Continuous Bupivacaine Infusion versus Liposomal Bupivacaine in Adductor Canal Block for Total Knee Arthroplasty

The efficacy of liposomal bupivacaine in parasacral ischial plane block for pain management after total knee arthroplasty: a randomized controlled trial

BACKGROUND

Utilizing liposomal bupivacaine (LB) for postoperative analgesia post-total knee arthroplasty (TKA) is prevalent. However, its effectiveness in pain control, specifically in the parasacral ischial plane block (PIPB) post-TKA, remains unknown.

METHODS

This single-center, double-blinded, randomized controlled trial recruited patients scheduled for unilateral TKA. Forty-five patients were randomly assigned in a 1:1 ratio to receive 133 mg (Group A) or 266 mg (Group B) LB using the block randomization method. The PIPB effectiveness was assessed by evaluating changes in sensory and motor functions. The primary outcome was the cumulative area under the curve (AUC) of the Numerical Rating Scale (NRS) at rest within 72 h postoperatively. All patients were included in the analyses of analgesic efficacy, rehabilitation quality, and adverse events.

RESULTS

Between January 30, 2024, and May 1, 2024, 45 patients were enrolled and randomly assigned to Group A (n = 22) and Group B (n = 23). A significant between-group difference was observed in the NRS-AUC0-72 h at rest postoperatively (132.3 ± 19.7 vs. 97.3 ± 19.1, p = 0.001), but none was observed in NRS-AUC0-72 h during activity (p = 0.642). Kaplan-Meier survival analysis revealed significant between-group differences in the median onset times of sensory [60 vs. 35(min), p < 0.0001] and motor blocks [85 vs. 50(min), p < 0.0001]. The onset time of sensory block was notably shorter than that of motor block in both groups. No significant variance was observed in the median regression time for the sensory block. A significant between-group difference in the rescue analgesic dosage was observed on the first postoperative day [43.1 vs. 27.2(mg), p = 0.009], with no significant differences in the subsequent two days or the total amount. No significant between-group differences were found in adverse events or rehabilitation quality.

CONCLUSION

LB used in the PIPB was effective for analgesia at rest post-TKA, with 266 mg demonstrating superiority. Trial RegistrationThe randomized controlled trial was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/, No: ChiCTR2400079606).

Analgesic Efficacy of Repeated Daily Injections Versus Continuous Adductor Canal Block After Total Knee Arthroplasty: An Open-Label, Randomized Clinical Trial

BACKGROUND

Total knee arthroplasty is frequently associated with postoperative pain. Continuous adductor canal blocks are widely used for postoperative analgesia. However, the high dislocation rate of nerve block catheters often leads to ineffective pain control. This study aimed to compare the analgesic effectiveness of repeated daily injections of adductor canal block up to postoperative day (POD) 2 and continuous adductor canal block in patients who underwent total knee arthroplasty.

METHODS

Seventy-six patients who underwent total knee arthroplasty under spinal anesthesia were randomized to receive repeated daily adductor canal blocks at the end of surgery and in the morning of POD1 and POD2 (n = 39) or continuous adductor canal block with a patient-controlled bolus (n = 37). All patients received perioperative multimodal analgesia. The primary outcome was the time-weighted average numeric rating scale pain score at rest, measured from the end of surgery to 14:00 on POD2. Pain scores over time were also compared using generalized estimating equations.

RESULTS

There was no significant difference in the time-weighted average pain score at rest (from POD0 to POD2) between the repeated injection group (2.9 ± 1.9) and the continuous group (3.1 ± 2.1; mean difference 0.09, 95% confidence interval [CI], -0.81 to 0.99; P = .842). Repeated daily injections did not reduce pain at rest or pain during movement after adjusting for time. In the continuous group, the cumulative occurrence of nerve block catheter dislocation was 48.6% (18/37) on POD1 and 62.2% (23/37) on POD2, as assessed using ultrasonography.

CONCLUSIONS

This study was unable to determine whether repeated daily injections or continuous adductor canal block provided superior analgesia in terms of the average pain score during the first 2 days after total knee arthroplasty. However, considering the high dislocation rate of nerve block catheters, reducing catheter dislodgement may improve the analgesic effectiveness of continuous adductor canal blocks.

A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty

BACKGROUND

Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA.

METHODS

This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes.

RESULTS

A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups.

CONCLUSION

The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research.

TRIAL REGISTRATION

This project was retrospectively registered with clinicaltrials.gov ( NCT05635916 ) on 2 December 2022.