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Jorgen B Dahl - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers.
Anesthesia and analgesia, 2016Co-Authors: Ulrik Grevstad, Pia Jaeger, Johan Klovgaard Sorensen, Bo Gottschau, Brian M. Ilfeld, Martin Ballegaard, Mike Hagelskjaer, Jorgen B DahlAbstract:BACKGROUND:Single-injection adductor canal block (ACB) provides analgesia after Knee Surgery. Which nerves that are blocked by an ACB and what influence—if any—local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (whi
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adductor canal blockade for moderate to severe pain after arthroscopic Knee Surgery a randomized controlled trial
Acta Anaesthesiologica Scandinavica, 2014Co-Authors: Malene Espelund, Pia Jaeger, Ulrik Grevstad, Ole Mathiesen, P Holmich, L Kjeldsen, Jorgen B DahlAbstract:Background The analgesic effect of the adductor canal block (ACB) after Knee Surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic Knee Surgery. Methods Fifty subjects with moderate to severe pain after arthroscopic Knee Surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB with the opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the Knee at 45 min after the first block, assessed on a 0–100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the Knee, worst pain experienced during a 5-m walk, patient's evaluation of muscle strength during walk, and amount of sufentanil administered during the 90-min study period. Results Regarding primary outcome, mean pain score difference between groups was 34 (95% CI: 25 to 44) mm, P < 0.001, in favour of the R group. At rest, mean pain score difference was 32 (23 to 41) mm, P < 0.001, and during walk: 21 (6 to 36) mm, P = 0.01 in favour of the R group. There were no differences between groups regarding other secondary outcome measures. Conclusion The ACB is a relevant option for patients with moderate to severe pain after arthroscopic Knee Surgery.
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the efficacy of adductor canal blockade after minor arthroscopic Knee Surgery a randomised controlled trial
Acta Anaesthesiologica Scandinavica, 2014Co-Authors: Malene Espelund, Jorgen B Dahl, J S Fomsgaard, J Haraszuk, Ole MathiesenAbstract:Background Adductor canal blockade (ACB) has been demonstrated to be effective in the treatment of post-operative pain after major Knee Surgery. We hypothesised that the ACB would reduce pain and analgesic requirements after minor arthroscopic Knee Surgery. Methods Seventy-two patients scheduled for minor Knee Surgery were enrolled in this placebo-controlled, blinded trial. The patients were randomised to receive an ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 36) or saline (n = 35) in addition to a basic analgesic regimen with paracetamol and ibuprofen. Primary outcome measure was pain during standing at 2 h after Surgery. Secondary outcomes were pain at rest, while standing and after a 5-m walk; opioid consumption and opioid-related side effects 0–24 h after Surgery. Results Pain scores {median [interquartile range (IQR)]}, regarding primary outcome were 15 (0–26) mm in the ropivacaine vs. 17 (5–28) mm in the control group, 95% confidence interval (CI) (−10 to 4) mm, P = 0.41. Ketobemidone consumption 0–2 h post-operatively [median (IQR)] was lower in the ropivacaine vs. the control group: 0.0 (0.0–2.5) mg vs. 2.5 (0.0–5.0) mg, 95% CI: −2.5 to 0 mg, P = 0.01. No differences were observed for any other outcome. Conclusion No significant analgesic effect of the ACB could be detected after minor arthroscopic Knee Surgery with a basic analgesic regimen with acetaminophen and ibuprofen, except from a minor reduction in immediate requirements for supplemental opioids. Clinicaltrials.gov Identifier: NCT01254825.
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continuous adductor canal blockade for adjuvant post operative analgesia after major Knee Surgery preliminary results
Acta Anaesthesiologica Scandinavica, 2011Co-Authors: Jorgen Lund, M Jenstrup, Pia Jaeger, A M Sorensen, Jorgen B DahlAbstract:Because both the saphenous nerve and in part the obturator nerve are traversing the adductor canal of the thigh, we hypothesised that repeated administration of a local anaesthetic (LA) into this aponeurotic space could be a useful option for post-operative analgesia after Knee replacement Surgery. A systematic search of the literature pertinent to the blockade of the saphenous and/or obturator nerves for pain relief after Knee Surgery was conducted. Further, pain and opioid requirements were evaluated in eight patients receiving a continuous blockade of the saphenous and obturator nerve (adductor-canal-blockade) after total Knee arthroplasty (TKA). Finally, we performed cross-sectional MR scans of the adductor canal after injection of ropivacaine 30ml in one patient. The systematic literature search revealed only one controlled study, where selective blockade of the saphenous nerve was investigated for the purpose of clinical pain relief after Knee arthroscopy. We located no studies reporting on saphenous and/or obturator nerve block for pain relief after TKA. Preliminary findings in eight patients demonstrated that a continuous adductor-canal-blockade for 48h after TKA was associated with low mean pain scores at rest and low mean requirements for supplemental morphine. MR scans in one patient demonstrated that 30ml of LA filled the adductor canal, including the distal part, where the posterior branch of the obturator nerve joins the vessels and the saphenous nerve. Continuous adductor-canal-blockade may be a valuable adjunct for post-operative analgesia after major Knee Surgery. These preliminary results should be confirmed in randomised, controlled trials.
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a systematic review of intra articular local anesthesia for postoperative pain relief after arthroscopic Knee Surgery
Regional Anesthesia and Pain Medicine, 1999Co-Authors: S Moiniche, Soren Mikkelsen, Jorn Wetterslev, Jorgen B DahlAbstract:Abstract Background and Objectives . In a systematic review, we have evaluated double-blind, randomized, controlled trials of intra-articular local anesthesia compared with placebo or no treatment in the control of postoperative pain after arthroscopic Knee Surgery. Methods . Outcome measures were pain scores, supplementary analgesics, and time to first analgesic request. Efficacy was estimated by significant difference ( P Results . Twenty studies with data from 895 patients were considered appropriate for analysis. Twelve of these 20 studies showed improved pain relief after intra-articular local anesthesia in at least one of the considered pain parameters, whereas the eight other studies were without such improvements. In ten of the positive studies, pain scores were significantly lower in the treatment groups compared with the control groups with visual analog scale (VAS) score reductions of between 10 and 35 mm early (1–4 hours) postoperatively. Quantitative analysis with calculation of the weighted mean difference in VAS confirmed a statistically significant but minor clinically important effect on postoperative pain scores. In nine studies, the consumption of supplementary analgesics was reduced 10–50% during observation periods of up to 4 hours; however, in most cases, the analgesic requirements were small to moderate. Only in two of six studies, where time to first analgesic request was evaluated, a significant prolongation of pain relief was observed as lasting between 30 and 50 minutes. Conclusions . There is a weak evidence for a reduction of postoperative pain after intra-articular local anesthesia in patients undergoing arthroscopic Knee Surgery, which although being small to moderate and of short duration, may be of clinical significance in day-case Surgery.
Shijun Gao - One of the best experts on this subject based on the ideXlab platform.
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incidence of deep venous thrombosis in chinese patients undergoing arthroscopic Knee Surgery for cruciate ligament reconstruction
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Jiangtao Dong, Xin Wang, Xiaoqian Men, Xiaofeng Wang, Xiaozuo Zheng, Shijun GaoAbstract:This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament Surgery. A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL–MCL/LCL; and five (14.7 %) of the ACL–MCL. In patients with tourniquets applied for 120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. The incidence of DVT in normal patients undergoing ACL Surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be considered after arthroscopic Knee Surgery in order to decrease the incidence of DVT if specific risk factors are present. IV.
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incidence of deep venous thrombosis in chinese patients undergoing arthroscopic Knee Surgery for cruciate ligament reconstruction
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Jiangtao Dong, Xin Wang, Xiaoqian Men, Xiaofeng Wang, Xiaozuo Zheng, Shijun GaoAbstract:Purpose This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament Surgery. Methods A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. Results DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL–MCL/LCL; and five (14.7 %) of the ACL–MCL. In patients with tourniquets applied for 120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. Conclusion The incidence of DVT in normal patients undergoing ACL Surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be consid ered after arthroscopic Knee Surgery in order to decrease the incidence of DVT if specific risk factors are present. Levels of evidence IV.
John M Bonvini - One of the best experts on this subject based on the ideXlab platform.
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intrathecal hyperbaric 2 prilocaine versus 0 4 plain ropivacaine for same day arthroscopic Knee Surgery a prospective randomized double blind controlled study
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2015Co-Authors: Jose Aguirre, Alain Borgeat, Philipp Buhler, Jelena Mrdjen, Beat Hardmeier, John M BonviniAbstract:Short-duration spinal anesthesia is a good option for ambulatory Knee Surgery. Hyperbaric 2% prilocaine has short onset and rapid recovery times and, therefore, may be well suited in this setting. The aim of this study was to compare the times to reach motor block, motor block resolution, and discharge from the postanesthesia care unit (PACU) between hyperbaric 2% prilocaine and 0.4% plain ropivacaine. In this prospective randomized double-blind study, 140 patients (ages 18-80 yr and American Society of Anesthesiologists physical status I-II) scheduled for elective unilateral arthroscopic Knee Surgery lasting < 45 min were allocated to either 3 mL of 2% prilocaine (60 mg) or 3 mL of 0.4% plain ropivacaine (12 mg). Time to reach complete recovery of motor block, time to reach criteria for discharge, as well as side effects up to 48 hr after discharge were recorded. The median (interquartile range [IQR]) time to recovery from the motor block was faster in the 2% prilocaine group compared with the 0.4% ropivacaine group (180 [169-240] min vs 240 [180-300] min, respectively; median difference, 60 min, 95% confidence interval (CI), 23 to 97 min; P = 0.036). The median [IQR] time to reach discharge criteria was similar between the two groups (330 [295-365] min vs, 335 [290-395] min; median difference 5 min, 95% CI, −25 to 35 min; P = 0.330). The incidence of side effects was low and similar in both groups. No case of transient neurologic symptoms occurred in either group. The recovery of motor block was faster after intrathecal administration of hyperbaric 2% prilocaine compared with 0.4% plain ropivacaine; however, discharge time was similar between the two groups. Both drugs showed a similar risk profile.
Jiangtao Dong - One of the best experts on this subject based on the ideXlab platform.
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incidence of deep venous thrombosis in chinese patients undergoing arthroscopic Knee Surgery for cruciate ligament reconstruction
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Jiangtao Dong, Xin Wang, Xiaoqian Men, Xiaofeng Wang, Xiaozuo Zheng, Shijun GaoAbstract:This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament Surgery. A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL–MCL/LCL; and five (14.7 %) of the ACL–MCL. In patients with tourniquets applied for 120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. The incidence of DVT in normal patients undergoing ACL Surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be considered after arthroscopic Knee Surgery in order to decrease the incidence of DVT if specific risk factors are present. IV.
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incidence of deep venous thrombosis in chinese patients undergoing arthroscopic Knee Surgery for cruciate ligament reconstruction
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Jiangtao Dong, Xin Wang, Xiaoqian Men, Xiaofeng Wang, Xiaozuo Zheng, Shijun GaoAbstract:Purpose This study investigated the incidence of deep venous thrombosis (DVT) in patients undergoing arthroscopic cruciate ligament Surgery. Methods A total of 282 patients were examined by color Doppler ultrasound preoperatively and 3 and 7 days postoperatively. Results DVT was present in 34 of 282 patients (12.1 %); of these, 11 (32.6 %) underwent reconstruction of the anterior cruciate ligament (ACL), alone or in conjunction with the medial or lateral collateral ligament (MCL or LCL, respectively; 17.6 %); eight (23.5 %) of the posterior cruciate ligament (PCL); four (11.8 %) of the PCL–MCL/LCL; and five (14.7 %) of the ACL–MCL. In patients with tourniquets applied for 120 min, the incidence of DVT was 5.6, 12.8, and 17.4 %, respectively. Conclusion The incidence of DVT in normal patients undergoing ACL Surgery was 12.1 %. A higher incidence was observed among cases of multiligament reconstruction, especially those involving the PCL, as well as in patients with tourniquets applied for more than 2 h. Based on these findings, prophylactic measures for DVT may be consid ered after arthroscopic Knee Surgery in order to decrease the incidence of DVT if specific risk factors are present. Levels of evidence IV.
Pia Jaeger - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers.
Anesthesia and analgesia, 2016Co-Authors: Ulrik Grevstad, Pia Jaeger, Johan Klovgaard Sorensen, Bo Gottschau, Brian M. Ilfeld, Martin Ballegaard, Mike Hagelskjaer, Jorgen B DahlAbstract:BACKGROUND:Single-injection adductor canal block (ACB) provides analgesia after Knee Surgery. Which nerves that are blocked by an ACB and what influence—if any—local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (whi
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adductor canal blockade for moderate to severe pain after arthroscopic Knee Surgery a randomized controlled trial
Acta Anaesthesiologica Scandinavica, 2014Co-Authors: Malene Espelund, Pia Jaeger, Ulrik Grevstad, Ole Mathiesen, P Holmich, L Kjeldsen, Jorgen B DahlAbstract:Background The analgesic effect of the adductor canal block (ACB) after Knee Surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic Knee Surgery. Methods Fifty subjects with moderate to severe pain after arthroscopic Knee Surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB with the opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the Knee at 45 min after the first block, assessed on a 0–100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the Knee, worst pain experienced during a 5-m walk, patient's evaluation of muscle strength during walk, and amount of sufentanil administered during the 90-min study period. Results Regarding primary outcome, mean pain score difference between groups was 34 (95% CI: 25 to 44) mm, P < 0.001, in favour of the R group. At rest, mean pain score difference was 32 (23 to 41) mm, P < 0.001, and during walk: 21 (6 to 36) mm, P = 0.01 in favour of the R group. There were no differences between groups regarding other secondary outcome measures. Conclusion The ACB is a relevant option for patients with moderate to severe pain after arthroscopic Knee Surgery.
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continuous adductor canal blockade for adjuvant post operative analgesia after major Knee Surgery preliminary results
Acta Anaesthesiologica Scandinavica, 2011Co-Authors: Jorgen Lund, M Jenstrup, Pia Jaeger, A M Sorensen, Jorgen B DahlAbstract:Because both the saphenous nerve and in part the obturator nerve are traversing the adductor canal of the thigh, we hypothesised that repeated administration of a local anaesthetic (LA) into this aponeurotic space could be a useful option for post-operative analgesia after Knee replacement Surgery. A systematic search of the literature pertinent to the blockade of the saphenous and/or obturator nerves for pain relief after Knee Surgery was conducted. Further, pain and opioid requirements were evaluated in eight patients receiving a continuous blockade of the saphenous and obturator nerve (adductor-canal-blockade) after total Knee arthroplasty (TKA). Finally, we performed cross-sectional MR scans of the adductor canal after injection of ropivacaine 30ml in one patient. The systematic literature search revealed only one controlled study, where selective blockade of the saphenous nerve was investigated for the purpose of clinical pain relief after Knee arthroscopy. We located no studies reporting on saphenous and/or obturator nerve block for pain relief after TKA. Preliminary findings in eight patients demonstrated that a continuous adductor-canal-blockade for 48h after TKA was associated with low mean pain scores at rest and low mean requirements for supplemental morphine. MR scans in one patient demonstrated that 30ml of LA filled the adductor canal, including the distal part, where the posterior branch of the obturator nerve joins the vessels and the saphenous nerve. Continuous adductor-canal-blockade may be a valuable adjunct for post-operative analgesia after major Knee Surgery. These preliminary results should be confirmed in randomised, controlled trials.