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Yoo JD, Huh MH, Lee SH, D'Lima DD, Shin YS. A Network Meta-Analysis of Randomized Controlled Trials Assessing Intraoperative Anesthetic Therapies for Analgesic Efficacy and Morphine Consumption Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:1361-1373. [PMID: 37952743 DOI: 10.1016/j.arth.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare intraoperative anesthetic therapies for total knee arthroplasty (TKA) regarding postoperative analgesic efficacy and morphine consumption by conducting a systematic literature search. METHODS Randomized controlled trials of TKA using various anesthetic therapies were identified from various databases from conception through December 31, 2021. A network meta-analysis of relevant literature was performed to investigate which treatment showed better outcomes. In total, 40 trials were included in this study. RESULTS Surface under the cumulative ranking curve showed local infiltration anesthesia (LIA) with saphenous nerve block (SNB) to produce the best pain relief on postoperative days (PODs) 1 and 2 and the best reduction of morphine consumption on PODs 1 and 3. However, femoral nerve block showed the largest effect on pain relief on POD 3, and liposomal bupivacaine showed the largest effect on reduction of morphine consumption on POD 2. CONCLUSIONS According to this network meta-analysis, surface under the cumulative ranking curve percentage showed that LIA with SNB provided the best analgesic effect after TKA. Furthermore, patients receiving LIA with SNB had the lowest consumption of morphine. Although femoral nerve block resulted in better pain relief on POD 3, LIA with SNB could be selected first when trying to reduce morphine consumption or increase early ambulation.
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Affiliation(s)
- Jae-Doo Yoo
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Min-Hwan Huh
- Department of Medicine, The Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education, Scripps Health, La Jolla, California
| | - Young-Soo Shin
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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2
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Khan MJ, Tauheed N, Siddiqui AH, Sabir AB, Haleem S. Adductor Canal Block Versus Local Infiltration Analgesia for Postoperative Pain Management in Total Knee Arthroplasty. Cureus 2024; 16:e57408. [PMID: 38694679 PMCID: PMC11062595 DOI: 10.7759/cureus.57408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis, often associated with postoperative pain. Effective pain management strategies are essential for improving patient outcomes and satisfaction. This study aimed to compare the efficacy of two analgesic modalities, local infiltration analgesia (LIA) and adductor canal block (ACB), in providing postoperative pain relief for patients undergoing TKA. METHODS This prospective randomized comparative study included 60 patients undergoing TKA for knee osteoarthritis under subarachnoid block (spinal anaesthesia). Patients were divided into two groups: LIA group (local wound infiltration with periarticular injection of bupivacaine 0.125% + dexmedetomidine 1 mcg/kg) and ACB group (ACB with bupivacaine 0.125% + 1 mcg/kg dexmedetomidine). Pain relief was assessed using the Numerical Rating Scale (NRS) score, time to first rescue analgesic requirement (NRS > 3), and total amount of analgesic needed in the first 24 hours post-surgery. RESULTS The time to first perception of pain with NRS > 3 was 11.30±0.8 hours in the ACB group and 9.40 ± 1.1 hours in the LIA group, with a statistically significant difference (p < 0.001). Additionally, the total number of rescue analgesic doses given in the first 24 hours post-operatively differed significantly between the two groups (p = 0.046). CONCLUSION The study concludes that ACB is an effective postoperative analgesic modality, superior to local infiltration analgesia, for patients undergoing TKA.
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Affiliation(s)
- Mohd J Khan
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, IND
| | - Nazia Tauheed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, IND
| | - Anwar H Siddiqui
- Department of Physiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, IND
| | - Amir B Sabir
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, IND
| | - Shahla Haleem
- Department of Anaesthesiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, IND
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Xu H, Hao C, Wang X, Du J, Zhang T, Zhang X. Effect of Intraoperative infusion Magnesium Sulfate Infusion on Postoperative Quality of Recovery in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:919-929. [PMID: 38560523 PMCID: PMC10980840 DOI: 10.2147/dddt.s444896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Magnesium sulfate, an intravenous adjuvant, has recently attracted immense attention in multimodal analgesia. Previous studies confirmed the crucial role of magnesium sulfate in postoperative pain and nociceptive hypersensitivity. However, the effect of magnesium sulfate in multimodal analgesia on the quality of recovery (QoR) for elderly patients has not been thoroughly studied. Therefore, the present experiment aimed to investigate the effect of continuous intravenous magnesium sulfate on the quality of postoperative recovery in elderly patients undergoing total knee arthroplasty (TKA). Patients and Methods In this study, a total of 148 patients scheduled to undergo unilateral total knee arthroplasty were randomized into a magnesium sulfate group (Group M, n=68) and a control group (Group C, n=66) using a double-blind, randomized controlled trial. Before induction of anesthesia, Group M received intravenous magnesium sulfate (40 mg/kg) for 15 min, followed by a continuous infusion (15 mg/kg) until the end of the procedure. In the same manner, Group C received an infusion of the same amount of isotonic saline using the same method as the Group M. Results Compared with Group C, Group M had significantly better QoR-15 scores on postoperative day 1(POD1) than Group C (P <0.05). Analysis of the dimensions of QoR-15 scores indicated that Group M exhibited notably reduced levels of pain, and higher levels of emotional state and physical comfort than Group C (P <0.05). Furthermore, Group C had significantly higher numerical rating scale (NRS) scores at POD1 than Group M (P <0.05). Conclusion For elderly patients undergoing knee arthroplasty, magnesium sulfate can be used as an adjuvant in a multimodal analgesic regimen to reduce early postoperative pain and improve the quality of early postoperative recovery.
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Affiliation(s)
- Hai Xu
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Conghui Hao
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Xinxin Wang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Jingjing Du
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Tianyu Zhang
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China
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Jensen AE, Bjørn S, Nielsen TD, Moriggl B, Hoermann R, Vaeggemose M, Bendtsen TF. Distal subsartorial compartment block of the saphenous nerve - A dissection study and a patient case series. J Clin Anesth 2024; 92:111315. [PMID: 37926063 DOI: 10.1016/j.jclinane.2023.111315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
STUDY OBJECTIVE A saphenous nerve block is an important tool for analgesia after foot and ankle surgery. The conventional midthigh approach to saphenous nerve block in the femoral triangle may impede ambulation by impairing quadriceps motor function. PRIMARY OBJECTIVE Developing a selective saphenous nerve block targeting the nerve distal to its emergence from the adductor canal in the subsartorial compartment. DESIGN This study consists of A) a dissection study and B) Data from a clinical case series. SETTING A) Medical University of Innsbruck, Austria (dissection of 15 cadaver sides) and. B) Aarhus University Hospital, Denmark (5 patients). INTERVENTIONS A) Five mL of methylene blue was injected into the subsartorial compartment distal to the intersection of the saphenous nerve and the tendon of the adductor magnus guided by ultrasound. B) Five patients undergoing major hindfoot and ankle surgery had a subsartorial compartment block with 10 mL of local anesthetic in addition to a popliteal sciatic nerve block. MEASUREMENT A) The frequencies of staining the saphenous and medial vastus nerves. B) Assessment of postoperative pain by NRS score (0-10) and success rate of saphenous nerve block by presence of cutaneous anesthesia in the anteromedial lower leg, and motor impairment by ability to ambulate. MAIN RESULTS A) The saphenous nerve was stained in 15/15 cadaver sides. A terminal branch of the medial vastus nerve was stained in 2/15 cadaver sides. B) All patients were fully able to ambulate without support. No patients had any post-surgical pain from the anteromedial aspect of the ankle and foot (NRS score 0). The success rate of saphenous nerve block was 100%. CONCLUSION The saphenous nerve can be targeted in the subsartorial compartment distal to the intersection of the nerve and the tendon of the adductor magnus. The subsartorial compartment block provided efficient analgesia without quadriceps motor impairment.
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Affiliation(s)
- Anne E Jensen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Siska Bjørn
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas D Nielsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Vaeggemose
- GE Healthcare, Brøndby, Denmark; MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas F Bendtsen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
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Christopher ZK, Clarke HD, Spangehl MJ, Bingham JS. Posteromedial Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00008. [PMID: 38354222 PMCID: PMC11136512 DOI: 10.5435/jaaosglobal-d-23-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
Achieving optimal pain control in total knee arthroplasty has improved with the use of regional anesthesia and periarticular injections (PAIs). When performing a PAI, the relative location of the anesthetic spread is not well defined in comparison with an adductor canal block (ACB). In this study, our aim was to evaluate the location of posteromedial PAI spread compared with a surgeon administered ACB. One PAI and one surgeon-administered ACB were performed in the contralateral limbs of four human cadavers. The injectate was composed of methylene blue dye to visually inspect the dye spread from the tip of the needle. Dissections were performed on each cadaver to quantify the dye spread from the tip of the needle and compare the location of the dye spread. Dye spread location was characterized as either entering the adductor canal or including the posterior capsule. The mean distance of dye spread from the needle tip to the proximal most aspect of the dyed tissue was 10.125 cm in the ACB group compared with 6.5 cm in the posteromedial PAI group. In the ACB group, 4 of 4 injections were present in the adductor canal block group compared with 3 of 4 in the posteromedial PAI group. The posteromedial PAI group also had 3 of 4 injections involve the area around the posterior capsule compared with 0 of 4 in the ACB group. Posteromedial PAI appears to provide local delivery to both the adductor canal and the posterior capsule. Intraoperative, surgeon-administered ACB reliably delivers injectate to the adductor canal only but may allow for more proximal dye spread. Posteromedial PAI may provide a benefit in delivering injectate to the posterior capsule in addition to the ACB. Additional clinical studies are necessary to determine the clinical effects of this finding.
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Domagalska M, Wieczorowska-Tobis K, Reysner T, Kowalski G. Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review. Perioper Med (Lond) 2023; 12:59. [PMID: 37968690 PMCID: PMC10652613 DOI: 10.1186/s13741-023-00346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is commonly performed in patients with end-stage osteoarthritis or rheumatoid arthritis of the knee to reduce joint pain, increase mobility, and improve quality of life. However, TKA is associated with moderate to severe postoperative pain, which remains a significant clinical challenge. Surgeon-administered PAI and anesthesiologist-administered iPACK have proven viable alternatives to conventional peripheral nerve blocks. This review aims to discuss which IPACK block or periarticular injection, combined or not with different peripheral nerve blocks, has better effects on postoperative rehabilitation, patient satisfaction, and overall outcome. MATERIAL AND METHODS The literature review was performed on standards of care, current therapeutic options, a pain management protocol, and innovative treatment options for patients undergoing total knee arthroplasty. The literature was reviewed through four electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase. RESULTS The initial search yielded 694 articles. Fifty relevant articles were selected based on relevance, recentness, search quality, and citations. Six studies compared PAI to peripheral nerve block (PNB), and eight studies checked the effectiveness of adding PNB to PAI. Three studies compared iPACK to PNB, and ten reviewed the point of adding PNB to iPACK. CONCLUSIONS The literature review indicates that the best analgesic effect is obtained by combining PAI or iPACK with a peripheral nerve block, particularly with ACB, due to its analgesic, motor-sparing effect, and satisfactory analgesia.
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Affiliation(s)
- Małgorzata Domagalska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55 61-245, Poznań, Poland.
| | | | - Tomasz Reysner
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55 61-245, Poznań, Poland
| | - Grzegorz Kowalski
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55 61-245, Poznań, Poland
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Lawrence KW, Buehring W, Habibi AA, Furgiuele DL, Schwarzkopf R, Rozell JC. The Influence of Tourniquet and Adductor Canal Block Use on Pain and Opioid Consumption after Total Knee Arthroplasty. Orthop Clin North Am 2023; 54:383-396. [PMID: 37718078 DOI: 10.1016/j.ocl.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Reducing pain and opioid consumption after total knee arthroplasty (TKA) is an important perioperative consideration. Though commonly used, the combined influence of tourniquets and adductor canal blocks (ACBs) on pain and opioid consumption is unknown. This study evaluated inpatient opioid consumption and pain between patients with TKA based on tourniquet and/or ACB use. Pain and opioid consumption were highest when a tourniquet, but no ACB was used, and lowest when an ACB, but no tourniquet was used - though absolute differences in pain scores were not clinically significant. Tourniquet and ACB use should be considered as part of TKA opioid-sparing protocols.
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Affiliation(s)
- Kyle W Lawrence
- Division or Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA.
| | - Weston Buehring
- Division or Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA
| | - Akram A Habibi
- Division or Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA
| | - David L Furgiuele
- Department of Anesthesiology, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA
| | - Ran Schwarzkopf
- Division or Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA
| | - Joshua C Rozell
- Division or Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, USA
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8
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Visser TG, Cross AS, Mason MW. Effects of a Continuous Adductor Canal Block After Total Knee Arthroplasty. Orthopedics 2023; 46:185-191. [PMID: 36719421 DOI: 10.3928/01477447-20230125-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This retrospective cohort study analyzed the short-term outcomes of patients undergoing total knee arthroplasty receiving periarticular anesthetic injections (PAIs) with and without continuous adductor canal blocks (CACBs) regarding early postoperative narcotic use, pain scores, and range of motion with otherwise similar postoperative regimens. Two hundred ninety-four patients were included: 120 received PAIs with CACBs, and 174 received PAIs only. Matched analysis was performed for type of anesthesia. There were substantial decreases in early inpatient narcotic use with the addition of CACBs to PAIs with general and spinal anesthesia without an adverse effect on pain, knee range of motion, or length of stay. [Orthopedics. 2023;46(3):185-191.].
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Zhao C, Wang L, Chen L, Wang Q, Kang P. Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Surg Res 2023; 18:301. [PMID: 37060089 PMCID: PMC10105472 DOI: 10.1186/s13018-023-03790-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND To investigate whether adding magnesium sulfate to a periarticular infiltration analgesia (PIA) cocktail could improve pain control and functional outcomes in patients undergoing total knee arthroplasty (TKA). METHODS Ninety patients were randomly assigned to the magnesium sulfate and control groups, with 45 patients in each group. In the magnesium sulfate group, patients were given a periarticular infusion of a cocktail of analgesics consisting of epinephrine, ropivacaine, magnesium sulfate, and dexamethasone. The control group received no magnesium sulfate. The primary outcomes consisted of visual analogue scale (VAS) pain scores, postoperative morphine hydrochloride consumption for rescue analgesia, and time to first rescue analgesia. Secondary outcomes were postoperative inflammatory biomarkers (IL-6 and CRP), postoperative length of stay, and knee functional recovery (assessed by knee range of motion, quadriceps strength, daily mobilization distance, and time to first straight-leg raising). Tertiary outcomes included the postoperative swelling ratio and complication rates. RESULTS Within 24 h of surgery, patients in the magnesium sulfate group had markedly lower VAS pain scores during motion and at rest. After the addition of magnesium sulfate, the analgesic effect was dramatically prolonged, leading to a reduction in morphine dosage within 24 h and the total morphine dosage postoperatively. Postoperative inflammatory biomarker levels were significantly reduced in the magnesium sulfate group compared with the control. There were no considerable differences between the groups in terms of the postoperative length of stay and knee functional recovery. Both groups had similar postoperative swelling ratios and incidences of complications. CONCLUSIONS The addition of magnesium sulfate to the analgesic cocktail for PIA can prolong postoperative analgesia, decrease the consumption of opioids, and effectively alleviate early postoperative pain after TKA. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056549. Registered on 7 February 2022, https://www.chictr.org.cn/showproj.aspx?proj=151489 .
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Affiliation(s)
- Chengcheng Zhao
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Liying Wang
- Department of Operating Room, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Liyile Chen
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qiuru Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Pengde Kang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
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10
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Pic C, Macabeo C, Waissi E, Lasselin P, Raffin M, Pradat P, Lalande L, Lustig S, Aubrun F, Dziadzko M. No Benefit of Adductor Canal Block Compared with Anterior Local Infiltration Analgesia in Primary Total Knee Arthroplasty: A Single-Blinded Randomized Controlled Clinical Trial. J Bone Joint Surg Am 2023; 105:231-238. [PMID: 36723467 DOI: 10.2106/jbjs.22.00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND An adductor canal block (ACB) performed by an anesthesiologist is an established component of analgesia after total knee arthroplasty. Alternatively, surgeons may perform periarticular local infiltration analgesia (LIA) intraoperatively. We hypothesized that ACB would be superior to anterior LIA in terms of morphine consumption in the first 48 hours after primary total knee arthroplasty under spinal anesthesia. METHODS This prospective controlled and blinded trial included 98 patients; 48 received an ACB plus sham (saline solution) anterior LIA, and 50 received a sham (saline solution) ACB plus anterior LIA. Both groups received posterior LIA with local anesthetic. The primary outcome was cumulative morphine consumption at 48 hours after surgery. Secondary outcomes were pain while resting, standing, and walking, rehabilitation scores, opioid-related side effects, and patient satisfaction. RESULTS No difference in the primary outcome was found, and the 48-hour morphine consumption was low in both arms (28.8 ± 17.6 mg with ACB, 26.8 ± 19.2 mg with anterior LIA; p = 0.443). Pain scores were significantly better in the anterior LIA arm, but the differences were not clinically relevant. There were no differences in any other secondary outcome measures. CONCLUSIONS LIA may be used as the primary option for multimodal postoperative pain management in patients undergoing primary total knee arthroplasty with spinal anesthesia. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Caroline Pic
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Caroline Macabeo
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Emran Waissi
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Philippe Lasselin
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Mahé Raffin
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Laure Lalande
- Service de Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Sebastien Lustig
- Département de Chirurgie Orthopédique et Médecine de Sport, Centre d'Excellence FIFA Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.,IFSTTAR, LBMC UMR_T9406, Université Claude Bernard, Lyon, France
| | - Frederic Aubrun
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.,Research on Healthcare Performance Lab (RESHAPE INSERM U1290), Université Claude Bernard, Lyon, France
| | - Mikhail Dziadzko
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.,Research on Healthcare Performance Lab (RESHAPE INSERM U1290), Université Claude Bernard, Lyon, France
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11
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Motor-Sparing Effect of Adductor Canal Block for Knee Analgesia: An Updated Review and a Subgroup Analysis of Randomized Controlled Trials Based on a Corrected Classification System. Healthcare (Basel) 2023; 11:healthcare11020210. [PMID: 36673579 PMCID: PMC9859112 DOI: 10.3390/healthcare11020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy. MATERIALS AND METHODS We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system. RESULTS The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = -22.44, 95%-CI [-35.37; -9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery. CONCLUSION By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research.
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Fillingham YA, Hannon CP, Kopp SL, Austin MS, Sershon RA, Stronach BM, Meneghini RM, Abdel MP, Griesemer ME, Woznica A, Casambre FD, Nelson N, Hamilton WG, Della Valle CJ. The Efficacy and Safety of Regional Nerve Blocks in Total Knee Arthroplasty: Systematic Review and Direct Meta-Analysis. J Arthroplasty 2022; 37:1906-1921.e2. [PMID: 36162923 DOI: 10.1016/j.arth.2022.03.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Regional nerve blocks are widely used in primary total knee arthroplasty (TKA) to reduce postoperative pain and opioid consumption. The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after TKA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. METHODS We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published before March 24, 2020 on femoral nerve block, adductor canal block, and infiltration between Popliteal Artery and Capsule of Knee in primary TKA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks compared to a control, local peri-articular anesthetic infiltration (PAI), or between regional nerve blocks. RESULTS Critical appraisal of 1,673 publications yielded 56 publications representing the best available evidence for analysis. Femoral nerve and adductor canal blocks are effective at reducing postoperative pain and opioid consumption, but femoral nerve blocks are associated with quadriceps weakness. Use of a continuous compared to single shot adductor canal block can improve postoperative analgesia. No difference was noted between an adductor canal block or PAI regarding postoperative pain and opioid consumption, but the combination of both may be more effective. CONCLUSION Single shot adductor canal block or PAI should be used to reduce postoperative pain and opioid consumption following TKA. Use of a continuous adductor canal block or a combination of single shot adductor canal block and PAI may improve postoperative analgesia in patients with concern of poor postoperative pain control.
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Affiliation(s)
- Yale A Fillingham
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Charles P Hannon
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Sandra L Kopp
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew S Austin
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Anne Woznica
- Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Francisco D Casambre
- Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Nicole Nelson
- Department of Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | | | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Fillingham YA, Hannon CP, Austin MS, Kopp SL, Sershon RA, Stronach BM, Meneghini RM, Abdel MP, Griesemer ME, Hamilton WG, Della Valle CJ. Regional Nerve Blocks in Primary Total Knee Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty 2022; 37:1691-1696. [PMID: 35970570 DOI: 10.1016/j.arth.2022.02.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/19/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Charles P Hannon
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Sandra L Kopp
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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14
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Lavand'homme PM, Kehlet H, Rawal N, Joshi GP. Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J Anaesthesiol 2022; 39:743-757. [PMID: 35852550 PMCID: PMC9891300 DOI: 10.1097/eja.0000000000001691] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The PROSPECT (PROcedure SPEcific Postoperative Pain ManagemenT) Working Group is a global collaboration of surgeons and anaesthesiologists formulating procedure-specific recommendations for pain management after common operations. Total knee arthroplasty (TKA) is associated with significant postoperative pain that is difficult to treat. Nevertheless, pain control is essential for rehabilitation and to enhance recovery. OBJECTIVE To evaluate the available literature and develop recommendations for optimal pain management after unilateral primary TKA. DESIGN A narrative review based on published systematic reviews, using modified PROSPECT methodology. DATA SOURCES A literature search was performed in EMBASE, MEDLINE, PubMed and Cochrane Databases, between January 2014 and December 2020, for systematic reviews and meta-analyses evaluating analgesic interventions for pain management in patients undergoing TKA. ELIGIBILITY CRITERIA Each randomised controlled trial (RCT) included in the selected systematic reviews was critically evaluated and included only if met the PROSPECT requirements. Included studies were evaluated for clinically relevant differences in pain scores, use of nonopioid analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs and current clinical relevance. RESULTS A total of 151 systematic reviews were analysed, 106 RCTs met PROSPECT criteria. Paracetamol and nonsteroidal anti-inflammatory or cyclo-oxygenase-2-specific inhibitors are recommended. This should be combined with a single shot adductor canal block and peri-articular local infiltration analgesia together with a single intra-operative dose of intravenous dexamethasone. Intrathecal morphine (100 μg) may be considered in hospitalised patients only in rare situations when both adductor canal block and local infiltration analgesia are not possible. Opioids should be reserved as rescue analgesics in the postoperative period. Analgesic interventions that could not be recommended were also identified. CONCLUSION The present review identified an optimal analgesic regimen for unilateral primary TKA. Future studies to evaluate enhanced recovery programs and specific challenging patient groups are needed.
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Affiliation(s)
- Patricia M Lavand'homme
- From the Department of Anaesthesiology and Perioperative Pain Service, Cliniques Universitaires St Luc, University Catholic of Louvain (UCL), Brussels, Belgium (PML), Section of Surgical Pathophysiology 7621, Rigshospitalet, Copenhagen, Denmark (HK), Department of Anaesthesiology, Orebro University, Orebro, Sweden (NR) and Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States (GPJ)
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Choi JW, Lahori A, Merlo JA, Gill O, Ghoddoussi F, Patel KM, Desai RG, Hakim J, Zatkoff J, Krishnan S. Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption: A Prospective Randomized Controlled Trial. Clin J Pain 2022; 38:388-395. [PMID: 35440521 DOI: 10.1097/ajp.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adequate pain management is a critical component of facilitating same-day discharge for total knee arthroplasty (TKA). Adductor canal blocks (ACB) have been shown to be an effective technique for managing pain after TKA. The objective of this study was to investigate the impact of adding magnesium to local anesthetic in ACB on postoperative pain, opioid consumption, nausea, and overall patient satisfaction. MATERIALS AND METHODS A sample of 119 adults undergoing elective unilateral TKA were included. Patients were randomly assigned to receive ACB with magnesium and bupivacaine (n=56) or with bupivacaine only (n=63). Primary outcomes were total opioid consumption in the first 48 hours after surgery and pain scores. Secondary outcomes were the incidence of nausea in the first 48 hours after surgery and total overall satisfaction. RESULTS Opioid consumption decreased significantly in the Mg group compared with the no-Mg group over the first 24 hours (33.2±3.0 vs. 21.3±2.4, P=0.003), the second 24 hours (35.4±2.7 vs. 27.3±2.3, P=0.026), and the first 48 hours total after surgery (68.6±5.1 vs. 48.6±4.3, P=0.004). Pain scores were reduced in the Mg group (24 h: 5.1±2.3 vs. 3.5±2.0, P=0.000; 48 h: 5.1±1.6 vs. 3.9±1.6, P=0.000). Secondary outcomes showed no difference in the incidence of nausea over the first 48 hours and overall satisfaction. CONCLUSION The addition of magnesium to local anesthetic in ACB decreases pain scores and opioid consumption, without increasing nausea, when compared with ACB with local anesthetic alone.
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Affiliation(s)
- Jae W Choi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Anna Lahori
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | | | - Opinderjit Gill
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Jason Zatkoff
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
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Rodriguez-Patarroyo FA, Cuello N, Molloy R, Krebs V, Turan A, Piuzzi NS. A guide to regional analgesia for Total Knee Arthroplasty. EFORT Open Rev 2021; 6:1181-1192. [PMID: 35839095 PMCID: PMC8693230 DOI: 10.1302/2058-5241.6.210045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain scores, opioid use and adverse effects. Combination of regional analgesia techniques is associated with better pain management and lower side effects than single regional techniques. Adductor canal block provides good analgesia and considerably lower detrimental effect in muscular strength than femoral nerve block, enhancing surgical recovery. Infiltration techniques may have equivalent analgesic effect than epidural analgesia and peripheral nerve blocks, however there should be awareness of dose dependent toxicity. Novel long-acting local anesthetics role for regional analgesia is still to be determined, and will require larger randomized trials to support its advantage over traditional local anesthetics.
Cite this article: EFORT Open Rev 2021;6:1181-1192. DOI: 10.1302/2058-5241.6.210045
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Affiliation(s)
| | - Nadin Cuello
- Department of Orthopaedic and Trauma Surgery, Hospital Interzonal General de Agudos Eva Perón, San Martín, Buenos Aires, Argentina
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Viktor Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alparslan Turan
- Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic Ohio, USA
- Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas S. Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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17
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Guven Kose S, Kose HC, Arslan G, Eler Cevik B, Tulgar S. Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study. Int J Clin Pract 2021; 75:e14747. [PMID: 34428334 DOI: 10.1111/ijcp.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
STUDY OBJECTIVE The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy. DESIGN Prospective, randomised, controlled. SETTING Tertiary hospital. PATIENTS A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 patients in each group. INTERVENTIONS Standardised postoperative analgesia was performed in all groups. In addition, ultrasound-guided ACB (same volume/two different concentrations of bupivacaine: 0.25% vs 0.16%) was applied to the experimental groups. MEASUREMENTS Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). MAIN RESULTS Tramadol requirement in the first 24 hours was significantly higher in the control group (209.5 ± 23.27 mg) (P < .001), and there was no difference between the experimental groups (63 ± 42.06 mg vs 80.5 ± 36.63 mg). Although the mean NRS scores in the first three hours were higher in the control group when compared with both block groups, it was similar in all groups in the following measurements. CONCLUSION In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics when compared with the control group.
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Affiliation(s)
- Selin Guven Kose
- Department of Anesthesiology and Pain Medicine, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Halil Cihan Kose
- Department of Anesthesiology and Pain Medicine, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gulten Arslan
- Department of Anesthesiology, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Banu Eler Cevik
- Department of Anesthesiology, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology, Maltepe University Faculty of Medicine, Istanbul, Turkey
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Narayan P, Sahitya VA, Chandrashekaraiah MM, Butt AJ, Johnston KA, Skowronski S. Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery - A Randomized Controlled Trial. Anesth Essays Res 2021; 15:32-37. [PMID: 34667345 PMCID: PMC8462420 DOI: 10.4103/aer.aer_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022] Open
Abstract
Context: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. Aim: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. Settings and Design: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. Statistical Analysis: Statistical analysis was performed using the Student's t-test, Mann–Whitney test, and Chi-square test. Results: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. Conclusion: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.
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Affiliation(s)
- Priti Narayan
- Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Vijay A Sahitya
- Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Mahesh M Chandrashekaraiah
- Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Ahsan J Butt
- Department of Orthopedics, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Keith A Johnston
- Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
| | - Sharon Skowronski
- Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain
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Comparison of Efficacy of Adductor Canal Block, Local Infiltration Analgesia and Both Combined in Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial. Indian J Orthop 2021; 55:1111-1117. [PMID: 34824710 PMCID: PMC8586381 DOI: 10.1007/s43465-021-00482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/07/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of our study is to compare the efficacy of adductor canal block (ACB), periarticular local infiltration (PLI) and both combined (ACB + PLI) in multimodal pain management after TKA. METHODS This is a prospective, randomized controlled double-blinded study undergoing primary unilateral TKA. They were randomized into three groups with fifty patients in each group: ACB alone (30 ml of 0.2% ropivacaine), PLI alone (30 ml 0.5% ropivacaine in 20 ml of normal saline), and both combined (ACB + PLI). The primary outcome studied was pain using visual analog score (VAS) in postoperative days (POD) 1 and 2. The secondary outcomes estimated were the ambulation capacity, the knee range of motion, need for rescue analgesia and length of hospital stay. RESULTS The mean VAS score was significantly lower at rest and after mobilization in the combined group (3.51 at POD 1, 2.04 at POD 2), compared with either alone group (ACB = 4.70, 2.86 versus PLI = 4.39, 3.41 at POD 1 and 2 respectively after mobilization, p < 0.001). The ambulation capacity (combined = 103.3 steps versus ACB = 98.1 and PLI = 95.2 steps, p = 0.04) and the knee range of motion (arc of motion 106.7 degrees versus ACB = 104.9 and PLI = 102.2 degrees, p = 0.004) were significantly higher in the combined group compared to the other groups. There was no significant difference in the length of stay between the groups (p = 0.12). CONCLUSION Adductor canal block combined with periarticular local infiltration provides better pain relief, good range of motion, quicker rehabilitation, and reduced opioid consumption.
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Karam JA, Schwenk ES, Parvizi J. An Update on Multimodal Pain Management After Total Joint Arthroplasty. J Bone Joint Surg Am 2021; 103:1652-1662. [PMID: 34232932 DOI: 10.2106/jbjs.19.01423] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols. ➤ Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty. ➤ Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge. ➤ There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.
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Affiliation(s)
- Joseph A Karam
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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21
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Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, Mariano ER, Johnson RL, Go G, Hargett MJ, Lee BH, Wendel P, Brouillette M, Kim SJ, Baaklini L, Wetmore DS, Hong G, Goto R, Jivanelli B, Athanassoglou V, Argyra E, Barrington MJ, Borgeat A, De Andres J, El-Boghdadly K, Elkassabany NM, Gautier P, Gerner P, Gonzalez Della Valle A, Goytizolo E, Guo Z, Hogg R, Kehlet H, Kessler P, Kopp S, Lavand'homme P, Macfarlane A, MacLean C, Mantilla C, McIsaac D, McLawhorn A, Neal JM, Parks M, Parvizi J, Peng P, Pichler L, Poeran J, Poultsides L, Schwenk ES, Sites BD, Stundner O, Sun EC, Viscusi E, Votta-Velis EG, Wu CL, YaDeau J, Sharrock NE. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021; 46:971-985. [PMID: 34433647 DOI: 10.1136/rapm-2021-102750] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
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Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Janis Bekeris
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Dace Bekere
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - George Go
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Mary J Hargett
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bradley H Lee
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Pamela Wendel
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Mark Brouillette
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Sang Jo Kim
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Lila Baaklini
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Douglas S Wetmore
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Genewoo Hong
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Rie Goto
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bridget Jivanelli
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Vassilis Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eriphili Argyra
- Faculty of Medicine, Aretaieion University Hospital, Athens, Greece
| | - Michael John Barrington
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Alain Borgeat
- Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Jose De Andres
- Anesthesia, Critical Care and Multidisciplinary Pain Management Department, Valencia University General Hospital, Valencia, Spain.,Anesthesia Unit, Surgical Specialties Department, School of Medicine, University of Valencia, Valencia, Spain
| | | | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University Of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Gautier
- Department of Anesthesiology and Resuscitation, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| | - Peter Gerner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Enrique Goytizolo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Zhenggang Guo
- Department of Anesthesiology, Peking Universtiy Shougang Hospital, Beijing, China
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Henrik Kehlet
- Department of Clinical Medicine, Rigshosp, Copenhagen, Denmark
| | - Paul Kessler
- Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alan Macfarlane
- School of Medicine, Dentistry & Nursing, Glasgow Royal Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK
| | - Catherine MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, New York, USA.,Center for the Advancement of Value in Musculoskeletal Care, Weill Cornell Medical College, New York, New York, USA
| | - Carlos Mantilla
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexander McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Joseph M Neal
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.,Benaroya Research Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Parks
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Javad Parvizi
- Orthopedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jashvant Poeran
- Orthopaedics/Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, New York Langone Orthopaedic Hospital, New York, New York, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian D Sites
- Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Ottokar Stundner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria.,Department of Anesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eugene Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Effrossyni Gina Votta-Velis
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Jacques YaDeau
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Nigel E Sharrock
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
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22
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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23
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Wang F, Ma W, Huang Z. Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement: A systematic review of the literature and meta-analysis of 5 randomized controlled trials. Medicine (Baltimore) 2021; 100:e25884. [PMID: 34087830 PMCID: PMC8183733 DOI: 10.1097/md.0000000000025884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Currently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Only level I randomized controlled trials (RCTs) were included in our study. The primary outcome was the pain scores with rest and activity. Secondary outcomes included cumulative opioid consumption, cumulative distance ambulated, and length of stay (LOS). RESULTS Five RCTs with a total of 467 patients were included. The most important finding in our study was that although IPACK block supplementation improved pain scores at 12 hours with rest or activity after surgery, no such benefit was observed at subsequent time points during the postoperative period. Interestingly, IPACK supplementation did not reduce opioid consumption, especially in the first 24 hours after surgery. Furthermore, other postoperative outcomes, including cumulative distance ambulated and LOS, were also not improved by the addition of an IPACK. CONCLUSIONS The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. However, it may be an appropriate method to improve immediate analgesic effects after TKR.
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24
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Qin L, You D, Zhao G, Li L, Zhao S. A comparison of analgesic techniques for total knee arthroplasty: A network meta-analysis. J Clin Anesth 2021; 71:110257. [PMID: 33823459 DOI: 10.1016/j.jclinane.2021.110257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVE There is no established analgesic method for postoperative total knee arthroplasty. We comprehensively compared the analgesic methods for postoperative total knee arthroplasty. DESIGN A network meta-analysis of randomised controlled trials was used to compare 18 interventions, which were ranked by six outcome indices, to select the best modality. SETTING Postoperative recovery room and inpatient ward. PATIENTS 98 randomised controlled trials involving 7452 patients (ASA I-III) were included in the final analysis. INTERVENTIONS Studies that included the use of at least one of the following 12 nerve block(fascia iliaca compartment block (FIB), FNB, cFNB, single femoral nerve block (sFNB), adductor canal block (ACB), sciatic nerve block (SNB), obturator nerve block (ONB), continuous posterior lumbar plexus block (PSOAS), FNB + SNB, ACB + LIA, FNB + LIA, PCA + FNB). MEASUREMENTS Pain intensity was compared using Visual Analogue Scale (VAS). Also, postoperative complications, function score, hospital length of stay, morphine consumption and patient satisfaction were measured. MAIN RESULTS For visual analogue scale scores, continuous femoral nerve block (FNB) and FNB + sciatic nerve block (SNB) were the the most effective interventions. For reducing postoperative complications, fascia iliaca compartment block, FNB, SNB, and obturator nerve block showed the best results. For reducing postoperative morphine consumption, adductor canal block (ACB) + local infiltration analgesia (LIA) and FNB + SNB were preferred. For function scores (range of motion, Timed-Up-and-Go test), ACB and LIA were optimal choices. For reducing hospital length of stay and patient satisfaction, ACB + LIA and FNB + LIA were best, respectively. CONCLUSIONS Peripheral nerve block, especially FNB and ACB, is a better option than other analgesic methods, and its combination with other methods can be beneficial. Peripheral nerve block is a safe and effective postoperative analgesia method. However, our findings can only provide objective evidence. Clinicians should choose the treatment course based on the individual patient's condition and clinical situation.
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Affiliation(s)
- Lu Qin
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China.
| | - Di You
- China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Guoqing Zhao
- China-Japan Union Hospital of Jilin University, Changchun, China; Jilin University, Changchun, China.
| | - Longyun Li
- China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Shishun Zhao
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China.
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25
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Kertkiatkachorn W, Kampitak W, Tanavalee A, Ngarmukos S. Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. J Arthroplasty 2021; 36:122-129.e1. [PMID: 32694032 DOI: 10.1016/j.arth.2020.06.086] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty. This study aimed to determine if ACB with iPACK block was noninferior to ACB with periarticular injection (PAI) when combined with postoperative multimodal analgesia regimen. METHODS Seventy-six patients were randomized to receive either ACB + iPACK block and continuous ACB (CACB) (ACB + iPACK group) or PAI and CACB (ACB + PAI group). Noninferiority was concluded for the primary outcome if the adjusted mean between-group difference in pain on movement at 12 postoperative hours was within 1.3 points on a visual analog pain scale. Pain scores, morphine consumption, functional performance, and adverse events were the secondary outcome measures assessed for superiority. RESULTS Adjusted mean differences, (ACB + iPACK) - (ACB + PAI), in anterior and posterior knee pain scores on movement at 12 postoperative hours were -0.66 (-1.86, 0.54) and -0.19 (-1.36, 0.99), respectively. The upper limit of 95% confident interval was lower than the prespecified noninferiority limit. The mean visual analog scale pain scores were low and no clinically significant differences between groups. However, morphine requirement at 48 postoperative hours was significantly higher (P < .05) and showed greater reduced quadriceps strength at 0 and 45 degrees on postoperative day 0 (P = .006 and .04, respectively) in the ACB + iPACK group. CONCLUSIONS ACB with iPACK block provides a noninferior analgesia compared with PAI when combined with CACB. However, patients who received ACB + iPACK block may require higher amounts of opioids and have worse immediate functional performance. LEVEL OF EVIDENCE Therapeutic level I.
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Affiliation(s)
- Wannida Kertkiatkachorn
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wirinaree Kampitak
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aree Tanavalee
- Department of Orthopedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Srihatach Ngarmukos
- Department of Orthopedics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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26
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Gurava Reddy AV, Manohar M, Shetty A, Sankineani SR, Ashok Kumar PS, Bose VC, Pichai S, Patil S, Mukartihal R, Dhanasekhara Raja P, Rajkumar N, Rajasekharan S. A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial. Musculoskelet Surg 2020; 104:267-271. [PMID: 31236778 DOI: 10.1007/s12306-019-00616-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.
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Affiliation(s)
- A V Gurava Reddy
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - M Manohar
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - A Shetty
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S R Sankineani
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India.
- South India Arthroplasty Academy (SIAA), Secunderabad, India.
| | - P S Ashok Kumar
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - V C Bose
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Pichai
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Patil
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - R Mukartihal
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - P Dhanasekhara Raja
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - N Rajkumar
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Rajasekharan
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
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27
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Chen J, Zhou C, Ma C, Sun G, Yuan L, Hei Z, Guo C, Yao W. Which is the best analgesia treatment for total knee arthroplasty: Adductor canal block, periarticular infiltration, or liposomal bupivacaine? A network meta-analysis. J Clin Anesth 2020; 68:110098. [PMID: 33129063 DOI: 10.1016/j.jclinane.2020.110098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/21/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To review all randomized controlled trials (RCTs) comparing the analgesic efficacy of adductor canal block (ACB), periarticular infiltration (PAI), and any other mode of these treatments in analgesia, such as PAI with liposomal bupivacaine (LB), continuous adductor canal block (cACB) or ACB + PAI, after total knee arthroplasty (TKA). DESIGN Systematic review and network meta-analysis of RCTs. PATIENTS We searched PubMed, Embase, and the Cochrane database to detect all relevant RCTs on investigating the analgesic effects of ACB, PAI and LB for TKA published until April 2020. INTERVENTIONS Use of different analgesic methods of ACB, PAI, cACB, ACB + PAI and LB. MEASUREMENTS The primary endpoint was visual analog scale (VAS) score at rest and movement. The secondary endpoints were opioids consumption, length of hospitalization and knee range of motion (ROM). We used Cochrane risk of bias to assess the quality of evidence for outcomes. RESULTS Forty-two studies involving 3785 patients with 5 different methods containing ACB, PAI, ACB + PAI, continuous ACB (cACB), LB, were evaluated. According to surface under the cumulative ranking curve value, 24 h resting VAS score was the lowest the ACB + PAI (88.4%), followed by cACB (73.4%); Resting VAS score at 48 h and movement VAS score at 24 h and 48 h was the lowest in the cACB (99.9%, 92% and 100%). Total opioids consumption was the least in LB (81.4%) before cACB (60.8%). ROM was the largest in the ACB + PAI (84.1%) before cACB (78.8%). CONCLUSION Although all analgesic methods available were not evaluated, and further studies are needed to establish our results, the 24 h resting VAS score was lowest in ACB + PAI and 48 h resting and movement VAS score was lowest in cACB. CLINICAL TRIAL REGISTRATION PROSPERO (CRD 42020168102).
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Affiliation(s)
- Junheng Chen
- Department of Anesthesiology, Shantou Central Hospital, Shantou, China
| | - Chunbin Zhou
- Department of Orthopedic, First Affiliated Hospital of Shantou University, Guangdong Province, People's Republic of China
| | - Chuzhou Ma
- Department of Anesthesiology, Shantou Central Hospital, Shantou, China
| | - Guoliang Sun
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China
| | - Lianxiong Yuan
- Department of Research Service Office, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China
| | - Chunming Guo
- Department of Anesthesiology, Shantou Central Hospital, Shantou, China.
| | - Weifeng Yao
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, People's Republic of China.
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28
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Layera S, Aliste J, Bravo D, Saadawi M, Salinas FV, Tran DQ. Motor-sparing nerve blocks for total knee replacement: A scoping review. J Clin Anesth 2020; 68:110076. [PMID: 33035871 DOI: 10.1016/j.jclinane.2020.110076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE This scoping review investigates the optimal combination of motor-sparing analgesic interventions for patients undergoing total knee replacement (TKR). DESIGN Scoping review. INTERVENTION MEDLINE, EMBASE and CINAHL databases were searched (inception-last week of May 2020). Only trials including motor-sparing interventions were included. Randomized controlled trials lacking prospective registration and blinded assessment were excluded. MAIN RESULTS The cumulative evidence suggests that femoral triangle blocks outperform placebo and periarticular infiltration. When combined with the latter, femoral triangle blocks are associated with improved pain control, higher patient satisfaction and decreased opioid consumption. Continuous femoral triangle blocks provide superior postoperative analgesia compared with their single-injection counterparts. However, these benefits seem less pronounced when perineural adjuvants are used. Combined femoral triangle-obturator blocks result in improved analgesia and swifter discharge compared with femoral triangle blocks alone. CONCLUSIONS The optimal analgesic strategy for TKR may include a combination of different analgesic modalities (periarticular infiltration, femoral triangle blocks, obturator nerve block). Future trials are required to investigate the incremental benefits provided by local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK), popliteal plexus block and genicular nerve block.
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Affiliation(s)
- Sebastián Layera
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 2nd Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile.
| | - Julián Aliste
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 2nd Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Daniela Bravo
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 2nd Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Mohammed Saadawi
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal, Quebec H3T-1M5, Canada
| | - Francis V Salinas
- US Anesthesia Partners-Washington, Swedish Medical Center, Department of Anesthesiology, Seattle, WA, USA
| | - De Q Tran
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal, Quebec H3T-1M5, Canada
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Peterson JR, Steele JR, Wellman SS, Lachiewicz PF. Surgeon-Performed High-Dose Bupivacaine Periarticular Injection With Intra-Articular Saphenous Nerve Block Is Not Inferior to Adductor Canal Block in Total Knee Arthroplasty. J Arthroplasty 2020; 35:1233-1238. [PMID: 32057598 DOI: 10.1016/j.arth.2020.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/19/2019] [Accepted: 01/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is insufficient data comparing the efficacy and safety of these methods. METHODS This is a retrospective two-surgeon cohort study comparing short-term perioperative outcomes after primary total knee arthroplasty, in 50 consecutive patients with surgeon-performed high-dose periarticular injection and intra-articular saphenous nerve block (60 mL 0.5% bupivacaine, 30 mL saline, 30mg ketorolac) and 50 consecutive patients with anesthesiologist-performed adductor canal catheter (0.25% bupivacaine 6 mL/h infusion pump placed postoperatively with ultrasound guidance). Chart review assessed pain scores through POD #1, opioid use, length of stay, and short-term complications, including local anesthetic systemic toxicity. Statistical analysis was performed with two-tailed Student's T-test. RESULTS The high-dose periarticular injection cohort had significantly lower pain scores in the postanesthesia care unit (mean difference 1.4, P = .035), on arrival to the inpatient ward (mean difference 1.7, P = .013), and required less IV narcotics on the day of surgery (mean difference 6.5 MME, P = .0004). There was no significant difference in pain scores on POD #1, total opioid use, day of discharge, or short-term complications. There were no adverse events related to the high dose of bupivacaine. CONCLUSION Compared with postoperative adductor canal block catheter, an intraoperative high-dose periarticular block demonstrated lower pain scores and less IV narcotic use on the day of surgery. No difference was noted in pain scores on POD #1, time to discharge, or complications. There were no cardiovascular complications (local anesthetic systemic toxicity) despite the high dose of bupivacaine injected. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - John R Steele
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, NC; Department of Orthopaedic Surgery, Durham VA Medical Center, Durham, NC
| | - Paul F Lachiewicz
- Department of Orthopaedic Surgery, Duke University, Durham, NC; Department of Orthopaedic Surgery, Durham VA Medical Center, Durham, NC
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30
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Summers S, Mohile N, McNamara C, Osman B, Gebhard R, Hernandez VH. Analgesia in Total Knee Arthroplasty: Current Pain Control Modalities and Outcomes. J Bone Joint Surg Am 2020; 102:719-727. [PMID: 31985507 DOI: 10.2106/jbjs.19.01035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Spencer Summers
- Departments of Orthopaedics and Rehabilitation (S.S., N.M., C.M., and V.H.H.), and Anesthesiology, Perioperative Medicine, and Pain Management (B.O. and R.G.), University of Miami, Miami, Florida
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31
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Li JW, Ma YS, Xiao LK. Postoperative Pain Management in Total Knee Arthroplasty. Orthop Surg 2020; 11:755-761. [PMID: 31663286 PMCID: PMC6819170 DOI: 10.1111/os.12535] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.
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Affiliation(s)
- Jing-Wen Li
- Department of Orthopaedic Surgery, Yueyang Second People's Hospital, Yueyang, China.,Department of Orthopaedic Surgery, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang, China
| | - Ye-Shuo Ma
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Liang-Kun Xiao
- Department of Orthopaedic Surgery, Yueyang Second People's Hospital, Yueyang, China.,Department of Orthopaedic Surgery, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang, China
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32
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Tian Y, Tang S, Sun S, Zhang Y, Chen L, Xia D, Wang Y, Ren L, Huang Y. Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty. J Orthop Surg Res 2020; 15:41. [PMID: 32028972 PMCID: PMC7006123 DOI: 10.1186/s13018-020-1577-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results There were 82 patients in the PNB group and 124 patients in the LIA group. The patients’ characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.
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Affiliation(s)
- Yi Tian
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
| | - Shuai Tang
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China.
| | - Sijin Sun
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
| | - Lin Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
| | - Di Xia
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
| | - Yingli Wang
- Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Liying Ren
- Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, CAMS&PUMC, No.1, Wangfujing, DongCheng District, Beijing, 100730, China
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Alsheikh KA, Alkhelaifi AS, Alharbi MK, Alhabradi FA, Alzahrani FA, Alsalim AA, Alhandi AA, Aldosary AK. Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study. Saudi J Anaesth 2020; 14:38-43. [PMID: 31998018 PMCID: PMC6970349 DOI: 10.4103/sja.sja_354_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR). Materials and Methods: This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores. Results: Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively (P < 0.05), and the total drain output was also significantly less (P < 0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale (P < 0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia. Conclusion: This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications.
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Affiliation(s)
- Khalid A Alsheikh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed S Alkhelaifi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed K Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal A Alhabradi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal A Alzahrani
- Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman A Alsalim
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali A Alhandi
- Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Arwa K Aldosary
- Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Zhang LK, Li Q, Zhu FB, Liu JS, Zhang ZJ, Zhang YH, Quan RF. Comparison of adductor canal block with periarticular infiltration analgesia in total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e18356. [PMID: 31852139 PMCID: PMC6922493 DOI: 10.1097/md.0000000000018356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. METHOD Randomized controlled trials about relevant studies were searched from PubMed (1996 to May 2019), Embase (1980 to May 2019), and Cochrane Library (CENTRAL, May 2019). Five studies which compared the ACB with the PIA methods were included in our meta-analysis. RESULTS Five studies containing 413 patients met the inclusion criteria. There were no significant differences between the ACB and the PIA group in visual analog scale (VAS) score at rest (P = .14) and movement (P = .18), quadriceps muscle strength (P = .95), complications (P = .78), length of stay (LOS) (P = .54), and time up and go (TUG) test (P = .09), While patients in the ACB group had less equivalent morphine consumption (P < .05) compared with the PIA group. CONCLUSIONS Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.
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Affiliation(s)
- Lu-Kai Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
| | - Qiang Li
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
| | - Fang-Bing Zhu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
| | - Jun-Sheng Liu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
| | - Zhi-Jin Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
| | - Yu-Hang Zhang
- Department of Orthopedics, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ren-Fu Quan
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University
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Schnabel A, Reichl SU, Weibel S, Zahn PK, Kranke P, Pogatzki‐Zahn E, Meyer‐Frießem CH. Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery. Cochrane Database Syst Rev 2019; 2019:CD012262. [PMID: 31684698 PMCID: PMC6814953 DOI: 10.1002/14651858.cd012262.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Peripheral regional anaesthesia techniques are well established for postoperative pain treatment following knee surgery. The adductor canal block (ACB) is a new technique, which can be applied as a single shot or by catheter for continuous regional analgesia. OBJECTIVES To compare the analgesic efficacy and adverse events of ACB versus other regional analgesic techniques or systemic analgesic treatment for adults undergoing knee surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase, five other databases, and one trial register on 19 September 2018; we checked references, searched citations, and contacted study authors to identify additional studies. SELECTION CRITERIA We included all randomized controlled trials (RCTs) comparing single or continuous ACB versus other regional analgesic techniques or systemic analgesic treatment. Inclusion was independent of the technique used (landmarks, peripheral nerve stimulator, or ultrasound) and the level of training of providers. DATA COLLECTION AND ANALYSIS We used Cochrane's standard methodological procedures. Our primary outcomes were pain intensity at rest and during movement; rate of accidental falls; and rates of opioid-related adverse events. We used GRADE to assess the quality of evidence for primary outcomes. MAIN RESULTS We included 25 RCTs (1688 participants) in this review (23 trials combined within meta-analyses). In 18 studies, participants underwent total knee arthroplasty (TKA), whereas seven trials investigated patients undergoing arthroscopic knee surgery. We identified 11 studies awaiting classification and 11 ongoing studies. We investigated the following comparisons. ACB versus sham treatment We included eight trials for this comparison. We found no significant differences in postoperative pain intensity at rest (2 hours: standardized mean difference (SMD) -0.56, 95% confidence interval (CI) -1.20 to 0.07, 4 trials, 208 participants, low-quality evidence; 24 hours: SMD -0.49, 95% CI -1.05 to 0.07, 6 trials, 272 participants, low-quality evidence) or during movement (2 hours: SMD -0.59, 95% CI -1.5 to 0.33; 3 trials, 160 participants, very low-quality evidence; 24 hours: SMD 0.03, 95% CI -0.26 to 0.32, 4 trials, 184 participants, low-quality evidence). Furthermore, they noted no evidence of a difference in postoperative nausea between groups (24 hours: risk ratio (RR) 1.91, 95% CI 0.48 to 7.58, 3 trials, 121 participants, low-quality evidence). One trial reported that no accidental falls occurred 24 hours postoperatively (low-quality evidence). ACB versus femoral nerve block We included 15 RCTs for this comparison. We found no evidence of a difference in postoperative pain intensity at rest (2 hours: SMD -0.74, 95% CI -1.76 to 0.28, 5 trials, 298 participants, low-quality evidence; 24 hours: SMD 0.04, 95% CI -0.09 to 0.18, 12 trials, 868 participants, high-quality evidence) or during movement (2 hours: SMD -0.47, 95% CI -1.86 to 0.93, 2 trials, 88 participants, very low-quality evidence; 24 hours: SMD 0.56, 95% CI -0.00 to 1.12, 9 trials, 576 participants, very low-quality evidence). They noted no evidence of a difference in postoperative nausea (24 hours: RR 1.22, 95% CI 0.42 to 3.54, 2 trials, 138 participants, low-quality evidence) and no evidence that the rate of accidental falls during postoperative care was significantly different between groups (24 hours: RR 0.20, 95% CI 0.04 to 1.15, 3 trials, 172 participants, low-quality evidence). AUTHORS' CONCLUSIONS We are currently uncertain whether patients treated with ACB suffer from lower pain intensity at rest and during movement, fewer opioid-related adverse events, and fewer accidental falls during postoperative care compared to patients receiving sham treatment. The same holds true for the comparison of ACB versus femoral nerve block focusing on postoperative pain intensity. The overall evidence level was mostly low or very low, so further research might change the conclusion. The 11 studies awaiting classification and the 11 ongoing studies, once assessed, may alter the conclusions of this review.
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Affiliation(s)
- Alexander Schnabel
- University Hospital MünsterDepartment of Anesthesiology, Intensive Care and Pain MedicineAlbert‐Schweitzer‐Campus 1, Gebäude AMünsterGermany48149
| | - Sylvia U Reichl
- Paracelsus Medical UniversityDepartment of Anesthesiology, Perioperative and Intensive Care MedicineSalzburgAustria
| | - Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Peter K Zahn
- BG‐Universitätsklinikum Bergmannsheil gGmbHDepartment of Anaesthesiology, Intensive Care Medicine and Pain ManagementBochumGermany
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Esther Pogatzki‐Zahn
- University Hospital MünsterDepartment of Anesthesiology, Intensive Care and Pain MedicineAlbert‐Schweitzer‐Campus 1, Gebäude AMünsterGermany48149
| | - Christine H Meyer‐Frießem
- BG‐Universitätsklinikum Bergmannsheil gGmbHDepartment of Anaesthesiology, Intensive Care Medicine and Pain ManagementBochumGermany
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Opioid Consumption after Plastic Surgery: Tailoring Opioid Administration to Patient Needs. Plast Reconstr Surg 2019; 145:216e-217e. [PMID: 31524800 DOI: 10.1097/prs.0000000000006237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhao Y, Huang Z, Ma W. Comparison of adductor canal block with local infiltration analgesia in primary total knee arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg 2019; 69:89-97. [DOI: 10.1016/j.ijsu.2019.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/22/2019] [Indexed: 12/26/2022]
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38
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Canbek U, Akgun U, Aydogan NH, Kilinc CY, Uysal AI. Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: A prospective randomized controlled trial. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:334-339. [PMID: 31056404 PMCID: PMC6819841 DOI: 10.1016/j.aott.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/08/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare single-shot adductor canal block and continuous infusion adductor canal block techniques in total knee arthroplasty patients. METHODS We prospectively randomized 123 patients who were scheduled for unilateral primary total knee arthroplasty surgery into single shot (n = 60; mean age: 67.1 ± 6.9 years) and continuous (n = 63; mean age: 66.9 ± 6.8 years) adductor canal block groups. Postoperative visual analog scale pain scores, need for additional opioids and functional results as; timed up and go test, the 30-s chair stand test, 5 times sit-to-stand test, the 6-min walking test, the time to active straight leg raise, time to walking upstairs, maximal flexion at the time of discharge, duration of stay in hospital were compared between the two groups. RESULTS Pain scores were lower in the continuous adductor canal block group as compared to the single-shot adductor canal block group throughout the postoperative period (p = 0.001). Rescue analgesia was required for 6 (10%) patients in the single shot group and for 1 (1.59%) patient in the continuous group (p = 0.044). Patients in the continuous adductor canal block group displayed better functional results than the single-shot adductor canal block group with respect to active straight-leg rise time (25.52 ± 4.56 h vs 30.47 ± 8.07 h, p = 0.001), 6-min walking test (74.52 ± 29.38 m vs 62.18 ± 33.32 m, p = 0.035) and maximal knee flexion degree at discharge (104.92 ± 5.35° vs 98.5 ± 7.55°, p = 0.001). There was no significant difference between the two groups for other functional and ambulation scores. CONCLUSION Pain control following total knee arthroplasty was found to be better in those patients treated with continuous adductor canal block as compared to those treated with single-shot adductor canal block. Patients treated with continuous adductor canal block also displayed better ambulation and functional recovery following total knee arthroplasty. LEVEL OF EVIDENCE Level I, Therapeutic Study.
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39
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Wang Q, Yue Y, Li D, Yang Z, Yeersheng R, Kang P. Efficacy of Single-Shot Adductor Canal Block Combined With Posterior Capsular Infiltration on Postoperative Pain and Functional Outcome After Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. J Arthroplasty 2019; 34:1650-1655. [PMID: 31060917 DOI: 10.1016/j.arth.2019.03.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/17/2019] [Accepted: 03/31/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adductor canal block (ACB) may preserve muscle strength and promote faster recovery than other methods of analgesia following total knee arthroplasty (TKA). However, there are contradictory reports on the efficacy of ACB. Here, we evaluated the efficacy of single-shot ACB combined with posterior capsular infiltration (PCI) vs multimodal periarticular infiltration analgesia in treating postoperative pain. METHODS This study involved patients undergoing unilateral primary TKA at our institution from January 2018 to January 2019. Patients were randomized into 2 groups, one of which was treated with ACB combined with PCI, and the other with periarticular infiltration analgesia. Primary outcomes included postoperative pain as assessed by the visual analog scale (VAS) and consumption of morphine hydrochloride. The secondary outcome was functional recovery, as assessed by range of knee motion, quadriceps strength, and daily ambulation distance. Tertiary outcomes included the duration of hospital stay and postoperative adverse effects. RESULTS Patients treated with ACB and PCI had lower resting VAS scores at 8 and 24 hours after surgery, and lower VAS scores during motion within 48 hours after surgery. Patients treated with ACB and PCI also consumed less morphine. There was no difference in functional recovery, duration of hospitalization, or incidence of adverse events. CONCLUSION The ACB combined with PCI can reduce postoperative pain sooner after TKA without affecting postoperative functional recovery and increasing complications.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Yue
- Department of Orthopaedics Surgery, Karamay Municipal People's Hospital, Karamay, People's Republic of China
| | - Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Releken Yeersheng
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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40
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Mordehai E. Letter to the Editor. Confounding factors in predicting postoperative pain and opioid consumption after spine surgery. J Neurosurg Spine 2019; 31:454-455. [PMID: 31299641 DOI: 10.3171/2019.3.spine19324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Selznick A, Chhina T, Sennik VB, Tam K, El Beheiry H. The effects of adding local infiltration analgesia of the knee to a multimodal pain protocol for total arthroplasty: A matched pair retrospective study. Can J Pain 2019; 3:98-105. [PMID: 35005398 PMCID: PMC8730671 DOI: 10.1080/24740527.2019.1603077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: We hypothesize that the addition of local infiltration analgesia (LIA) to a multimodal pain protocol will reduce the total amount of opioids consumed for acute pain control post total knee arthrolplasty (TKA). Methods: This study was a retrospective, matched pair study including patients who had primary TKA. All patients included in the analysis had preoperative oral celecoxib and acetaminophen, had single-dose spinal anesthetic with intrathecal morphine, and had intravenous patient-controlled analgesia with an opioid agent in addition to gabapentin and celecoxib in the first 48 h. Patients whose charts were excluded from the study had revision TKA, received opioid therapy prior to the surgery, were classified as American Society of Anesthesiology (ASA) IV, and had general anesthesia. Fifty patients who underwent TKA and had LIA were matched for age, body mass index (BMI), and gender with patients who did not receive LIA. The primary outcome measures were total doses of opioids consumed post TKA. Results: Patients receiving LIA consumed on average significantly less intravenous (IV) morphine equivalents than patients not receiving LIA, with a mean difference (±SD) of 88.9 ± 15.6 mg IV morphine equivalents. Furthermore, pain control was better in the LIA group. The incidences of nausea and vomiting, pruritis, and excessive sedation were higher in the non-LIA group compared to the LIA group. There was no difference in the hospital length of stay between both groups. Conclusions: The addition of LIA to our multimodal pain protocol for TKA was associated with a reduction in total opioid consumption.
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Affiliation(s)
- Asher Selznick
- Department of Anesthesia, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Tejinder Chhina
- Department of Anesthesia, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Vir B Sennik
- Department of Orthopedic Surgery, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kenny Tam
- Department of Anesthesia, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Hossam El Beheiry
- Department of Anesthesia, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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Zhu X, Wang F, Ling W, Dai X. The Efficacy and Safety of Combined Adductor Canal Block with Periarticular Anesthetic Injection Following Primary Total Knee Arthroplasty: A Meta-Analysis. J INVEST SURG 2019; 33:904-913. [PMID: 30885020 DOI: 10.1080/08941939.2019.1579278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Xiaowen Zhu
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Feng Wang
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Weiqi Ling
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Xiaoyu Dai
- Department of Orthopaedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
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Sardana V, Burzynski JM, Scuderi GR. Adductor Canal Block or Local Infiltrate Analgesia for Pain Control After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2019; 34:183-189. [PMID: 30360981 DOI: 10.1016/j.arth.2018.09.083] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/11/2018] [Accepted: 09/21/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is a treatment option for debilitating arthritis. In the postoperative period, patients experience moderate to severe pain affecting the rehabilitation, hospital stay, and patient satisfaction. This study aims at utilizing current best evidence to determine whether adductor canal block (ACB) or periarticular injection (PAI) is a better modality for managing short-term postoperative pain and opioid consumption. METHODS Embase, MEDLINE, HealthStar, Emcare, and PubMed were searched for randomized controlled trials from 1946 to August 2018, for literature addressing the comparison of ACB and PAI for pain management in the setting of total knee arthroplasty. A systematic review and meta-analysis were performed. RESULTS Six studies were included in our meta-analysis. When examining the combined visual analog scale (VAS) pain values for each group, analysis demonstrated greater reduction in scores for the PAI group, and the difference was statistically significant (P = .001). When comparing the VAS scores of subgroups analyzed at specific periods in time, there was a trend toward lower VAS scores in subgroups analyzed at 24 hours and 48 hours postoperatively (at rest and at movement) in the PAI group. Overall opioid consumption was lower in the PAI group, with demonstrated statistical significance (P = .03). When comparing the postoperative subgroups, there was a trend toward decreased opioid use in the PAI group, with 13.25% less opioid use at 48 hours and 9.5% less opioid use at 24 hours. CONCLUSION PAI could significantly improve postoperative pain and opioid consumption when compared with ACB. Additional, high-quality studies are required to further address this topic.
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Affiliation(s)
- Vandit Sardana
- Adult Reconstruction, Hofstra School of Medicine, Lenox Hill Hospital, New York, NY
| | - Joanna M Burzynski
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Giles R Scuderi
- Adult Reconstruction, Hofstra School of Medicine, Lenox Hill Hospital, New York, NY
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The importance of appropriate control groups in perioperative analgesic studies: One size does not fit all. J Clin Anesth 2018; 48:91-92. [PMID: 29803193 DOI: 10.1016/j.jclinane.2018.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/24/2022]
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