This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Major orthopedic surgery of the upper extremity, such as total shoulder or elbow replacement, results in severe postoperative pain that has traditionally required a hospital admission to provide intravenous opioids. Furthermore, the convalescence period and ultimate outcome of many procedures is dependent upon intensive physical therapy following discharge that is often limited by severe pain. While the typical hospital admission duration is 1-3 nights, following discharge patients do not have the benefit of intravenous opioids and must rely on far-less potent oral opioids to provide analgesia both during and following their frequent daily physical therapy sessions. Local anesthetic infused via a perineural catheter has been demonstrated to provide potent postoperative analgesia. Therefore, utilizing perineural brachial plexus local anesthetic infusion with portable infusion pumps, the proposed study will (1) evaluate the feasibility of converting major orthopedic procedures of the upper extremity currently requiring a hospital admission solely for analgesia into ambulatory surgery with a pilot study; and (2) evaluate the effects of this intervention on physical therapy and the rehabilitation period with a randomized, controlled trial. Other factors that will be investigated include postoperative pain, oral opioid requirements, sleep disturbances, patient satisfaction, resource utilization, and health-care costs.
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