Single-Dose Adductor Canal Block With Local Infiltrative Analgesia Compared With Local Infiltrate Analgesia After Total Knee Arthroplasty

Nader, Antoun; Kendall, Mark C.; Manning, David W.; Beal, Matthew D.; Rahangdale, Rohit; Dekker, Robert G.; Oliveira, Gildàsio S. De; Kamenetsky, Eric; McCarthy, Robert J.

doi:10.1097/aap.0000000000000494

Cited by 132 publications

(74 citation statements)

References 31 publications

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“…In fact, many patients who undergo TKA report posterior knee pain as the location of their initial perceived pain after surgery 12. The genicular nerves that supply the posterior knee are in close proximity to the tibial nerve and the arterial vasculature in the popliteal fossa,26 a region that is purposely avoided to prevent iatrogenic thermal injury to motor nerve fibers and vascular structures 27.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Walega

McCormick

Manning

et al. 2019

Reg Anesth Pain Med

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Background and objectivesRefractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.MethodsThis was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA.ResultsSeventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point.ConclusionsCooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2–6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.Trial registration number NCT02746874.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Walega

McCormick

Manning

et al. 2019

Reg Anesth Pain Med

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“…No gray studies are included. Finally, four RCTs [ 13 – 16 ] comprising 297 patients were determined to fulfil the inclusion criteria for our meta-analysis which contains 149 patients in combined groups and 148 patients in controls.…”

Section: Resultsmentioning

confidence: 99%

“…All articles provide that allocation concealment is achieved by closed envelope. Double blinding is showed in 2 RCTs, [ 13 , 16 ] and 3 studies [ 13 , 14 , 16 ] attempt to blind the assessors. Low risk of bias due to incomplete outcome data or selective outcome reporting is detected.…”

Section: Resultsmentioning

confidence: 99%

Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty

Xing

Dai²,

Zhao

et al. 2017

Medicine

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Background:This meta-analysis aimed to evaluate the efficiency and safety of the combined adductor canal block with peri-articular infiltration versus periarticular infiltration alone for pain control after total knee arthroplasty (TKA).Methods:PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify articles comparing the combined adductor canal block with peri-articular infiltration and periarticular infiltration alone for pain control after TKA. Main outcomes were numeric rating scale (NRS) at postoperative day (POD) 0–2 and opioid consumption. Meta-analysis was performed using Stata 11.0 software.Results:Four randomized controlled trial (RCTs) including 297 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between the groups regarding NRS score at POD 0 (weighted mean difference [WMD] = −0.849, 95% confidence interval [CI]: −1.345 to −0.353, P = .001), POD 1 (WMD = −0.960, 95% CI: −1.474 to −0.446, P = .000), and POD 2 (WMD = −0.672, 95% CI: −1.163 to −0.181, P = .007) after TKA. Significant differences were found in terms of opioid consumption at POD 0 (WMD = −3.761, 95% CI: −6.192 to −1.329, P = .002), POD 1 (WMD = −4.795, 95% CI: −8.181 to −1.409, P = .006), and POD 2 (WMD = −2.867, 95% CI: −4.907 to −0.827, P = .006).Conclusion:Combined adductor canal block with peri-articular infiltration could significantly reduce NRS scores and opioid consumption in comparison with periarticular infiltration alone following TKA. Additionally, there is a lower incidence of nausea and vomiting in the combined groups.

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“…Currently, bupivacaine and ropivacaine are commonly used medications in ACB. 1,[6][7][8] The duration of analgesia for ropivacaine lasts between 7 and 15 hours. 9 Ropivacaine and bupivacaine have similar analgesic effect when used for peripheral nerve blocks.…”

mentioning

confidence: 99%

“…9 Ropivacaine and bupivacaine have similar analgesic effect when used for peripheral nerve blocks. 10 Adjunct medications added to peripheral nerve blocks to augment duration of action such as epinephrine, 1,5 buprenorphine, 11 clonidine, [12][13][14] dexmedetomidine, 15 and dexamethasone 16,17 yielded unsatisfactory or conflicting results, with some carrying additional side effects such as increased nausea, vomiting, bradycardia, and hypotension.…”

mentioning

confidence: 99%

Efficacy of Liposomal Bupivacaine versus Ropivacaine in Adductor Canal Block for Total Knee Arthroplasty

2020

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Adductor canal block (ACB) is advantageous for postoperative analgesia in total knee arthroplasty (TKA) because it results in minimal motor block. Liposomal bupivacaine (LB) is Food and Drug Administration-approved extended-release formulation of bupivacaine for interscalene peripheral nerve blocks. Its use is increasing in the TKA setting, mainly as a local infiltration agent. We compared the efficacy of ACB using LB versus ropivacaine in TKA. Two cohorts of patients were retrospectively analyzed at a single institution receiving ropivacaine and LB ACB for TKA. Duration of LB ACB, time to first opioid use postrecovery room, amount of opioid use postrecovery room, length of stay (LOS), and average and highest pain scores were collected. A total of 91 and 142 TKA patients received ropivacaine and LB for ACB, respectively. At 8 hours postrecovery room, more patients in the LB group required no opioids compared with the ropivacaine group (p = 0.026). Mean opioid consumption was lower in the LB group than in the ropivacaine group at 8 and 24 hours postrecovery room, although statistical significance was only observed at 8 hours (p = 0.022). The highest pain score for patients in the two groups was not statistically different. The average pain score for patients with a 2-day LOS was higher in the LB group, but average pain scores were similar for patients with 1- and 3-day LOS. Median LOS for the LB and ropivacaine groups was 1 and 2 days, respectively (p < 0.0001). Significantly lower opioid use at 8 hours postrecovery room was seen in the LB group compared with the ropivacaine group. There was no difference in opioid use at 24 and 48 hours. There was also no advantage with LB ACB in decreasing pain scores. However, the LB ACB group demonstrated a significantly shorter LOS compared with the ropivacaine ACB group.

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Single-Dose Adductor Canal Block With Local Infiltrative Analgesia Compared With Local Infiltrate Analgesia After Total Knee Arthroplasty

Abstract: Adductor canal blockade with bupivacaine 0.25% with epinephrine 1:300,000 effectively reduces pain and opioid requirement in the postoperative period after TKA. Adductor canal blockade is an effective pain management adjunct for patients undergoing TKA.

Cited by 132 publications

References 31 publications

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty

Efficacy of Liposomal Bupivacaine versus Ropivacaine in Adductor Canal Block for Total Knee Arthroplasty

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