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Intrathecal baclofen for postoperative analgesia after total knee arthroplasty.
J Clin Anesth. 2009 Nov; 21(7):486-92.JC

Abstract

STUDY OBJECTIVE

To determine whether intrathecal baclofen is an effective adjunctive agent to decrease acute and chronic postoperative pain after total knee arthroplasty.

DESIGN

Prospective, randomized, double-blind controlled trial.

SETTING

Operating room and inpatient units of a university hospital.

PATIENTS

60 adult, ASA physical status I, II, and III patients presenting for total knee arthroplasty.

INTERVENTIONS

Anesthesia was provided by spinal injection of 15 mg of 0.75% hyperbaric bupivacaine combined with either 100 mcg baclofen or saline. Sedation was provided with intravenous midazolam and propofol.

MEASUREMENTS

Data were collected on adverse effects, opioid usage, and verbal pain scale (VPS) from 0 to 10. The study period was divided into six discrete time intervals that included the 1(st) 72-hour postoperative period and a three-month post-discharge follow-up telephone call.

MAIN RESULTS

The baclofen group used less morphine in the PACU than the control group (5 mg vs. 9.3 mg; P = 0.04). VPS were lower in the baclofen group than the treatment group, but significant differences could be demonstrated only in the time periods 48-72 hours and three months postoperatively. At three months, fewer patients in the baclofen group reported pain than the control group (8/27 vs. 19/29; P = 0.009). Regression analysis showed that the baclofen group was 4.5 times less likely to report pain at three months (95% CI: 1.5-16.6).

CONCLUSIONS

IT baclofen used as an adjuvant to spinal anesthesia for total knee arthroplasty allows for less postoperative opioid usage and less chronic pain at three months.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA. jcsanders@shrinenet.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20006256

Citation

Sanders, John C., et al. "Intrathecal Baclofen for Postoperative Analgesia After Total Knee Arthroplasty." Journal of Clinical Anesthesia, vol. 21, no. 7, 2009, pp. 486-92.
Sanders JC, Gerstein N, Torgeson E, et al. Intrathecal baclofen for postoperative analgesia after total knee arthroplasty. J Clin Anesth. 2009;21(7):486-92.
Sanders, J. C., Gerstein, N., Torgeson, E., & Abram, S. (2009). Intrathecal baclofen for postoperative analgesia after total knee arthroplasty. Journal of Clinical Anesthesia, 21(7), 486-92. https://doi.org/10.1016/j.jclinane.2008.12.019
Sanders JC, et al. Intrathecal Baclofen for Postoperative Analgesia After Total Knee Arthroplasty. J Clin Anesth. 2009;21(7):486-92. PubMed PMID: 20006256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal baclofen for postoperative analgesia after total knee arthroplasty. AU - Sanders,John C, AU - Gerstein,Neal, AU - Torgeson,Eli, AU - Abram,Stephen, PY - 2007/09/30/received PY - 2008/11/29/revised PY - 2008/12/01/accepted PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/2/20/medline SP - 486 EP - 92 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 21 IS - 7 N2 - STUDY OBJECTIVE: To determine whether intrathecal baclofen is an effective adjunctive agent to decrease acute and chronic postoperative pain after total knee arthroplasty. DESIGN: Prospective, randomized, double-blind controlled trial. SETTING: Operating room and inpatient units of a university hospital. PATIENTS: 60 adult, ASA physical status I, II, and III patients presenting for total knee arthroplasty. INTERVENTIONS: Anesthesia was provided by spinal injection of 15 mg of 0.75% hyperbaric bupivacaine combined with either 100 mcg baclofen or saline. Sedation was provided with intravenous midazolam and propofol. MEASUREMENTS: Data were collected on adverse effects, opioid usage, and verbal pain scale (VPS) from 0 to 10. The study period was divided into six discrete time intervals that included the 1(st) 72-hour postoperative period and a three-month post-discharge follow-up telephone call. MAIN RESULTS: The baclofen group used less morphine in the PACU than the control group (5 mg vs. 9.3 mg; P = 0.04). VPS were lower in the baclofen group than the treatment group, but significant differences could be demonstrated only in the time periods 48-72 hours and three months postoperatively. At three months, fewer patients in the baclofen group reported pain than the control group (8/27 vs. 19/29; P = 0.009). Regression analysis showed that the baclofen group was 4.5 times less likely to report pain at three months (95% CI: 1.5-16.6). CONCLUSIONS: IT baclofen used as an adjuvant to spinal anesthesia for total knee arthroplasty allows for less postoperative opioid usage and less chronic pain at three months. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/20006256/Intrathecal_baclofen_for_postoperative_analgesia_after_total_knee_arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(09)00256-6 DB - PRIME DP - Unbound Medicine ER -