title: Epidural infusions of bupivacaine and fentanyl do not improve rehabilitation following one-stage bilateral total knee arthroplasty.
abstract: Epidural analgesia with local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopaedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were allocated to receive infusions of either continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. Infusions were maintained for 36 to 48 hours in a post-anaesthesia care unit (PACU). Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Cornell University Medical College, New York, NY 10021, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Sharrock
authors.forename: B L
authors.initials: BL
authors.lastname: Urquhart
authors.forename: S
authors.initials: S
authors.lastname: Ganz
authors.forename: P G
authors.initials: PG
authors.lastname: Williams-Russo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007720:Knee Prosthesis / Q000009:adverse effects / Q000534:rehabilitation*; D008124:Locomotion / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine