The effect of intra-articular methadone on postoperative pain following anterior cruciate ligament reconstruction
ABSTRACT Intra-articular narcotics have proven efficacy for providing pain relief following knee arthroscopy. This effect is short-lived. Methadone, with its long serum half-life (thirty-five hours, compared with two hours for morphine) could provide improved and prolonged pain relief. The purpose of the present study was to examine the effects of an intra-articular injection of methadone on postoperative analgesia following arthroscopic anterior cruciate ligament reconstruction.
Sixty-five skeletally mature patients undergoing primary anterior cruciate ligament reconstruction were randomly assigned to one of three groups, all of which received an intra-articular injection consisting of 9.5 mL of 0.5% bupivacaine with 1:200,000 epinephrine at the completion of the procedure. In addition, the remaining 0.5 mL of the syringe was filled with one of three substances. The study group (twenty-five patients) received 5 mg of methadone, the comparison group (twenty-one patients) received 5 mg of morphine, and the control group (nineteen patients) received 0.5 mL of saline solution. All supplemental pain medications were given on an as-needed basis, recorded, and converted to morphine equivalents. Specific variables that were measured included supplemental analgesia requirements during both the inpatient period and the outpatient period (from the time of discharge to the seventh postoperative day) and pain scores.
There was no significant difference in inpatient (p = 0.998) or outpatient (p = 0.887) supplemental analgesic requirements or pain scores between the methadone group (Group 1) and the control group (Group 3). The morphine group (Group 2) required significantly less inpatient (p = 0.014) and outpatient (p = 0.044) supplemental analgesia compared with the control group (Group 3). There were no complications.
The present report represents the first known study of the use of intra-articular methadone and establishes that this analgesic is safe at a single dose of 5 mg. At this dose, however, methadone does not provide improved postoperative analgesia following arthroscopic anterior cruciate ligament reconstruction. In contrast, intra-articular morphine does appear to be effective for decreasing postoperative pain.
SourceAvailable from: Christine E Stake[Show abstract] [Hide abstract]
ABSTRACT: BackgroundMultimodal analgesia following total hip arthroplasty has been shown to improve patient satisfaction, participation with physical therapy, and allow early return to self care. Liposomal bupivacaine is a formulation of local anesthetic which has the potential to provide anesthesia for up to 72 hours following administration. The purpose of this study was to compare the effectiveness of liposomal bupivacaine with bupivacaine following total hip arthroplasty.MethodsA retrospective chart review was performed on 28 patients undergoing total hip arthroplasty or hip resurfacing who received intraoperative administration of liposomal bupivacaine. A control group of 30 patients who had previously undergone total hip arthroplasty or hip resurfacing and had received intraoperative administration of bupivacaine also underwent a chart review. Length of stay, post-operative opioid use, and pain scores were compared for both groups.ResultsThe average length of stay in the study group was 1.93 days and the control group length of stay was 2.47 days (p ≤ 0.05). Morphine equivalent use was less in the study group during the first 24 hours compared to the control group (p ≤0.05). During the second and third 24 hours the morphine equivalent use difference was not statistically significant. Visual analogue scores were not significantly different between groups at any time point.ConclusionLiposomal bupivacaine administration during total hip arthroplasty appears to decrease the need for opioid use post operatively and decrease length of stay. The results of this study justify the need for a well-designed randomized controlled trial utilizing liposomal bupivacaine as part of multimodal analgesia during THA.BMC Musculoskeletal Disorders 09/2014; 15(1):310. DOI:10.1186/1471-2474-15-310 · 1.90 Impact Factor
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ABSTRACT: Rehabilitation protocols after bone–patellar tendon–bone anterior cruciate ligament reconstruction have become significantly more aggressive over the past decade. Key concepts of an accelerated rehabilitation protocol include immediate full weight bearing, unrestricted range of motion, early closed kinetic exercises, and return to play by 4 months. Additional components of a successful rehabilitation program include appropriate timing of surgery, adequate postoperative analgesia, use of cryotherapy, and diligent surveillance for the development of postoperative motion complications. In addition to thorough patient evaluation and meticulous surgical technique, a comprehensive rehabilitation protocol for the reconstructed knee is an essential part of the overall treatment algorithm of the anterior cruciate ligament-injured extremity. This article reviews a variety of different factors involved in successful rehabilitation after anterior cruciate reconstruction using patellar bone–tendon–bone autograft and presents a comprehensive rehabilitation protocol.Techniques in Orthopaedics 11/2005; 20(4):439-451. DOI:10.1097/01.bto.0000190445.31887.bc
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ABSTRACT: Background: End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation. Objective: To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran. Methods: From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected. Results: Patients (7 women and 5 men) aged between 14 and 55 years. Indications for the transplantation included HBV infection (n=5), cryptogenic cirrhosis (n=2), Wilson’s disease, alcoholism (n=1), HCV infection (n=1), Budd-Chiari syndrome (n=1), and autoimmune hepatitis (n=1). MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, postoperatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions. Conclusion: We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success.08/2012; 3(3):120-3.