Perineural Anesthetic Infusion After Joint Replacement

关节置换术后神经周围麻醉输注

• 批准号: 6965786
• 负责人: Brian M Ilfeld
• 金额: $ 12.34万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6965786
• 关键词: analgesia; autonomic block; catheterization; clinical research; clinical trials; drug administration rate /duration; drug administration routes; functional ability; hip prosthesis; hip surgery; human subject; human therapy evaluation; joint prosthesis; knee; local anesthesia; local anesthetics; orthopedics; patient oriented research; postoperative state

DESCRIPTION (provided by applicant): Career Development: The applicant's primary interest is in designing perioperative anesthetic techniques to improve postoperative surgical outcomes, thereby making unique contributions to the dynamic study of anesthesia, pain management, and rehabilitation outcomes research. The ultimate objective of this K-23 Career Development Award is to prepare the applicant for a career as an independent investigator, designing and implementing hypothesis driven clinical investigations to evaluate the clinical, functional, and cost benefits of these anesthetic interventions. This will be accomplished with didactic coursework, participation in seminars, research focus groups, scientific conferences, and focused tutorials by experienced practitioners in multiple relevant, diverse fields of study. Because interdisciplinary collaboration is required to advance the field of postoperative outcomes research, the applicant will assemble an integrated, multidisciplinary team of highly-trained researchers and clinicians dedicated to this goal. Finally, implementing a clinical investigation using acquired didactic knowledge and close mentor supervision will allow integration and application of these educational components. Clinical Investigation: Following knee and hip replacement, ambulation is often limited by joint pain, greatly decreasing functional mobility, rehabilitation quality, and possibly the ultimate functional outcome. "Perineural infusion" is a relatively new analgesic technique that involves the percutaneous insertion of a catheter directly adjacent to the peripheral nerves that supply the affected joint. Local anesthetic is then infused via the catheter to provide potent, site-specific analgesia free of significant side effects. The ultimate objective of the proposed research is to determine if perineural local anesthetic infusion in the immediate postoperative period has both short- and long-term benefits following knee and hip replacement surgery for osteoarthritis. The research plan consists of two (knee or hip replacement) randomized, double-blind, placebo-controlled, parallel-arm clinical investigations. Patients will randomly receive either perineural local anesthetic or normal saline for 4 days following surgery. Primary outcomes include functional mobility (ambulatory distance) and the time until specific, predefined readiness-fordischarge criteria are met following surgery. Secondary outcomes include the relationship between analgesic technique administered in the immediate postoperative period and subsequent pain, stiffness and functional disability.

描述（由申请人提供）： 职业发展：申请人的主要兴趣是设计围手术期麻醉技术以改善术后手术结果，从而为麻醉、疼痛管理和康复结果研究的动态研究做出独特的贡献。 K-23 职业发展奖的最终目标是让申请人为独立研究者的职业生涯做好准备，设计和实施假设驱动的临床研究，以评估这些麻醉干预措施的临床、功能和成本效益。这将通过讲授课程、参加研讨会、研究焦点小组、科学会议以及由多个相关、不同研究领域的经验丰富的从业者提供的重点教程来完成。由于需要跨学科合作来推进术后结果研究领域，因此申请人将组建一个由训练有素的研究人员和临床医生组成的综合、多学科团队，致力于实现这一目标。最后，利用所获得的教学知识和密切的导师监督来实施临床调查将允许这些教育成分的整合和应用。 临床研究：膝关节和髋关节置换术后，行走通常受到关节疼痛的限制，大大降低了功能活动能力、康复质量，甚至可能影响最终的功能结果。 “神经周围输注”是一种相对较新的镇痛技术，涉及将导管经皮插入直接邻近供应受影响关节的周围神经。然后通过导管注入局部麻醉剂，以提供有效的、特定部位的镇痛，且不会产生明显的副作用。本研究的最终目的是确定术后立即进行神经周围局部麻醉剂输注是否对骨关节炎膝关节和髋关节置换手术具有短期和长期益处。该研究计划包括两项（膝关节或髋关节置换术）随机、双盲、安慰剂对照、平行组临床研究。手术后 4 天，患者将随机接受神经周围局部麻醉剂或生理盐水。主要结局包括功能活动能力（步行距离）以及手术后达到特定的、预先定义的准备出院标准的时间。次要结果包括术后立即使用的镇痛技术与随后的疼痛、僵硬和功能障碍之间的关系。