orthopaedic pain, as well as in the functional recovery process. Une étude multicentrique, randomisée et contrôlée a été réalisée afin d’étudier les bénéfices potentiels de l’association chondroïtine sulfate, chitosan, l-sélénométhionine et épigallocatechine-3-gallate (CSCSE) dans le contrôle de l’arthrose et de la récupération fonctionnelle après une chirurgie orthopédique. Quarante-deux chiens de propriétaires, de race, sexe et poids variés, âgés de plus de quatre mois et présentant une dysplasie de la hanche ou une rupture du ligament croisé antérieur (LCA), admis pour une triple ostéotomie du bassin (TPO) ou une ligamentoplastie du LCA, ont été inclus dans l’étude. Tous les chiens ont reçu une injection de carprofène en période préopératoire immédiate. Vingt-quatre heures après la chirurgie, les chiens ont été assignés par randomisation à l’un des deux groupes de traitement suivant : carprofène par voie orale pendant quatre jours consécutifs ou l’association CSCSE pendant 30 jours consécutifs. Les investigateurs ont évalué avant la chirurgie, six semaines (S6) et trois mois (M3) après la chirurgie, le poids corporel, la mobilité articulaire, la circonférence musculaire du membre atteint, le stade de douleur et le score radiographique d’arthrose des animaux. Les propriétaires ont également évalué la douleur pendant les dix premiers jours après la chirurgie. Aucune différence significative n’a été mise en évidence entre les groupes de traitement, à l’exception du score radiographique d’arthrose à S6 chez les chiens opérés du LCA en faveur de l’association CSCSE (p = 0,046), ce qui n’est plus le cas à M3. Tous les paramètres mesurés, à l’exception de la mobilité articulaire et de l’arthrose, ont montré dans chaque groupe de traitement une évolution significative dans le temps. En conclusion, l’association CSCSE semble apporter certains bénéfices dans le traitement de la douleur postopératoire aiguë et à moyen terme, ainsi que dans le processus de récupération fonctionnelle en chirurgie orthopédique.

Comparison of the analgesic properties of transdermally administered fentanyl and intramuscularly administered buprenorphine during and following experimental orthopedic surgery in sheep

To evaluate the analgesic properties of transdermally administered fentanyl and IM administered buprenorphine in sheep undergoing unilateral tibial osteotomy. 20 mature sheep. Fentanyl patches (n = 15 sheep) or placebo patches (5 sheep) were applied 12 hours before sheep underwent general anesthesia and a unilateral tibial osteotomy. Buprenorphine was administered to the placebo group every 6 hours commencing at time of induction. Signs of pain were assessed every 12 hours after surgery by 2 independent observers unaware of treatment groups. There were no differences in preoperative and intraoperative physiologic data between the 2 groups. Sheep treated with fentanyl required less preoperative administration of diazepam for sedation and had significantly lower postoperative pain scores, compared with those treated with buprenorphine. No complications associated with the antebrachium at the site of patch application were detected. Under the conditions of this study, transdermally administered fentanyl was a superior option to IM administered buprenorphine for alleviation of postoperative orthopedic pain in sheep. This information can be used to assist clinicians in the development of a rational analgesic regimen for research and clinical patients.

Psychometric Testing of a Respiratory Distress Observation Scale

The purpose of this study was to establish the reliability and construct validity of a new behavioral instrument to measure the presence and intensity of respiratory distress for patients who are unable to self-report about dyspnea. Patient reports about dyspnea were compared to displayed behaviors in three groups of 70 patients (n = 210). Pulmonary rehabilitation patients were assessed with the respiratory distress observation scale (RDOS) after controlled exercise while hypoxemic and subsequently asked to report current dyspnea on a dyspnea visual analog scale (DVAS). Patients with postoperative orthopedic pain were evaluated with the RDOS and asked to report current pain and dyspnea. Healthy volunteers were assessed with the RDOS at rest and asked to report current dyspnea. The internal consistency (alpha) of this seven variable scale is 0.78. A positive correlation between the RDOS and DVAS (p = 0.001) was found in dyspneic patients indicating convergent validity. Significant differences were found when RDOS scores were compared between groups indicating discriminant validity. The instrument is reliable and has convergent and discriminant validity. There are clinical and research applications for this scale for assessment of patients who are unable to self-report about distress from dyspnea.

Minimally Invasive Retrieval of Knotted Nonstimulating Peripheral Nerve Catheters

Continuous peripheral nerve blockade is rapidly becoming the technique of choice for the management of postoperative orthopedic pain. However, the insertion of perineural catheters may be associated with complications, including catheter kinking and knotting. A knotted catheter may be difficult or impossible to remove at the patient bedside, requiring surgical excision under general anesthesia. We describe a previously unreported minimally invasive technique of retrieving knotted peripheral nerve catheters and avoiding the need for surgical intervention. Although the described technique has been used by interventional radiologists for the removal of knotted intravascular devices, it has not been previously described for the retrieval of knotted perineural catheters. The Mayo Clinic Acute Pain Service database was queried and patients identified with knotted peripheral nerve catheters during the 3-year period from January 2003 to January 2006. The medical records of all identified patients were retrospectively reviewed and details of catheter placement including catheter type and location, size (gauge), ease of placement, distance threaded, and duration of use recorded. During the study period, 5,964 nonstimulating peripheral nerve catheters were placed. Of these, 8 (0.13%) patients experienced catheter knotting resulting in difficult or impossible catheter removal at the bedside. Seven (88%) of the 8 catheters were successfully removed by using a minimally invasive technique of catheter retrieval using guided fluoroscopy. The remaining catheter was removed at the bedside with patient repositioning. The knotting of peripheral nerve catheters is a relatively uncommon phenomenon, occurring in only 0.13% of patients. However, because the use of perineural catheters has increased within anesthesia practice, clinicians may begin to encounter these complications with greater frequency. Practitioners should be aware of surgical alternatives, including guided-fluoroscopic techniques, when simple catheter traction or tension proves unsuccessful at the patient bedside.