Not all the patients undergoing TKA who receive tranexamic acid need the same preoperative Hb optimization target. Two easily available factors, such as the ASA score and the Hb level, can help individualize the Hb optimization target.
BACKGROUND
Standard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis.
OBJECTIVE
To test the noninferiority of the analgesic effect of genicular nerves block in comparison with local infiltration analgesia after 24 h of total knee arthroplasty.
DESIGN
Prospective cohort study.
SETTING
Perioperative setting.
PATIENTS
Thirty-five patients scheduled for total knee arthroplasty were prospectively included in the study and compared with 35 patients in a retrospective cohort.
INTERVENTION
Genicular nerve blocks in the prospective cohort were compared with local infiltration analgesia in the retrospective cohort.
MAIN OUTCOME MEASURES
The pain numeric rating scale and the cumulative opioid consumption in oral morphine equivalents during the first 24 h.
RESULTS
We conducted propensity score-matched analyses of patients using acute postoperative pain-related risk covariates. After one-to-one propensity score matching, 21 patients were included in the local infiltration analgesia group and 21 in the genicular nerve block group. The median difference in numeric rating score at rest at 24 h was −0.99 [95% confidence interval (CI), −1.99 to 0.5, P = 0.012] on the unmatched cohort and −1.9 (95% CI, −2 to 0, P = 0.002) on the matched cohort (meeting the noninferiority criteria, Δ=1). The median difference in cumulative opioid consumption was 2.5 mg (95% CI, −13.5 to 2.5, P < 0.001) for the unmatched cohort and 4.99 mg (95% CI, −11.5 to 2.5, P < 0.001) on the matched group (meeting the noninferiority criteria, Δ = 21 mg).
CONCLUSION
Local infiltration analgesia and genicular nerve block are comparable in terms of analgesic results. Therefore, genicular nerves block is an alternative to local infiltration analgesia in patients undergoing total knee arthroplasty.
TRIAL REGISTRATION
Clinicaltrials.gov identifier: NCT04024319.
We know that metaraminol is a sympathomimetic amine which acts on the a1-adrenergic receptor with some stimulation of the b-adrenergic receptors. The combination of increased systemic vascular resistance and increased contractility results in an elevation in arterial pressure. However, the effect of metaraminol (or other sympathomimetics) in patients with Takotsubo cardiomyopathy may be less predictable due to the dysfunctional myocardial response to catecholamine stimulation. Indeed, there is evidence to suggest a paradoxical negative inotropic effect of sympathomimetic amines in these patients which appears to be dosedependent. 4 This finding was corroborated by Rathakrishnan and Lee, 5 who also observed that augmenting already high concentrations of circulating catecholamines with exogenous compounds may cause accelerated deterioration. Limited evidence suggests that using agents which have no action on the b-adrenergic receptors may be safer in these patients. 6 This interesting case demonstrates that caution is advised when using sympathomimetic drugs in people with Takotsubo cardiomyopathy. Furthermore, avoidance of agents which act on the b-adrenergic receptors may be a safer option for these patients.
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