Perineural Anesthetic Infusion After Joint Replacement

关节置换术后神经周围麻醉输注

• 批准号: 7483780
• 负责人: Brian M Ilfeld
• 金额: $ 12.34万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 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/7483780
• 关键词: Absence of pain sensation; Activities of Daily Living; Admission activity; Adverse effects; Affect; American; Analgesics; Anesthesia procedures; Anesthetics; Anticoagulants; Arthralgia; Catheters; Chronic; Clinical; Clinical Trials; Costs and Benefits; Data; Degenerative polyarthritis; Development; Double-Blind Method; Elderly; Focus Groups; Future; Goals; Hip region structure; Hospitalization; Hour; Infusion Pumps; Infusion procedures; Intervention; Intravenous; Joints; K-Series Research Career Programs; Knee; Knowledge; Local Anesthetics; Low-Molecular-Weight Heparin; Measures; Mentors; Methods; Minor; Nerve Block; Normal saline; Ontario; Operative Surgical Procedures; Opioid; Outcome; Outcomes Research; Outpatients; Pain; Pain management; Patients; Perioperative; Peripheral Nerves; Personal Satisfaction; Placebo Control; Postoperative Period; Procedures; Process; Prosthesis; Purpose; Randomized; Readiness; Rehabilitation Outcome; Rehabilitation therapy; Replacement Arthroplasty; Research; Research Personnel; Score; Site; Supervision; Techniques; Testing; Time; Total Hip Replacement; Training; United States; Universities; Upper arm; Walking; analog; career; day; design; disability; experience; field study; functional disability; functional outcomes; improved; indexing; interdisciplinary collaboration; interest; intravenous administration; knee replacement arthroplasty; meter; multidisciplinary; nerve supply; novel; perineural; programs; success; symposium

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，以改善术后手术结局，从而为麻醉，疼痛管理和康复结局研究的动态研究做出独特贡献。该K-23职业发展奖的最终目标是为申请人作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。这将通过教学课程，参加研讨会，研究焦点小组，科学会议和有经验的从业人员在多个相关的，不同的研究领域的重点教程来完成。由于需要跨学科合作来推进术后结局研究领域，申请人将组建一支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，使用获得的教学知识和密切的导师监督实施临床研究将允许这些教育组件的集成和应用。 临床研究：膝关节和髋关节置换术后，截肢通常受到关节疼痛的限制，大大降低了功能活动度，康复质量，并可能影响最终的功能结局。“神经周围灌注”是一种相对较新的镇痛技术，其涉及直接邻近供应受影响关节的周围神经经皮插入导管。然后通过导管输注局部麻醉剂，以提供有效的、无显著副作用的部位特异性镇痛。本研究的最终目的是确定在膝关节和髋关节置换术治疗骨关节炎后，术后立即进行神经周围局麻药输注是否具有短期和长期益处。研究计划包括两项（膝关节或髋关节置换）随机、双盲、安慰剂对照、平行组临床研究。患者将在手术后随机接受神经周围局部麻醉或生理盐水4天。主要结局包括功能活动度（步行距离）和手术后达到特定预定出院准备标准的时间。次要结局包括术后即刻给予的镇痛技术与随后的疼痛、僵硬和功能障碍之间的关系。