Pain Control in Total Knee Arthroplasty

Background: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. Method: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). Results: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption ( P = .54), average visual analog scale (VAS) score ( P = .35), worst VAS score ( P = .19), block success rate ( P = .86), and time of catheter insertion ( P = .54). Conclusions: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.

Section: Introductionmentioning

confidence: 99%

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Zhang

Chen

et al. 2020

“…[ 1 – 3 ] Severe pain after TJA may cause discomfort and stress which is an important clinical challenge. [ 4 ] Inadequate pain management following TJA is associated with poor postoperative rehabilitation and a prolonged length of hospital stay. Pain management following TJA remains an interesting topic and the optimal methods remain controversial.…”

Section: Introductionmentioning

confidence: 99%

The efficiency of intravenous acetaminophen for pain control following total knee and hip arthroplasty

Liu

Cai²,

Li³

et al. 2017

Background:This meta-analysis aimed to evaluate the efficiency and safety of intravenous acetaminophen as an adjunct to multimodal analgesia for pain control after total joint arthroplasty (TJA).Methods:PubMed, Embase, Web of science, Medline, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) and non-RCTs were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata 11.0 software.Results:Four studies including 865 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of pain scores at 24 hours (weighted mean difference [WMD] = −0.926, 95% confidence interval [CI]: −1.171 to −0.681, P = .000), 48 hours (WMD = −0.905, 95% CI: −1.198 to −0.612, P = .000), and 72 hours (WMD = −0.279, 95% CI: −0.538 to −0.021, P = .034). Significant differences were found regarding opioid consumption at 24 hours (WMD = −4.043, 95% CI: −5.041 to −3.046, P = .000), 48 hours (WMD = −5.665, 95% CI: −7.383 to −3.947, P = .000), and 72 hours (WMD = −6.338, 95% CI: −7.477 to −5.199, P = .000).Conclusion:Intravenous acetaminophen was efficacious for reducing postoperative pain and opioid consumption than the placebo following total joint arthroplasty. Due to the limited quality of the evidence currently available, more RCTs are needed.

“…The reported incidence of severe postoperative knee pain after TKR ranges from 10.3% to 36.8%. [ 5 , 6 ] Opioid is frequently used for postoperative pain management. However, it may be associated with many adverse effects, including headache, nausea, vomiting, respiratory depression, retention of urine, and constipation.…”

Section: Introductionmentioning

confidence: 99%

Femoral nerve block versus obturator nerve block for pain management after total knee replacement

Zhang

Lin²,

Zhang³

et al. 2020

Background: Several studies reported short-term analgesic efficacy of obturator nerve block (ONB), as in comparison with the femoral nerve block (FNB) in the treatment of postoperative pain after the total knee replacement (TKR). The optimal method remains under debate. The purpose of our current work is to compare the safety and efficacy of FNB and ONB for postoperative analgesia after TKR. Methods: This prospective, randomized, and controlled study was performed from January 2018 to December 2019. It was authorized via the Institutional Review Committee in NO.971 Hospital of the People's Liberation Army Navy (2019-PLAN-132). Two hundred patients were divided randomly into 2 groups, the control group (n = 100) and study group (n = 100). The experimental group received FNB and control groups received ONB. Primary outcome included pain at different time point (Visual Analogue Scale score of anterior knee pain at rest and in motion). The Visual Analogue Scale scores were marked by patients themselves on a paper with a graduated line starting at 0 (no pain) and ending at 10 (the most painful). Opioid consumption was converted to equivalents of oral morphine uniformly for statistical analysis. Secondary outcomes included the knee range of motion, the hospital stay length as well as the postoperative complications such as pulmonary embolism and deep vein thrombosis. Results: Table 1 will show the clinical outcomes between the 2 groups. Conclusion: This trial would provide an evidence for the use of different types of peripheral nerve blocks in TKR.