دورية أكاديمية
أعرض في EDS

Effects of General Anesthesia Plus Multimodal Analgesia on Immediate Perioperative Outcomes of Hamstring Tendon Autograft ACL Reconstruction: A Randomized, Double-Blinded, Placebo-Controlled Trial.

التفاصيل البيبلوغرافية
العنوان: Effects of General Anesthesia Plus Multimodal Analgesia on Immediate Perioperative Outcomes of Hamstring Tendon Autograft ACL Reconstruction: A Randomized, Double-Blinded, Placebo-Controlled Trial.
المؤلفون: Walczak BE; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin.; Castle Orthopedics & Sports Medicine, Rush Copley Medical Center, Rush University Health, Aurora, Illinois., Bernardoni ED; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin., Steiner Q; School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin., Baer GS; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin., Donnelly MJ; Department of Anesthesia, University of Colorado, Denver, Colorado., Shepler JA; Department of Anesthesia, University of Wisconsin-Madison, Madison, Wisconsin.
المصدر: JB & JS open access [JB JS Open Access] 2023 Mar 27; Vol. 8 (1). Date of Electronic Publication: 2023 Mar 27 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: The Journal of Bone and Joint Surgery, Inc Country of Publication: United States NLM ID: 101726219 Publication Model: eCollection Cited Medium: Internet ISSN: 2472-7245 (Electronic) Linking ISSN: 24727245 NLM ISO Abbreviation: JB JS Open Access Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Needham, MA : The Journal of Bone and Joint Surgery, Inc., [2016]-
مستخلص: Anterior cruciate ligament reconstruction with hamstring tendon autograft (H-ACLR) is a standard ambulatory procedure with the potential for considerable postoperative pain. We hypothesized that general anesthesia combined with a multimodal analgesia regimen would reduce postoperative opioid use associated with H-ACLR.
Methods: This study was a single-center, surgeon-stratified, double-blinded, placebo-controlled, randomized clinical trial. The primary end point was the total postoperative opioid use during the immediate postoperative period, and secondary outcomes included postoperative knee pain, adverse events, and ambulatory discharge efficiency.
Results: One hundred and twelve subjects, 18 to 52 years of age, were randomized to placebo (57 subjects) or combination multimodal analgesia (MA) (55 subjects). The MA group required fewer opioids postoperatively (mean ± standard deviation, 9.81 ± 7.58 versus 13.88 ± 8.49 morphine milligram equivalents; p = 0.010; effect size = -0.51). Similarly, the MA group required fewer opioids within the first 24 hours postoperatively (mean ± standard deviation, 16.56 ± 10.77 versus 22.13 ± 10.66 morphine milligram equivalents; p = 0.008; effect size = -0.52). The subjects in the MA group reported lower posteromedial knee pain (median [interquartile range, IQR]: 3.0 [0.0 to 5.0] versus 4.0 [2.0 to 5.0]; p = 0.027) at 1 hour postoperatively. Nausea medication was required for 10.5% of the subjects receiving the placebo versus 14.5% of the subjects receiving MA (p = 0.577). Pruritis was reported for 17.5% of subjects receiving the placebo versus 14.5% receiving MA (p = 0.798). The median time to discharge was 177 minutes (IQR, 150.5 to 201.0 minutes) for subjects receiving placebo versus 188 minutes (IQR, 160.0 to 222.0 minutes) for those receiving MA (p = 0.271).
Conclusions: A combination of general anesthesia and local, regional, oral, and intravenous multimodal analgesia appears to reduce postoperative opioid requirements after H-ACLR compared with placebo. Adding preoperative patient education and focusing on donor-site analgesia may maximize perioperative outcomes.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A490).
(Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)
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تواريخ الأحداث: Date Created: 20230331 Latest Revision: 20230401
رمز التحديث: 20230403
مُعرف محوري في PubMed: PMC10043574
DOI: 10.2106/JBJS.OA.22.00144
PMID: 36999048
قاعدة البيانات: MEDLINE
الوصف
تدمد:2472-7245
DOI:10.2106/JBJS.OA.22.00144