IMPROVING POSTOPERATIVE REHABILITATION FOLLOWING MAJOR ORTHOPEDIC SURGERY

改善大型骨科手术后的术后康复

• 批准号: 7374643
• 负责人: Brian M Ilfeld
• 金额: $ 7.72万
• 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: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7374643
• 关键词: IMPROVING; POSTOPERATIVE; REHABILITATION; FOLLOWING; MAJOR

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Major orthopedic surgery of the upper extremity, such as total shoulder or elbow replacement, results in severe postoperative pain that has traditionally required a hospital admission to provide intravenous opioids. Furthermore, the convalescence period and ultimate outcome of many procedures is dependent upon intensive physical therapy following discharge that is often limited by severe pain. While the typical hospital admission duration is 1-3 nights, following discharge patients do not have the benefit of intravenous opioids and must rely on far-less potent oral opioids to provide analgesia both during and following their frequent daily physical therapy sessions. Local anesthetic infused via a perineural catheter has been demonstrated to provide potent postoperative analgesia. Therefore, utilizing perineural brachial plexus local anesthetic infusion with portable infusion pumps, the proposed study will (1) evaluate the feasibility of converting major orthopedic procedures of the upper extremity currently requiring a hospital admission solely for analgesia into ambulatory surgery with a pilot study; and (2) evaluate the effects of this intervention on physical therapy and the rehabilitation period with a randomized, controlled trial. Other factors that will be investigated include postoperative pain, oral opioid requirements, sleep disturbances, patient satisfaction, resource utilization, and health-care costs.

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心机构，不一定为研究者机构。上肢的主要整形外科手术，如全肩关节或肘关节置换术，会导致严重的术后疼痛，传统上需要住院提供静脉注射阿片类药物。此外，许多手术的恢复期和最终结果取决于出院后的强化物理治疗，这通常受到严重疼痛的限制。虽然典型的住院持续时间为1-3晚，但出院后患者无法从静脉注射阿片类药物中获益，必须依赖效力低得多的口服阿片类药物在其频繁的日常物理治疗期间和之后提供镇痛。经神经导管注入局部麻醉剂已被证明可提供有效的术后镇痛。因此，使用便携式输液泵进行神经周围臂丛局麻药输注，拟定研究将（1）通过初步研究评价将目前仅需要住院镇痛的上肢主要骨科手术转换为门诊手术的可行性;（2）采用随机对照试验评价该干预对物理治疗和康复期的影响。将调查的其他因素包括术后疼痛、口服阿片类药物需求、睡眠障碍、患者满意度、资源利用和医疗保健费用。