In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage

Abstract

Background:Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol.Methods:The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study.Results:We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting.Conclusion:In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.

Short stay total joint arthroplasty program: patient factors predicting readmission

“…[1][2][3] In surgery, the focus is on enhancing recovery and reducing morbidity by implementing additions or changes, including perioperative pain management, patient education in preparation for surgery, early mobilization and aggressive postoperative fluid administration. [4][5][6][7] In orthopedics, shorter hospital stays have been shown to be safe and effective for selected groups of total joint arthroplasty patients. [8][9][10][11] A dedicated short stay outpatient arthroplasty program aimed at reducing hospital stay to 36 hours was introduced in 2008 at one of our affiliated hospitals.…”

Fast track and outpatient surgery in total knee arthroplasty: beneficial for patients, doctors and hospitals

“…Level of pain appeared to be the most important risk factor for prolonged stay in hospital. This might explain the fact that an adequate multimodal pain management is one decisive cornerstone of multidisciplinary rapid recovery protocols [7].…”