Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine : Preliminary Report from a Randomized Clinical Trial
Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020. This work is written by US Government employees and is in the public domain in the US..
OBJECTIVE: We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery.
DESIGN: Prospective, parallel-arms, randomized, double-blind trial.
SETTING: A single veterans' hospital.
SUBJECTS: Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic.
METHODS: Participants underwent nerve/plexus blocks at L2-L4 and L4-S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test.
RESULTS: Significant (P < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27).
CONCLUSIONS: BPV-BCD provided 26-39 hours of perineural analgesia in the L2-L4 and L4-S3 nerve distributions after hip/knee replacement surgery, compared with 11-21 hours for plain BPV.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Pain medicine (Malden, Mass.) - 21(2020), 11 vom: 01. Nov., Seite 2893-2902 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Williams, Brian A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 14.05.2021 Date Revised 14.05.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/pm/pnaa229 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315976438 |
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| 100 | 1 | |a Williams, Brian A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Extended Perineural Analgesia After Hip and Knee Replacement When Buprenorphine-Clonidine-Dexamethasone Is Added to Bupivacaine |b Preliminary Report from a Randomized Clinical Trial |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 14.05.2021 | ||
| 500 | |a Date Revised 14.05.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020. This work is written by US Government employees and is in the public domain in the US. | ||
| 520 | |a OBJECTIVE: We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery | ||
| 520 | |a DESIGN: Prospective, parallel-arms, randomized, double-blind trial | ||
| 520 | |a SETTING: A single veterans' hospital | ||
| 520 | |a SUBJECTS: Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic | ||
| 520 | |a METHODS: Participants underwent nerve/plexus blocks at L2-L4 and L4-S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test | ||
| 520 | |a RESULTS: Significant (P < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27) | ||
| 520 | |a CONCLUSIONS: BPV-BCD provided 26-39 hours of perineural analgesia in the L2-L4 and L4-S3 nerve distributions after hip/knee replacement surgery, compared with 11-21 hours for plain BPV | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Bupivacaine | |
| 650 | 4 | |a Buprenorphine | |
| 650 | 4 | |a Clonidine | |
| 650 | 4 | |a Dexamethasone | |
| 650 | 4 | |a Joint Arthroplasty | |
| 650 | 4 | |a Total | |
| 650 | 4 | |a Nerve Block | |
| 650 | 7 | |a Anesthetics, Local |2 NLM | |
| 650 | 7 | |a Buprenorphine |2 NLM | |
| 650 | 7 | |a 40D3SCR4GZ |2 NLM | |
| 650 | 7 | |a Dexamethasone |2 NLM | |
| 650 | 7 | |a 7S5I7G3JQL |2 NLM | |
| 650 | 7 | |a Clonidine |2 NLM | |
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| 650 | 7 | |a Bupivacaine |2 NLM | |
| 650 | 7 | |a Y8335394RO |2 NLM | |
| 700 | 1 | |a Ibinson, James W |e verfasserin |4 aut | |
| 700 | 1 | |a Ritter, Marsha E |e verfasserin |4 aut | |
| 700 | 1 | |a Ezaru, Catalin S |e verfasserin |4 aut | |
| 700 | 1 | |a Rakesh, Hulimangala R |e verfasserin |4 aut | |
| 700 | 1 | |a Paiste, Henry J |e verfasserin |4 aut | |
| 700 | 1 | |a Gilbert, Karen L |e verfasserin |4 aut | |
| 700 | 1 | |a Mikolic, Joseph M |e verfasserin |4 aut | |
| 700 | 1 | |a Muluk, Visala S |e verfasserin |4 aut | |
| 700 | 1 | |a Piva, Sara R |e verfasserin |4 aut | |
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