| 1. |
- Bjurstrom, M. F., et al.
(författare)
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Acute reduction of cerebrospinal fluid volume prior to spinal anesthesia : implications for sensory block extent
- 2020
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Ingår i: Minerva Anestesiol. - 1827-1596. ; 86:6, s. 636-644
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Multiple patient and clinical characteristics contribute to the variable outcome of spinal anesthesia (SPA). Acute reduction of cerebrospinal fluid (CSF) volume may alter the effect of SPA. The objective of the present study was to test if aspiration of 10 mL CSF immediately prior to SPA is associated with higher extent of sensory block. METHODS: Interventional cohort study. One hundred and two patients undergoing total hip arthroplasty (THA) were included. Fifty-one patients underwent sampling of 10 mL CSF prior to SPA (CSF aspiration group); 51 consecutive patients were used as controls. The primary outcome was the extent of sensory block to cold stimulus 20 minutes after injection of hyperbaric bupivacaine. Secondary outcome measures included duration of motor block and incidence of failed SPA. RESULTS: Acute reduction of CSF volume by 10 mL increased the extent of sensory anesthesia (mean thoracic level [T] 4.3+/-2.4 vs. 7.1+/-2.6, P<0.001). There were no significant between-group differences regarding motor block duration (P>/=0.30) or failed SPA (three of 51 [CSF aspiration group] vs. one of 51 [control group], P=0.31). In a retrospective data analysis, 10 of 13 patients in the CSF aspiration group who had previously received SPA had a higher sensory block after 10 mL CSF aspiration compared to the previous SPA (T4.1 [range, 0-11] vs. T8.2 [4-10], P<0.01). CONCLUSIONS: Acute reduction of CSF volume by 10 mL prior to SPA leads to a higher thoracic level of sensory block.
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| 2. |
- Bjurstrom, M. F., et al.
(författare)
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Differential expression of cerebrospinal fluid neuroinflammatory mediators depending on osteoarthritis pain phenotype
- 2020
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 161:9, s. 2142-2154
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Tidskriftsartikel (refereegranskat)abstract
- Neuroinflammation is implicated in the development and maintenance of persistent pain states, but there are limited data linking cerebrospinal fluid (CSF) inflammatory mediators with neurophysiological pain processes in humans. In a prospective observational study, CSF inflammatory mediators were compared between patients with osteoarthritis (OA) who were undergoing total hip arthroplasty due to disabling pain symptoms (n = 52) and pain-free comparison controls (n = 30). In OA patients only, detailed clinical examination and quantitative sensory testing were completed. Cerebrospinal fluid samples were analyzed for 10 proinflammatory mediators using Meso Scale Discovery platform. Compared to controls, OA patients had higher CSF levels of interleukin 8 (IL-8) (P = 0.002), intercellular adhesion molecule 1 (P = 0.007), and vascular cell adhesion molecule 1 (P = 0.006). Osteoarthritis patients with central sensitization possibly indicated by arm pressure pain detection threshold <250 kPa showed significantly higher CSF levels of Fms-related tyrosine kinase 1 (Flt-1) (P = 0.044) and interferon gamma-induced protein 10 (IP-10) (P = 0.024), as compared to subjects with PPDT above that threshold. In patients reporting pain numerical rating scale score >/=3/10 during peripheral venous cannulation, Flt-1 was elevated (P = 0.025), and in patients with punctate stimulus wind-up ratio >/=2, CSF monocyte chemoattractant protein 1 was higher (P = 0.011). Multiple logistic regression models showed that increased Flt-1 was associated with central sensitization, assessed by remote-site PPDT and peripheral venous cannulation pain, and monocyte chemoattractant protein-1 with temporal summation in the area of maximum pain. Multiple proinflammatory mediators measured in CSF are associated with persistent hip OA-related pain. Pain phenotype may be influenced by specific CSF neuroinflammatory profiles.
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| 3. |
- Harsten, Andreas
(författare)
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Perioperative regimens for patients undergoing elective hip or knee arthroplasties.
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Elective knee and hip arthroplasty are common surgical procedures. Improved anaesthetic and nutritional care has the potential of increasing patient satisfaction and reducing length of hospital stay (LOS). The overall aim of this thesis was to evaluate the effect of perioperative nutrition and different anaesthetic techniques on per- and postoperative outcome after elective total hip (THA) or total knee arthroplasties (TKA). Methods: In this thesis prospective, randomized trials were performed in 358 patients. Results: Patients undergoing THA received an oral carbohydrate or placebo drink in a randomized controlled trial 90 min before and 120 min after surgery. The treatment resulted in less hunger and nausea and reduced pain compared with placebo. When intrathecal anaesthesia (ITA) and traditional intra- and postoperative care was compared with general anaesthesia (GA) combined with accelerated postoperative care for TKA the LOS was reduced without adversely affecting pain or total satisfaction. TKA patients given identical perioperative treatment were randomized to either ITA or GA and GA resulted in shorter LOS, less nausea, vomiting and dizziness. GA patients also required less postoperative analgesics and had lower pain scores. Patients receiving ITA indicated that they would like to change their method of anaesthesia in the event of a subsequent operation. THA patients receiving either ITA or GA resulted in similar findings as in the TKA-study In conclusion, this thesis shows that perioperative carbohydrate administration has a limited beneficial effect on THA patients. Accelerated postoperative care and GA has favourable recovery effects when compared with ITA and traditional postoperative care. When GA was compared with ITA in a Fast-Track set-up, GA resulted in a more favourable recovery profile for patients undergoing THA or TKA. Both TKA and THA patients preferred GA in case of a future operation.
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| 4. |
- Harsten, Andreas, et al.
(författare)
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Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial.
- 2013
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 1471-6771 .- 0007-0912. ; 111:3, s. 391-399
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: /st>This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA). METHODS: /st>One hundred and twenty subjects were randomly allocated to receive either intrathecal bupivacaine (SA group) or GA with target controlled infusion of propofol and remifentanil (GA group). Primary outcome was length of hospital stay (LOS) defined as time from end of surgery until the subject met the hospital discharge criteria. Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction. RESULTS: /st>GA resulted in shorter LOS (46 vs 52 h, P<0.001), and less nausea and vomiting (4 vs 15, P<0.05) and dizziness (VAS 0 mm vs 20 mm, P<0.05) compared with SA. During the first 2 postoperative hours, GA patients had higher pain scores (P<0.001), but after 6 h the SA group had significantly higher pain scores (P<0.001). Subjects in the GA group used fewer patient-controlled analgesia doses and less morphine (P<0.01), and were able to walk earlier compared with the SA group (P<0.001). Subjects receiving SA would request a change in the method of anaesthesia in the event of a subsequent operation more often than the GA subjects (P<0.05). CONCLUSION: /st>GA had more favourable recovery effects after TKA compared with SA.
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| 5. |
- Harsten, Andreas, et al.
(författare)
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Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial.
- 2012
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Ingår i: European Journal of Anaesthesiology. - 1365-2346. ; 29:6, s. 271-274
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Perioperative oral carbohydrate intake is beneficial to general surgery patients. Total hip arthroplasty is a common surgical procedure, and even a moderate improvement in patient outcome could have a significant effect on the resources needed for these patients. However, few studies have focused on the effects of carbohydrate intake on orthopaedic patients. OBJECTIVE: The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty. The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate. DESIGN: A randomised, double-blind, controlled trial. SETTING: This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery. PATIENTS: Sixty ASA physical status I-III patients scheduled for elective total hip arthroplasty were included. Exclusion criteria were obesity, diabetes, prior hip surgery to the same hip, ongoing infection, immunological deficiency or age less than 50 or more than 80 years. INTERVENTIONS: Patients were given 400 ml of either an oral 12.5% carbohydrate solution or a placebo beverage (flavoured water) 1.5 h before and 2 h after surgery. MAIN OUTCOME MEASURES: Visual analogue scales were used to score six discomfort parameters. RESULTS: Immediately prior to surgery, the carbohydrate-treated patients were less hungry (median score 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (P < 0.05). Postoperatively, patients in the carbohydrate group experienced less pain at 12, 16 and 20 h (median scores 20, 30 and 34 vs. 7, 5 and 0 mm; P < 0.05). CONCLUSION: This study shows that there is limited benefit from administering oral carbohydatre prior to total hip arthroplasty.
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| 7. |
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| 8. |
- Molt, Mats, et al.
(författare)
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The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial.
- 2014
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Ingår i: Knee. - : Elsevier BV. - 1873-5800. ; 21:2, s. 396-401
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Tidskriftsartikel (refereegranskat)abstract
- A concern that arises with any change in technique is whether it affects the long-term implant stability. The objective of this study was to evaluate the early migration, measured by radiostereometric analysis (RSA), and the functional outcome of the Triathlon™ cemented knee prosthesis, operated on with or without a tourniquet. During the last decades RSA has emerged as a way to assess prosthetic fixation and long time prognosis. The method has been used extensively in both hip and knee arthroplasty.
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