Perineural Anesthetic Infusion After Joint Replacement

关节置换术后神经周围麻醉输注

• 批准号: 7658153
• 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/7658153
• 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; Double-Blind Method; Elderly; Focus Groups; Future; Goals; Hip region structure; Hospitalization; Hour; Infusion Pumps; Infusion procedures; Intervention; Intravenous; Intravenous infusion procedures; 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; Randomized; Readiness; Rehabilitation Outcome; Rehabilitation therapy; Replacement Arthroplasty; Research; Research Personnel; Site; Supervision; Techniques; Testing; Time; Total Hip Replacement; Training; United States; Universities; Upper arm; Walking; analog; career; career development; design; disability; effective therapy; experience; field study; functional disability; functional outcomes; improved; indexing; interdisciplinary collaboration; interest; knee replacement arthroplasty; meetings; meter; multidisciplinary; nerve supply; novel; perineural; primary outcome; programs; secondary outcome; 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，以改善术后手术结果，从而在麻醉、疼痛管理和康复结果的动态研究中做出独特的贡献。这个K-23职业发展奖的最终目标是为申请者的职业生涯做好准备，成为一名独立的调查员，设计和实施假说驱动的临床调查，以评估这些麻醉干预的临床、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、科学会议和由多个相关、不同研究领域的有经验的实践者提供重点教程来实现。由于需要跨学科合作来推进术后结果研究领域，申请者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调查将允许这些教育组成部分的整合和应用。 临床研究：膝关节和髋关节置换术后，关节疼痛往往限制了患者的行走能力，极大地降低了患者的功能活动度、康复质量，甚至可能导致最终的功能结果。“神经周围输液”是一种相对较新的止痛技术，它涉及直接在供血关节的周围神经旁插入一根导管。然后通过导管注入局部麻醉剂，以提供有效的、没有明显副作用的局部特异性止痛。这项研究的最终目的是确定在膝关节和髋关节置换手术治疗骨性关节炎后，在术后即刻进行神经周局部麻醉剂输注是否有短期和长期的益处。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、平行手臂临床研究。术后患者将随机接受神经周围局部麻醉剂或生理盐水，为期4天。主要结果包括功能活动能力(行走距离)和手术后达到特定的、预定义的出院准备标准所需的时间。次要结果包括术后即刻使用的止痛技术与随后的疼痛、僵硬和功能残疾之间的关系。

项目成果

Regional anesthesia at home.

在家进行区域麻醉。

• DOI: 10.1097/aco.0b013e328303bfb5
• 发表时间: 2008
• 期刊: Current opinion in anaesthesiology
• 作者: Cheng,GloriaS;Choy,LynnaP;Ilfeld,BrianM
• 通讯作者: Ilfeld,BrianM

Ultrasound-guided (needle-in-plane) perineural catheter insertion: the effect of catheter-insertion distance on postoperative analgesia.

• DOI: 10.1097/aap.0b013e31820f3b80
• 发表时间: 2011-05
• 期刊: Regional anesthesia and pain medicine
• 影响因子: 5.1
• 作者: Ilfeld BM;Sandhu NS;Loland VJ;Madison SJ;Suresh PJ;Mariano ER;Bishop ML;Schwartz AK;Lee DK
• 通讯作者: Lee DK

Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia.

• DOI: 10.1007/s12630-010-9364-7
• 发表时间: 2010-10
• 期刊: CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
• 影响因子: 4.2
• 作者: Mariano, Edward R.;Loland, Vanessa J.;Sandhu, NavParkash S.;Bishop, Michael L.;Lee, Daniel K.;Schwartz, Alexandra K.;Girard, Paul J.;Ferguson, Eliza J.;Ilfeld, Brian M.
• 通讯作者: Ilfeld, Brian M.

Continuous femoral nerve blocks: the impact of catheter tip location relative to the femoral nerve (anterior versus posterior) on quadriceps weakness and cutaneous sensory block.

连续股神经阻滞：导管尖端相对于股神经的位置（前部与后部）对股四头肌无力和皮肤感觉阻滞的影响。

• DOI: 10.1213/ane.0b013e318261f326
• 发表时间: 2012
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Ilfeld,BrianM;Loland,VanessaJ;Sandhu,NavParkashS;Suresh,PreethamJ;Bishop,MichaelJ;Donohue,MichaelC;Ferguson,ElizaJ;Madison,SarahJ
• 通讯作者: Madison,SarahJ

Continuous interscalene nerve block following adhesive capsulitis manipulation.

粘连性囊炎处理后持续进行肌间神经阻滞。

• DOI: 10.1097/aap.0b013e318283475b
• 发表时间: 2013
• 期刊: Regional anesthesia and pain medicine
• 影响因子: 5.1
• 作者: Malhotra,Nisha;Madison,SarahJ;Ward,SamuelR;Mariano,EdwardR;Loland,VanessaJ;Ilfeld,BrianM
• 通讯作者: Ilfeld,BrianM