“Dual Subsartorial Block (DSB)”: An innovative procedure-specific, motor-sparing and opioid-sparing regional analgesia technique for Total knee replacement surgery – A pilot study

Sonawane, Kartik; Dixit, Hrudini; Balavenkatasubramanian, Jagannathan; Goel, Vipin Kumar

doi:10.1016/j.jclinane.2020.110149

Cited by 5 publications

(10 citation statements)

References 3 publications

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“…DSB is also classified as a procedure-specific block as it covers both anterior and posterior knee innervations of all pain generators involved in the surgical dissection [ 26 - 28 ]. The pain-generating components before and after surgery are different.…”

Section: Discussionmentioning

confidence: 99%

“…The number of participants to be included was calculated based on the pilot study [ 26 ] conducted with reported mean pain scores (SD) of 0.8 (1.1) in the 10/20 group and 1.6 (1.14) in the 20/10 group.…”

Section: Methodsmentioning

confidence: 99%

“…The dual subsartorial block (DSB) is a novel procedure-specific and motor-sparing RA technique that may reduce overall postoperative opioid consumption when used in conjunction with MMA [ 26 - 28 ]. In our hospital, the DSB is being used in patients scheduled for planned elective TKA as a cornerstone of postoperative analgesia protocols in combination with systemic analgesia since 2017.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial

Sonawane¹,

Dixit²,

Mistry³

et al. 2021

Cureus

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Introduction: Total knee arthroplasty (TKA) is a life-changing joint surgery that improves health-related quality of life and functional status. Patients in need of this surgery mostly belong to the geriatric age group with limited functional reserves and multiple co-morbidities requiring utmost perioperative care with the most suitable analgesic modalities. Regional analgesia (RA) should provide effective analgesia while allowing early mobility, reduced opioid consumption, and early discharge. Dual subsartorial block (DSB) is a novel procedure-specific, motor-sparing, and opioid-sparing RA technique for TKA surgeries. Our study compared the analgesic efficacy of the two different combinations of volumes used in DSB. Methods: This prospective randomized comparative study included patients between 25-75 years of age of American Society of Anesthesiology (ASA) I-II grades who underwent an elective cemented unilateral total knee replacement performed via medial approaches under neuraxial anesthesia. A total of 104 patients were divided into two equal groups based on the local anesthetic (LA) volumes (Group A 10/20 ml and Group B 20/10 ml) used in the DSB. Postoperative pain scores (using a visual analog scale) and quadriceps strengths (using neurological exam), and opioid consumption were measured at regular intervals till discharge. Results: Most patients (71.2%) remained pain-free and comfortable until discharge, while 28.8% complained of pain within 12 hours of DSB. Mean quadriceps strength remained almost normal (4-5/5) until the discharge with no incidences of buckling or fall in either group. Over time, the postoperative trend between the groups showed a significant difference for dynamic pain (p = 0.002) and quadriceps strength (p = <0.001). There was an insignificant difference (p = 0.161) between the groups regarding opioid consumption, with the median oral morphine equivalent of zero in both groups. Discussion: The effective analgesic coverage of DSB is based on the involvement of all innervations of the procedure-specific pain generators of TKR surgeries. The specific focus on selective sensory innervations and the type/volume of the LA used makes DSB a motor-sparing RA alternative that facilitates early mobility and discharge. It can provide effective postoperative analgesia without compromising the motor strength of the quadriceps muscle when administered in either 10/20 or 20/10 volumes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial

Sonawane¹,

Dixit²,

Mistry³

et al. 2021

Cureus

Self Cite

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“…Dual subsartorial block (DSB) is described as opioid-sparing, motor-sparing, and procedure-specific RA technique for total knee replacement (TKR) surgeries, mainly with medial incisions. It is a hybrid form of subsartorial block combining two subsartorial blocks (distal FT and AC block) to cover all procedure-specific innervations of pain generators involved in TKR surgery [46]. It is given immediately after the surgery with two different injections at two different locations below the sartorius muscle, hence termed a "dual subsartorial block" (Figure 10).…”

Section: A Femoral Triangle Blockmentioning

confidence: 99%

Regional Analgesia for Knee Surgeries: Thinking beyond Borders

Sonawane¹,

Dixit²

2022

Topics in Regional Anesthesia

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Knee surgeries are the most commonly performed joint surgeries in the modern world, which help maintain the quality of life by improving joint functions. These include open trauma, sports injury, or joint replacement surgeries. Among various available regional analgesia options for knee surgeries, the goal is to choose motor-sparing, opioid-sparing, and procedure-specific modalities. Therefore, it is essential to know the complex anatomy of the knee joint, essential steps of various surgical procedures, and innervations of the pain-generating structures for a particular surgery. Background knowledge of all these essentials helps select the most appropriate regional analgesia technique for knee surgeries.

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“…Most arthroplasty surgeons are keen to mobilize the patient soon after the surgery, necessitating the evolution of new RA techniques that would aid early ambulation with optimal analgesia. Dual Subsartorial Block (DSB) is a procedure-specifi c technique for TKA that would aid in early ambulation due to its motor-sparing and opioid-sparing effect [1]. The DSB covers almost all the innervations of the pain-generating components of the anterior and posterior knee joint.…”

Section: Introductionmentioning

confidence: 99%

Anatomical and Technical Considerations of "Dual Subsartorial Block" (DSB), A Novel Motor-sparing Regional Analgesia Technique for Total Knee Arthroplasty

Sonawane¹,

Dixit²,

Mistry³

et al. 2021

Open J Orthop Rheumatol

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Background:The modernization of arthroplasty has paved the way for the resurgence of ultrasound-guided regional analgesia (RA) techniques. The evolution of newer RA techniques aids in reducing postoperative pain considerably as well as facilitates early ambulation and discharge. "Dual Subsartorial Block (DSB)" is recently described as a novel procedure-specifi c, motor-sparing, and opioid-sparing RA technique for total knee arthroplasty (TKA) surgery. This review article highlights the innervations covered by DSB based on the anatomical considerations and its suitability for providing analgesic coverage in TKA with medial approaches. Methodology:We describe anatomical considerations based on the available literature about the anatomy related to the femoral triangle, adductor canal, and subsartorial region. The technical consideration of the DSB is based on our observations of the ongoing study on patients undergoing TKA with medial approaches. However, other details of the study are not part of this article.Results: After studying the anatomical and technical aspects of the DSB, it is possible to cover almost all procedure-specifi c innervations of TKA surgeries with the DSB. Our observations and statistical analysis found DSB as a procedure-specifi c, motor-sparing, and opioid-sparing RA technique. Discussion: We describe the complex anatomy of the femoral triangle and adductor canal block along with sonoanatomical variations of various subsartorial regions. We also elaborate on the technical details, analgesic coverage, and possible complications of DSB.

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“Dual Subsartorial Block (DSB)”: An innovative procedure-specific, motor-sparing and opioid-sparing regional analgesia technique for Total knee replacement surgery – A pilot study

Cited by 5 publications

References 3 publications

Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial

Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial

Regional Analgesia for Knee Surgeries: Thinking beyond Borders

Anatomical and Technical Considerations of "Dual Subsartorial Block" (DSB), A Novel Motor-sparing Regional Analgesia Technique for Total Knee Arthroplasty

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