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Background:Adductor canal blocks (ACBs) have become a popular technique for postoperative pain control in total knee arthroplasty patients. Proximal and distal ACB have been compared previously, but important postoperative outcomes have yet to be assessed.Aims:The primary objective of this study is to compare postoperative analgesia between proximal and distal ACB. Secondary outcomes include functional mobility, length of stay (LOS), and adverse events.Settings and Design:This study was a single-center, assessor-blinded, randomized trial.Subjects and Methods:Fifty-seven patients were randomly assigned to receive a proximal (n = 28) or distal (n = 29) ACB. A 20 mL bolus of 5 mg/mL ropivacaine was injected at the respective location followed by 2.0 mg/mL ropivacaine infusion for 24 h.Statistical Analysis:The primary outcome was intra- and postoperative 24-h opioid consumption in intravenous (IV) morphine equivalents. Secondary outcomes include percentage change in timed “Up and Go” (TUG) times, LOS, and average postoperative pain scores. Continuous variables were compared using Student's t-test.Results:The mean (±standard deviation) 24-h intra-and postoperative opioid consumption showed no difference between the proximal and distal groups (39.72 ± 23.6 and 41.28 ± 19.6 mg IV morphine equivalents, respectively, P = 0.793). There was also no significant difference in the median [minimum, maximum] percentage change in TUG times relative to preoperative performance comparing proximal and distal ACB (334.0 [131, 1084] %-change and 458.5 [169, 1696] %-change, respectively, P = 0.130). In addition, there were no differences in postoperative pain scores or LOS.Conclusions:ACB performed at either proximal or distal locations shows no difference in postoperative pain measured by opioid consumption or pain scores. Better TUG performance seen in the proximal group was not statistically significant but might represent a clinically important difference in functional mobility.

Introduction: Bio-Set® (Biodome, Issoire France) is a new needleless device developed for the reconstitution of a factor VIII concentrate, Kogenate® FS (Bayer HealthCare, Elkhart IN). Objectives: Quantitate time required to prepare FVIII concentrate for infusion and estimate the cost of medical waste produced using 3 reconstitution methods. Methods: 161 subjects (35 patients; 67 caregivers; and 59 nurses) were recruited from the US and Canada following an IRB-approved protocol. Reconstitution methods were Bio-Set®, the conventional 2 vial transfer needle reconstitution method, and 2 vial Baxject method (Baxter Healthcare, Westlake Village CA). Video and interviewer demonstrations were conducted, then participants practiced each reconstitution method once before performing a timed round. Diluent volume for the conventional reconstitution method and Baxject were controlled at 5 mL. After each timed round, participants separated reconstitution refuse into either medical waste or regular trash. The weights of component pieces were added and a cost for disposal of the medical waste was determined. Results: Participants completed preparation of the infusion with Bio-Set® in the shortest amount of time compared to the conventional method and Baxject (both p<0.0001). Results were similar across the 3 participant groups. The average weight of medical waste was lowest for Bio-Set® and highest for Baxject. The resulting disposal cost was significantly lower for Bio-Set® (p<0.0001). Conclusions: The results of the time study showed a reduction of 33% in infusion preparation time with the Bio-Set® when compared to the conventional method and 29% when compared to the Baxject. The cost of disposal of medical waste should be reduced with the use of the Bio-Set®.

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