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Brian D Owens - One of the best experts on this subject based on the ideXlab platform.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Brian D Owens
    Abstract:

    Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled IV morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. Implications: Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Spencer S Liu, Brian D Owens
    Abstract:

    UNLABELLED Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled i.v. morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. IMPLICATIONS Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

Hugh W Allen - One of the best experts on this subject based on the ideXlab platform.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Brian D Owens
    Abstract:

    Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled IV morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. Implications: Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Spencer S Liu, Brian D Owens
    Abstract:

    UNLABELLED Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled i.v. morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. IMPLICATIONS Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

Paul D Ware - One of the best experts on this subject based on the ideXlab platform.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Brian D Owens
    Abstract:

    Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled IV morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. Implications: Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Spencer S Liu, Brian D Owens
    Abstract:

    UNLABELLED Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled i.v. morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. IMPLICATIONS Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

Craig S Nairn - One of the best experts on this subject based on the ideXlab platform.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Brian D Owens
    Abstract:

    Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled IV morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. Implications: Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

  • peripheral nerve blocks improve analgesia after total Knee Replacement Surgery
    Anesthesia & Analgesia, 1998
    Co-Authors: Hugh W Allen, Paul D Ware, Craig S Nairn, Spencer S Liu, Brian D Owens
    Abstract:

    UNLABELLED Total Knee Replacement (TKR) produces severe postoperative pain. Peripheral nerve blocks can be used as analgesic adjuncts for TKR, but the efficacy of femoral nerve blocks alone is controversial. The sciatic nerve innervates posterior regions of the Knee; thus, performance of both sciatic and femoral nerve blocks may be necessary to improve analgesia after TKR. We performed this study to determine whether peripheral nerve blocks improve analgesia after TKR. In a randomized, double-blind fashion, 36 patients undergoing TKR received either femoral, sciatic-femoral, or sham nerve blocks after a standardized spinal anesthetic. Further postoperative analgesia was provided by patient-controlled i.v. morphine and ketorolac. Pain at rest and with physical therapy, morphine use, nausea, pruritus, sedation, and patient satisfaction were assessed. Patients receiving peripheral nerve blocks reported better analgesia at rest for at least 8 h after transfer to the hospital ward (P < 0.05). Morphine use was decreased by approximately 50% in the peripheral nerve block groups until the second postoperative day (P < 0.02). Side effect profiles and patient satisfaction were similar between groups. We conclude that femoral nerve blocks improve analgesia and decrease morphine use after TKR. The addition of a sciatic nerve block to the femoral nerve block did not further improve analgesic efficacy. IMPLICATIONS Performance of femoral nerve blocks improves analgesia and decreases the need for morphine after total Knee Replacement Surgery. The addition of a sciatic nerve block to the femoral nerve block does not provide additional benefits.

David S Stulberg - One of the best experts on this subject based on the ideXlab platform.

  • pain and depression influence outcome 5 years after Knee Replacement Surgery
    Clinical Orthopaedics and Related Research, 2007
    Co-Authors: Victoria A Brander, Stephen Gondek, Emily Martin, David S Stulberg
    Abstract:

    UNLABELLED We previously reported preoperative depression, anxiety, and pain were associated with greater pain, more utilization of healthcare resources, and worse outcome 1 year after total Knee arthroplasty. We asked whether these outcomes persisted over time and whether patients with unexplained heightened pain early after Surgery were ultimately satisfied. We prospectively followed and evaluated 83 patients (109 TKAs) 5 years postoperative. The mean age was 66 years; 55% were women. Preoperative pain and depression predicted lower Knee Society score mostly related to lower function subscores. Although anxiety was associated with greater pain, worse function, and more use of resources in the first year after Surgery, anxiety did not affect ultimate outcome. Most patients required a full year to recover from Surgery but with negligible improvements in most parameters afterward. However, patients with heightened, unexplained pain at 1 year had progressive improvement in pain over several years. By 5 years, nearly all of these patients were satisfied. Therefore, assuming good range of motion and well-aligned implants, most patients with pain 1 year after Surgery can be reassured pain ultimately improves. Depression drives long-term outcomes; the Knee Society score is influenced by psychologic variables and does not solely reflect issues related to the Knee. Expansion of this tool to include measures sensitive to psychologic and other health factors should be considered. LEVEL OF EVIDENCE Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  • computer assisted navigation in total Knee Replacement results of an initial experience in thirty five patients
    Journal of Bone and Joint Surgery American Volume, 2002
    Co-Authors: David S Stulberg, Peter Loan, Vineet K Sarin
    Abstract:

    The success of total Knee Replacement Surgery depends on several factors, including proper patient selection, appropriate implant design, correct surgical technique, and effective perioperative care. The outcome of total Knee Replacement Surgery is particularly sensitive to variations in surgical technique 1-9. Incorrect positioning or orientation of the implant and improper alignment of the limb can lead to accelerated implant wear and loosening as well as suboptimal functional performance. A number of studies have suggested that alignment errors of >3° are associated with more rapid failure and less satisfactory functional results after total Knee arthroplasty 1,10-20. Recent studies have also emphasized that the most common cause for revision total Knee Replacement is error in surgical technique. Mechanical alignment guides have improved the accuracy with which implants can be inserted. Although mechanical alignment systems are continually being refined, errors in implant and limb alignment continue to occur. It has been estimated that errors in tibial and femoral alignment of >3° occur in at least 10% of total Knee arthroplasties, even when performed by experienced surgeons using mechanical alignment systems of modern design. Mechanical alignment systems have fundamental problems that limit their ultimate accuracy. The accuracy of preoperative planning is limited by the errors inherent in standard radiographs. It is difficult to determine accurately, with standard instrumentation, the correct location of crucial alignment landmarks (e.g., the center of the femoral head, the center of the ankle). Moreover, mechanical alignment and sizing devices presume a standardized bone geometry that may not apply to a specific patient. Even the most elaborate mechanical instrumentation systems rely on visual inspection to confirm the accuracy of limb and implant alignment and stability at the conclusion of the total Knee Replacement procedure. Computer-based alignment systems have been developed to address the …