IMPROVING POSTOPERATIVE REHABILITATION FOLLOWING TOTAL HIP ARTHROPLASTY WITH PEN

使用笔改善全髋关节置换术后的康复

• 批准号: 7605458
• 负责人: Linda T Le
• 金额: $ 3.62万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-12-23 至 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7605458
• 关键词: Absence of pain sensation; Admission activity; Analgesics; Anticoagulants; Arthroplasty; Catheters; Client satisfaction; Computer Retrieval of Information on Scientific Projects Database; Funding; Grant; Health Care Costs; Hip region structure; Hospitalization; Hospitals; Infusion Pumps; Infusion procedures; Institution; Intravenous; Local Anesthetics; Low-Molecular-Weight Heparin; Lumbar plexus structure; Operative Surgical Procedures; Opioid; Oral; Outcome Measure; Outpatients; Pain; Patients; Perioperative; Physical therapy; Pilot Projects; Postoperative Pain; Postoperative Period; Randomized; Rehabilitation therapy; Research; Research Personnel; Resources; Sleep disturbances; Source; Techniques; United States National Institutes of Health; cohort; double-blind placebo controlled trial; experience; functional outcomes; improved; perineural; prospective; success

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 hip arthroplasty (THA) 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 lumbar plexus catheter provides potent analgesia following THA. These "psoas compartment" 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 THA. First, we will conduct a prospective cohort pilot study to evaluate the feasibility of shortening THA 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 postoperative pain, oral opioid requirements, sleep disturbances, patient satisfaction, resource utilization, and health-care costs.

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 全髋关节置换术后的物理治疗成功与否在很大程度上决定了手术本身的最终成功与否。 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。 但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，通过神经周围腰丛导管输注局部麻醉剂在THA后提供有效的镇痛。 这些“腰肌间隔”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调查涉及THA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THA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，以评估神经周围输注对PT和康复期的影响。 我们的次要结局指标将包括术后疼痛、口服阿片类药物需求、睡眠障碍、患者满意度、资源利用和医疗费用。