Impacto de la analgesia preventiva multimodal más un protocolo de bloqueo femoral sobre la rehabilitación, tiempo de hospitalización y analgesia postoperatoria después de artroplastia total de rodilla: estudio clínico controlado

Impacto de la analgesia preventiva multimodal más un protocolo de bloqueo femoral sobre la rehabilitación, tiempo de hospitalización y analgesia postoperatoria después de artroplastia total de rodilla: estudio clínico controlado.  Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: a controlled clinical pilot study. Beaupre LA, Johnston DB, Dieleman S, Tsui B. Department of Physical Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada. lauren.beaupre@ualberta.ca ScientificWorldJournal. 2012;2012:273821. doi: 10.1100/2012/273821. Epub 2012 Apr 30. Abstract PURPOSE: To compare preemptive multimodal analgesia (PMMA) without femoral nerve blocks (FNB) to PMMA including FNB following total knee arthroplasty (TKA). METHODS: In a prospective, controlled pilot study, subjects with noninflammatory arthritis undergoing TKA and a short postoperative stay received either PMMA + FNB (FNB group; n = 19) or PMMA only (PMMA group; n = 20). No preoperative group differences were noted. Evaluations occurred in hospital and at 2, 6, and 12 weeks postoperatively. The primary outcome (knee flexion) was measured on day two postoperatively. Rehabilitation indices, pain, analgesic use, and length of stay (LOS) were also measured. RESULTS: All subjects completed the study. The only significant group differences were quadriceps motor blocks in the FNB group (P < 0.001). No significant differences were noted in ROM, pain levels, analgesic use, or hospital LOS.CONCLUSION: Other than the quadriceps motor block, no group differences were noted; both achieved satisfactory analgesia. Best postoperative pain management strategies when following a short hospital stay program are still unclear. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361157/pdf/TSWJ2012-273821.pdf Papel de los bloqueos nerviosos periféricos continuos  The role of continuous peripheral nerve blocks. Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. Division of Anesthesiology, Balgrist University Hospital, 8008 Zurich, Switzerland. Anesthesiol Res Pract. 2012;2012:560879. Epub 2012 Jun 18. Abstract A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385590/pdf/ARP2012-560879.pdf

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