PubMed Health⌕ Search

Biomedical subjects

Brian M Ilfeld

Publications and source records attributed to Brian M Ilfeld.

30 records · Page 2Linked to original sources
PubMedDate not supplied

Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study.

BACKGROUND AND OBJECTIVES: Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA). METHODS: The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores. RESULTS: Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (-81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively). CONCLUSIONS: The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.

Adult↗
PubMedDate not supplied

Total hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study.

OBJECTIVE: Total hip arthroplasty (THA) results in severe postoperative pain requiring hospitalization to provide potent analgesia. Consequently, the average duration of hospitalization after THA in the United States is 4 to 5 days. This prospective study investigated the feasibility of converting THA into an overnight-stay procedure using a continuous psoas compartment nerve block provided at home with a portable infusion pump. CASE REPORT: Preoperatively, patients undergoing THA had a psoas compartment perineural catheter placed. Postoperatively, perineural ropivacaine 0.2% was delivered through postoperative day (POD) 4. Patients were discharged home when they met specific, prospectively defined criteria, as early as POD 3 for the first phase and POD 1 for the second phase. Of the patients in the first phase (n = 7) who remained hospitalized for at least 3 postoperative nights, 5 met discharge criteria on POD 1 and the remainder on POD 2. Of the patients in phase 2 (n = 5), all but 1 met discharge criteria on POD 1 and 3 were discharged directly home on POD 1. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction high. CONCLUSIONS: These results suggest that for a subset of patients without major comorbidities, it is feasible to convert THA into an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.

Aged↗
PubMedDate not supplied

Total elbow arthroplasty as an outpatient procedure using a continuous infraclavicular nerve block at home: a prospective case report.

OBJECTIVE: Total elbow arthroplasty (TEA) often results in severe postoperative pain requiring hospitalization to provide potent analgesia. This prospective series investigated the feasibility of converting TEA into an ambulatory procedure using a continuous infraclavicular nerve block provided at home with a portable infusion pump. CASE REPORT: Preoperatively, patients undergoing TEA had an infraclavicular perineural catheter and peripheral nerve block placed. Postoperatively, perineural ropivacaine was delivered through postoperative day (POD) 3 to 6. Patients were discharged home when they met specific, prospectively defined criteria as early as POD 1 for the first phase and directly from the recovery room for the second phase. Of the 2 patients in the first phase who remained hospitalized for at least 1 postoperative night, both met discharge criteria in the recovery room, required no medical interventions during their admission, and were discharged home the following morning. The patient of phase 2 met discharge criteria in the recovery room and was discharged home at that time. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high for all patients. CONCLUSIONS: These cases suggest that for a subset of patients without major comorbidities, it is feasible to convert total elbow arthroplasty into an ambulatory procedure using a continuous infraclavicular nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.

Aged↗
PubMedDate not supplied

Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis.

BACKGROUND AND OBJECTIVES: After total knee arthroplasty (TKA), hospitalization may be shortened by allowing patients to return home with a continuous femoral nerve block (CFNB). This study quantified the hospitalization costs for 10 TKA patients receiving ambulatory CFNB versus a matched cohort of 10 patients who received CFNB only during hospitalization. METHODS: We examined the medical records (n = 125) of patients who underwent a unilateral, primary, tricompartment TKA with a postoperative CFNB by 1 surgeon at one institution in an 18-month period beginning January 2004. Each of the 10 patients discharged home with an ambulatory CFNB (cases) was matched with a patient with a hospital-only CFNB (controls) for age, gender, body mass index, and health status. Financial data were extracted from the hospital microcosting database. RESULTS: Nine patients with ambulatory CFNB (cases) were discharged home on postoperative day (POD) 1 and 1 on POD 4. Of the controls, 3 were discharged home on POD 3, 6 on POD 4, and 1 on POD 5. The median (range) costs of hospitalization (excluding implant and professional fees) was US dollars 5,292 (US dollars 4,326-US dollars 7,929) for ambulatory cases compared with US dollars 7,974 (US dollars 6,931-US dollars 9,979) for inpatient controls (difference = US dollars 2,682, 34% decrease, P < .001). The total charges for hospitalization, the implant, and professional fees was US dollars 33,646 (US dollars 31,816-US dollars 38,468) for cases compared with US dollars 39,100 (US dollars 36,096-US dollars 44,098) for controls (difference = US dollars 5,454, 14% decrease, P < .001). CONCLUSIONS: This study provides evidence that ambulatory CFNB for selected patients undergoing TKA has the potential to reduce hospital length of stay and associated costs and charges. However, the current study has significant inherent limitations based on the study design. Additional research is required to replicate these results in a prospective, randomized, controlled trial and to determine whether any savings exceed additional CFNB costs such as from complications, having caregivers provide care at home, and additional hospital/health care provider visits.

Aged↗
PubMedDate not supplied

Portable infusion pumps used for continuous regional analgesia: delivery rate accuracy and consistency.

BACKGROUND AND OBJECTIVES: Multiple benefits of postoperative perineural local anesthetic infusion have been shown including potent analgesia, decreased opioid requirements, and improved rehabilitation. Consequently, portable infusion pumps have been used with increasing frequency to provide perineural infusion for medically unsupervised ambulatory patients. We believe that the infusion rate accuracy and reliability of these pumps infusing potentially toxic doses of medication should be investigated independently. Therefore, we studied the flow-rate accuracy and consistency of various portable infusion pumps that have not been examined previously. METHODS: Using a computer/mass balance combination to record infusion rates, 6 pumps (3 electronic and 3 non electronic) were tested. Several factors that may influence pump performance were varied: temperature (ambient/skin), battery (replacement/addition), and catheter exchange (wound/perineural). RESULTS: Infusion rate accuracy differed significantly among the pumps, exhibiting flow rates within +/-15% of their expected rate for 55% to 99% of their infusion duration. Furthermore, the profiles (infusion rate over time) of the various pumps differed significantly depending on the pump power source. Although elastomeric pump infusion rate increased with an increase in temperature, battery life was a limiting factor for one of the electronic pumps. Substituting wound catheters with commonly used perineural catheters did not significantly alter infusion profile. CONCLUSIONS: Factors such as infusion rate accuracy and consistency, infusion profile, temperature sensitivity, and battery life affect the dose of medication administered by various portable pumps used for continuous regional analgesia. Health care providers should take these factors into consideration when choosing and using a portable infusion pump for local anesthetic administration.

Analgesia↗
PubMedDate not supplied

Ambulatory perineural infusion: the patients' perspective.

BACKGROUND AND OBJECTIVES: Ambulatory perineural local anesthetic infusion is a relatively new method for providing postoperative analgesia, and many aspects of this technique remain in the domain of conjecture and speculation. This retrospective chart review and survey was undertaken to investigate patients' opinions on various aspects of their ambulatory perineural infusion experience. METHODS: Patients who had received an ambulatory perineural infusion from the University of Florida were identified via pharmacy records. Patients were contacted by phone and were asked various questions regarding their experiences and preferences during and after their perineural infusion. RESULTS: Of 217 patients identified, 215 charts were located and retrieved. Of these, 137 (64%) were successfully contacted and 131 (61%) consented to take part in the survey. More than 97% of patients reported that they felt "safe" during home infusion, that one physician telephone call each night was optimal contact, and that they were comfortable removing the catheter with instructions given over the phone. Only 4% would have preferred to return for catheter removal, and 43% felt that they would have been comfortable with only written instructions for catheter removal. CONCLUSION: This investigation suggests that perineural local anesthetic infusion is generally well tolerated by ambulatory patients.

Academic Medical Centers↗
PubMedDate not supplied

A portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home.

BACKGROUND AND OBJECTIVES: Local anesthetics infused via perineural catheters postoperatively decrease opioid use and side effects while improving analgesia. However, the infusion pumps described for outpatients have been limited by several factors, including the following: limited local anesthetic reservoir volume, fixed infusion rate, and inability to provide patient-controlled doses of local anesthetic in combination with a continuous infusion. We describe a patient undergoing open rotator cuff repair who was discharged home with an interscalene perineural catheter and a mechanical infusion pump that allowed a variable rate of continuous infusion, as well as patient-controlled boluses of local anesthetic for over 4 days. CASE REPORT: A 77-year-old woman, who had previously required a 3-day hospital admission for acute postoperative pain following an open repair of her left rotator cuff, presented for an open repair of her contralateral rotator cuff. Preoperatively she received an interscalene block and perineural catheter. After the procedure she was discharged home with a portable pump that infused ropivacaine continuously at a rate of 6 mL/h and allowed a 2-mL patient-controlled bolus every 20 minutes (550-mL reservoir). The basal infusion was decreased, as tolerated, by having the patient reprogram the pump with instructions given over the telephone. Without the use of any oral opioids, the patient scored her surgical pain 0 to 1 (on a scale of 0 to 10) while at rest and 2 to 3 for 2 physical therapy sessions during which she used the bolus function to reinforce her analgesia. After 98 hours of infusion, the patient's husband removed the catheter with instructions given over the telephone, and her subsequent surgical pain was treated with oral opioids. CONCLUSION: Continuous, perineural local anesthetic infusions are possible on an ambulatory basis for multiple days using a portable, programmable pump that provides a variable basal infusion rate, patient-controlled boluses, and a large anesthetic reservoir.

Aged↗
PubMedDate not supplied

Delivery rate accuracy of portable, bolus-capable infusion pumps used for patient-controlled continuous regional analgesia.

BACKGROUND AND OBJECTIVES: Portable patient-controlled pumps used for perineural local anesthetic infusion appear to be gaining acceptance and are used for an increasing number of medically unsupervised ambulatory patients. The infusion rate accuracy and reliability of these pumps, which allow patient-controlled boluses of potentially toxic medication, has not been independently investigated. We performed this laboratory study to define the flow-rate accuracy, reliability, and profiles of various portable bolus-capable infusion pumps and varied several factors that may influence pump performance. METHODS: Using a computer/scale combination, 4 electronic pumps were tested with 1 and 2 sets of batteries over 100 hours. One elastomeric pump was tested with its flow-regulator at room temperature (20 degrees C to 24 degrees C), skin temperature (32 degrees C), and increased temperature (36 degrees C). The elastomeric pump was also tested by varying the height of the pump relative to the distal end of the catheter. RESULTS: Infusion rate accuracy differed significantly among the pumps, exhibiting flow rates within +/-15% of their expected rate for 29% to 100% of their infusion duration. Changing the batteries after 50 hours affected the profile of 1 of the 4 electronic pumps. For the elastomeric pump, an increase in temperature significantly increased the infusion rate. An increase or decrease in pump-to-scale height significantly increased or decreased the infusion rate, respectively. CONCLUSIONS: These results suggest that factors such as flow-rate accuracy and consistency, infusion profile, and temperature sensitivity should be taken into consideration when choosing a portable infusion pump for local anesthetic administration.

Analgesia, Patient-Controlled↗