IMPROVING POSTOP REHAB FOLLOWING KNEE ARTHROPLASTY W/PERINEURAL LOCAL ANES INFUS

通过神经周围局部静脉输注改善膝关节置换术后的康复

• 批准号: 7374655
• 负责人: Brian M Ilfeld
• 金额: $ 18.49万
• 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/7374655
• 关键词: IMPROVING; POSTOP; REHAB; FOLLOWING; KNEE

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. Successful physical therapy (PT) following total knee arthroplasty (TKA) greatly determines the ultimate success of the surgery itself. Unfortunately, the frequent and intensive PT often results in severe pain. Pain limits the quality and quantity of PT patients can tolerate and the ultimate functional outcome of the surgery. Effective analgesia may be provided with epidural infusion or intravenous opioids. However, both require hospitalization. Furthermore, epidurals are contraindicated with new anticoagulants often given in the perioperative period (e.g. low molecular weight heparin). Alternatively, local anesthetic infused via a perineural femoral catheter provides potent analgesia following TKA. These femoral catheters may be used with new anticoagulants and do not require patients to remain hospitalized. Combining these catheters with portable infusion pumps, outpatients may experience the same level of analgesia previously afforded only to those remaining hospitalized. We will use these techniques to investigate two major questions involving TKA. First, we will conduct a prospective cohort pilot study to evaluate the feasibility of shortening TKA hospital admission. Second, we will conduct a randomized, double-blinded, placebo-controlled trial to evaluate the effects of perineural infusion on PT and the rehabilitation period. Our secondary outcome measures will include duration of hospitalization, 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，不一定是研究者所在机构。全膝关节置换术（TKA）后成功的物理治疗（PT）在很大程度上决定了手术本身的最终成功。不幸的是，频繁和密集的PT往往会导致严重的疼痛。疼痛限制了患者可以耐受的PT的质量和数量以及手术的最终功能结局。硬膜外输注或静脉注射阿片类药物可提供有效的镇痛。然而，两者都需要住院治疗。此外，围手术期常使用的新抗凝剂（如低分子量肝素）禁忌使用抗凝剂。或者，通过神经周围股动脉导管输注局部麻醉剂可在TKA后提供强效镇痛。这些股动脉导管可以与新的抗凝剂一起使用，并且不需要患者继续住院。结合这些导管与便携式输液泵，门诊病人可能会经历相同的镇痛水平，以前只提供给那些仍然住院。我们将使用这些技术来研究涉及TKA的两个主要问题。首先，我们将进行一项前瞻性队列试点研究，以评估缩短TKA住院时间的可行性。其次，我们将进行一项随机、双盲、安慰剂对照试验，评估神经周输液对PT和康复期的影响。我们的次要结局指标包括住院时间、术后疼痛、口服阿片类药物需求、睡眠障碍、患者满意度、资源利用和医疗费用。