Perineural dexamethasone successfully prolongs adductor canal block when assessed by objective pinprick sensory testing: A prospective, randomized, dose-dependent, placebo-controlled equivalency trial

Turner, Justin H.; Henshaw, Daryl S; Weller, Robert S.; Jaffe, J. Douglas; Edwards, Christopher J; Reynolds, J Wells; Russell, Gregory B.; Dobson, Sean

doi:10.1016/j.jclinane.2018.05.009

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…More studies are needed to explore the optimal dose and concentration of dexamethasone used around the nerves to guide clinical practice. Previous studies have reported that the dose of peripheral dexamethasone was mostly between 1 and 10 mg. [40][41][42] Our results should be interpreted with caution in the light of several limitations. First, we did not use acupuncture to assess the duration of block for the knee joint wrapped with a dressing after TKA.…”

Section: Discussionmentioning

confidence: 78%

Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty

Zeng¹,

Wang

Hu³

et al. 2022

The Clinical Journal of Pain

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Objective: Both adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the knee (iPACK) block are mainly sensory blocks, preserving muscle strength and the ability to ambulate. This study was designed to evaluate whether adding dexamethasone to ropivacaine could improve postoperative analgesia after total knee arthroplasty (TKA).Materials and Methods: This prospective double-blind randomized controlled trial included 60 patients who underwent unilateral TKA under general anesthesia. All patients who received ACB and iPACK block were randomly divided into a dexamethasone group (Group D, ropivacaine combined with dexamethasone) and a control group (Group C, ropivacaine only). The primary outcome was the time to first administration of rescue analgesic drugs. The secondary outcomes included the total amount of rescue analgesic drugs and the pain scores at different time points within 72 hours postoperatively; the time to first getting out of bed; the quality of recovery scale (QOR-15 score); and the levels of plasma inflammatory markers (interleukin-6 and C-reactive protein) on postoperative day 1.Results: Compared with Group C, the time to first administration of rescue analgesic drugs in Group D was significantly extended by ∼10.5 hours. Patients in Group D had significantly lower pain scores at different postoperative time points and consumed significantly less total morphine within 72 hours postoperatively. In addition, patients in group D reported significantly higher QoR-15 scores on postoperative days 1 and 3, earlier first time of getting out of bed, and significantly lower levels of C-reactive protein and interleukin-6 on postoperative day 1.Conclusions: Compared with using ropivacaine alone, ultrasonicguided ACB combined with iPACK using ropivacaine and dexamethasone could prolong the duration of postoperative analgesia and strength analgesic intensity and promote the early rehabilitation exercise of patients undergoing TKA.

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Section: Discussionmentioning

confidence: 78%

Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty

Zeng¹,

Wang

Hu³

et al. 2022

The Clinical Journal of Pain

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“…Currently, prolonging the duration and enhancing the analgesic effect of nerve blocks with local anesthetic adjuvants are one of the modalities of perioperative multimodal analgesia in TKA and are an attractive and technically simple analgesic strategy. Some studies have proved that dexmedetomidine and dexamethasone can significantly enhance the analgesic effect as local anesthetic adjuvants [16,17], but the former is not the most desirable local anesthetic adjuvant because of its side effects such as bradycardia and the latter because of a slight increase in blood glucose [9,18]. Opioid receptors are widely expressed in the central and peripheral nervous system as well as in non-neural tissues [19].…”

Section: Discussionmentioning

confidence: 99%

Butorphanol as an Adjuvant to Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty Patients: A Randomized, Double, Blind Study

Liu

Gao

2022

Journal of Healthcare Engineering

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Background. The objective of this study was to observe the effects of butorphanol as an adjuvant to ropivacaine for the adductor canal block (ACB) on postoperative analgesia in patients undergoing total knee arthroplasty (TKA). Methods. Seventy-four patients undergoing TKA were included and randomly divided into two groups: Group BR received 20 ml of 0.33% ropivacaine plus 1 mg butorphanol and Group R received 20 ml of 0.33% ropivacaine plus 1 ml normal saline for ultrasound-guided adductor canal blocks. The primary outcomes were the duration of the sensory block and the pain visual analogue scale (VAS), and secondary outcomes included the number of PCIA attempts (patient-controlled intravenous analgesia) and the time to first pressing and rescue analgesia. Other outcomes included knee active range of motion (ROM), quadriceps strength, the time to first mobilization, the duration of postoperative hospital stay, Knee Society Score (KSS), and postoperative complications. Results. Since two patients in each group rejected postoperative assessments, 35 patients were included in each group. Compared with Group R, Group BR had longer duration of sensory blocks (18.42 ± 3.46 vs. 15.36 ± 2.29 h, p < 0.01 ) and lower postoperative pain scores within 24 hours at rest and within 12 hours with activity ( p < 0.01 ). The number of PCIA attempts decreased within 48 hours after surgery (4.5 ± 1.2 vs. 7.8 ± 1.5 times, p < 0.01 ), and the time to first pressing was later (20.31 ± 2.59 vs. 16.25 ± 2.31 h, p < 0.01 ). In addition, Group BR had bigger knee ROM at within 24 hours after the operation than Group R (68.37 ± 4.70°vs. 59.21 ± 6.41,85.67 ± 5.17 vs. 74.37 ± 4.68°, 97.62 ± 5.43 vs. 84.18 ± 4.49°, p < 0.01 ). There was no significant difference between the two groups ( p > 0.05 ) in terms of rescue analgesia, quadriceps strength, the time to first mobilization, the duration of postoperative hospital stay, the KSS function scores, and postoperative complications. Conclusions. Butorphanol plus ropivacaine ultrasound-guided adductor canal block can prolong the duration of sensory block, relieve early postoperative pain, and improve the range of motion of the knee joint, without affecting the occurrence of postoperative complications. Name of the Registry. Chinese Clinical Trial Registry. Trial Registration Number. ChiCTR2100041859. URL of Trial Registry Record. http://www.chictr.org.cn/edit.aspx?pid=119731&htm=4. Date of Registration. 08/01/2021 0:00:00.

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“…We believed that while both anesthetic techniques had no difference in postoperative pain management, attention should be paid to achieve a good pain control for safe discharge of day-time surgery. Many studies have shown that adequate preoperative education, preemptive oral analgesia, nerve block and multimodal analgesia can effectively ensure the safety of day-time surgery [27]. A case-controlled study of hoorntje et al [25] suggested that effective pain management of outpatient UKA can reduce the anxiety and depression of patients during the perioperative period, enable patients to actively participate in rehabilitation training, achieve better clinical e cacy, and effectively improve patients' surgical satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were managed by multimodal analgesia, and only 5 patients (2 in Group A, 3 in Group B) were given tramadol and buprenorphine additionally due to obvious pain. Meanwhile, Turner et al [27] indicated that compared with femoral nerve block(FNB), adductor canal block can achieve the same analgesic effect and has less impact on strength quadriceps, which is bene cial for patients to start early mobilization and recovery on DOS, and thus more suitable for outpatient UKA.…”

Section: Discussionmentioning

confidence: 99%

Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

Chen¹,

Yin²,

Xu³

et al. 2020

Preprint

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Purpose: To compare the early clinical outcomes between anesthetic techniques in outpatient unicompartmental knee arthroplasty (UKA) and investigate factors responsible for delayed discharge. Method: A randomized controlled trial was conducted on 64 consecutive and unselected patients who underwent primary, medial UKA and randomly divided into two groups:32 patients with spinal anaesthesia(Group A) and 32 with general anaesthesia(Group B). There were no significant differences in gender, age, body mass index (BMI), the hospital for Special Surgery knee score (HSS), and American Society of Anesthesiology(ASA) class between the two groups (P >0.05).Results：Totally 64 patients were involved, including 20 males and 42 females, with an average age of 60.4 ± 3.8 year-old. The length of stay(LOS) and total expense were significantly less in group A than those in group B (P < 0.05). There was no significant difference between two groups on the discharge day and the reasons for not discharge(P>0.05). Lack of mobilization (84%), pain (23%), and PONV (17%) were main reasons for patients not meeting the discharge criteria on DOS (Table 2). Patients with spinal anaesthesia underwent a longer surgery time than those with GA.(P<0.05); Patients in the Group A had a significantly earlier oral fluid intake and walking unaided(P<0.05); Pain occurred significantly earlier in Group B(P<0.05). Conclusion: In patients who underwent outpatient UKA, spinal anaesthesia is significantly superior to general anaesthesia with shorter discharge time and lower cost. With strict patient selection and safe anaesthesia, outpatient UKA could attain a good clinical outcome with both anaesthesia techniques.

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Perineural dexamethasone successfully prolongs adductor canal block when assessed by objective pinprick sensory testing: A prospective, randomized, dose-dependent, placebo-controlled equivalency trial

Cited by 8 publications

References 18 publications

Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty

Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty

Butorphanol as an Adjuvant to Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty Patients: A Randomized, Double, Blind Study

Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

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