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Ifarraguerri AM, Trofa DP, Piasecki DP, Fleischli JE, Saltzman BM. Perioperative non-opioid analgesia strategies after high tibial osteotomy: a systematic review of prospective studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04000-x. [PMID: 38758390 DOI: 10.1007/s00590-024-04000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Little is known about the optimal analgesia regimen after HTO. Thus, this study systematically reviewed the literature on clinical and patient-reported outcomes of pain management strategies for patients after HTO. METHODS A comprehensive search of the PubMed, Cochrane CENTRAL, and CINAHL databases was conducted from inception through September 2023. Studies were included if they evaluated pain reduction with analgesia strategies after HTO and were excluded if they did not report pain control outcomes. RESULTS Five studies with 217 patients were included. Patients with a multimodal intraoperative injection cocktail to the knee, femoral nerve block (FNB), or adductor canal block (ACB) for HTO had significant improvement in visual analog scale (VAS) and numerical rating scale (NRS) scores in the first 12 h postoperatively compared to controls. Patients on duloxetine had significantly lower NRS scores at 1, 7, and 14 days postoperatively and significantly lower nonsteroidal anti-inflammatory drug (NSAID) usage throughout the two-week postoperative period than the control group. Patients receiving an ACB had significantly lower opioid consumption than controls at 12 h postoperative. In patients with an FNB or ACB, no significant difference in quadriceps strength or time to straight leg raise postoperatively was observed compared to controls. CONCLUSION A multimodal periarticular injection cocktail, FNB, or an ACB effectively reduces pain on the first day after HTO, with an ACB able to reduce opioid consumption on the first postoperative day. Duloxetine combined with an ACB effectively decreases pain for two weeks postoperatively while reducing NSAID consumption in patients after HTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anna M Ifarraguerri
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 111-1130, New York, NY, 10032, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA.
- Atrium Health, Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC, 28207, USA.
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Yoo JD, Huh MH, Lee SH, D'Lima DD, Shin YS. A Network Meta-Analysis of Randomized Controlled Trials Assessing Intraoperative Anesthetic Therapies for Analgesic Efficacy and Morphine Consumption Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:1361-1373. [PMID: 37952743 DOI: 10.1016/j.arth.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare intraoperative anesthetic therapies for total knee arthroplasty (TKA) regarding postoperative analgesic efficacy and morphine consumption by conducting a systematic literature search. METHODS Randomized controlled trials of TKA using various anesthetic therapies were identified from various databases from conception through December 31, 2021. A network meta-analysis of relevant literature was performed to investigate which treatment showed better outcomes. In total, 40 trials were included in this study. RESULTS Surface under the cumulative ranking curve showed local infiltration anesthesia (LIA) with saphenous nerve block (SNB) to produce the best pain relief on postoperative days (PODs) 1 and 2 and the best reduction of morphine consumption on PODs 1 and 3. However, femoral nerve block showed the largest effect on pain relief on POD 3, and liposomal bupivacaine showed the largest effect on reduction of morphine consumption on POD 2. CONCLUSIONS According to this network meta-analysis, surface under the cumulative ranking curve percentage showed that LIA with SNB provided the best analgesic effect after TKA. Furthermore, patients receiving LIA with SNB had the lowest consumption of morphine. Although femoral nerve block resulted in better pain relief on POD 3, LIA with SNB could be selected first when trying to reduce morphine consumption or increase early ambulation.
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Affiliation(s)
- Jae-Doo Yoo
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Min-Hwan Huh
- Department of Medicine, The Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education, Scripps Health, La Jolla, California
| | - Young-Soo Shin
- Department of Orthopaedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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Fu T, Ren S, Nie Y. THE EFFECTS OF DRAINAGE TUBE ON PAIN AND FUNCTIONAL RECOVERY AFTER UNICOMPARTMENTAL KNEE ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e266853. [PMID: 38532868 PMCID: PMC10962064 DOI: 10.1590/1413-785220243201e266853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 07/06/2023] [Indexed: 03/28/2024]
Abstract
Objective The objective of this study was to evaluate the impact of drainage tube placement on postoperative pain, recovery, and opioid consumption within a 72-hour period following unicompartmental knee arthroplasty (UKA). Methods Patients with medial knee osteoarthritis who underwent UKA from January 2019 to August 2020 were enrolled in the study and divided into two groups based on whether they received a drain postoperatively. Results The drainage group had significantly lower VAS scores on day 1, day 2, and day 3, in addition to significantly smaller changes in the circumference of the knee joint within 3 days postoperatively (P <0.05). The ROM in the drainage group significantly increased at 3 days and 1 month post-surgery, with a statistically significant difference in morphine consumption between the two groups at 3 days (P<0.05). The incidence of postoperative nausea and vomiting (5 cases) and wound bleeding (1 case) was lower in the drainage group compared to the non-drainage group (P<0.05). Conclusions The placement of a drainage tube in UKA may reduce the swelling of knee joint and pain, which not only reduces the use of Opioid but also facilitates early functional activities of the knee joint. Level of Evidence III; Retrospective Comparative Study.
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Affiliation(s)
- Ting Fu
- Fuyang People's Hospital, Fuyang, Anhui, China
| | - Shuzhen Ren
- Fuyang Second People's Hospital, Fuyang, Anhui, China
| | - Yu Nie
- Fuyang People's Hospital, Fuyang, Anhui, China
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Maniar AR, Khokhar A, Nayak A, Kumar D, Khanna I, Maniar RN. Addition of Surgeon-Administered Adductor Canal Infiltration to the Periarticular Infiltration in Total Knee Arthroplasty: Effect on Pain and Early Outcomes. J Arthroplasty 2024:S0883-5403(24)00127-X. [PMID: 38401617 DOI: 10.1016/j.arth.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Our aim was to study the additive effect of surgeon-administered adductor canal infiltration (SACI) over routine periarticular infiltration (PAI) on pain control [morphine consumption and pain score by the visual analog scale (VAS)] and early function [flexion and Timed Up and Go (TUG) test] post-total knee arthroplasty (TKA). METHODS We prospectively randomized 60 patients into 2 groups. Group I patients received the standard PAI, whereas in Group II, the patients received a SACI in addition to the PAI. The total volume of the injected drug and the postoperative pain management protocol were the same for all. The number of doses of patient-controlled analgesia (PCA) used for breakthrough pain was recorded as PCA consumption. For early function, flexion and the TUG test were used. The VAS score and PCA consumption were compared between the 2 groups by using analyses of variance with post hoc tests as indicated. The TUG test and flexion were compared using Student t tests. The level of significance was set at 0.05. RESULTS The PCA consumption in the first 6 hours was significantly higher in Group I (P = .04). The VAS at 6 hours was significantly lower in Group II (P = .042). The TUG test was comparable between the 2 groups preoperatively (P = .72) at 24 hours (P = .60) and 48 hours (P = .60) post-TKA. The flexion was comparable between the 2 groups preoperatively (P = .85) at 24 hours (P = .48) and 48 hours (P = .79) post-TKA. CONCLUSIONS Adding a SACI to PAI provides improved pain relief and reduces opioid consumption without affecting early function post-TKA. A SACI avoids the need for an anesthesiologist or specialized equipment with no added operating time and minimal added cost. We recommend routine use of SACI for all patients undergoing TKA.
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Affiliation(s)
- Adit R Maniar
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, Schulich School of Medicine and Dentistry, London Health Sciences Center, London, Ontario, Canada
| | - Ashwini Khokhar
- Department of Orthopaedics, Pandit Madan Mohan Malviya Hospital, Mumbai, India
| | | | - Dinesh Kumar
- Fewacity Hospital Private Limited, Pokhara, Nepal
| | - Ishan Khanna
- Lilavati hospital and Research Centre, Mumbai, India; Breach Candy Hopital Trust 60 A, Bhulabhai Desai, Mumbai, India
| | - Rajesh N Maniar
- Breach Candy Hopital Trust 60 A, Bhulabhai Desai, Mumbai, India; Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India
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Quaye A, McAllister B, Garcia JR, Nohr O, Laduzenski SJ, Mack L, Kerr CR, Kerr DA, Razafindralay CN, Richard JM, Craig WY, Rodrigue S. 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. ARTHROPLASTY 2024; 6:6. [PMID: 38297390 PMCID: PMC10832097 DOI: 10.1186/s42836-023-00226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
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.
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Affiliation(s)
- Aurora Quaye
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA.
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA.
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
| | - Brian McAllister
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Joseph R Garcia
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Orion Nohr
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Sarah J Laduzenski
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Lucy Mack
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Christine R Kerr
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Danielle A Kerr
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Charonne N Razafindralay
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, 04005, USA
| | - Janelle M Richard
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Wendy Y Craig
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
- Maine Health Institute for Research, 81 Research Dr, Scarborough, ME, 04074, USA
| | - Stephen Rodrigue
- Northern Light Mercy Orthopedics, 20 Northbrook Dr, Falmouth, ME, 04105, USA
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Piyakhachornrot C, Youngcharoen P. Pain management education needs for nurses caring for older adults undergoing total knee replacement. Int J Orthop Trauma Nurs 2024; 52:101037. [PMID: 37438242 DOI: 10.1016/j.ijotn.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care. AIM The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR. METHODS A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis. RESULTS Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression. CONCLUSIONS RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.
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Affiliation(s)
- Chayada Piyakhachornrot
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phichpraorn Youngcharoen
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Aldanyowi SN. Novel Techniques for Musculoskeletal Pain Management after Orthopedic Surgical Procedures: A Systematic Review. Life (Basel) 2023; 13:2351. [PMID: 38137952 PMCID: PMC10744474 DOI: 10.3390/life13122351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Effective postoperative pain management is critical for recovery after orthopedic surgery, but often remains inadequate despite multimodal analgesia. This systematic review synthesizes evidence on innovative modalities for enhancing pain control following major orthopedic procedures. Fifteen randomized controlled trials and comparative studies evaluating peripheral nerve blocks, local anesthetic infiltration, cryotherapy, transcutaneous electrical stimulation, adjunct medications, and other techniques are included. Thematic analysis reveals that peripheral nerve blocks and local anesthetic infiltration consistently demonstrate reduced pain scores, opioid consumption, and side effects versus conventional analgesia alone. Oral multimodal medications also show promise as part of opioid-sparing regimens. Adjunctive approaches like cryotherapy, music, and dexmedetomidine require further research to optimize protocols. Despite promising innovations, critical knowledge gaps persist regarding comparative effectiveness, optimal interventions and dosing, combination strategies, cost-effectiveness, and implementation. High-quality randomized controlled trials using standardized protocols are essential to guide the translation of enhanced multimodal regimens into clinical practice. This review provides a framework for pursuing research priorities and advancing evidence-based postoperative pain management across orthopedic surgeries.
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Affiliation(s)
- Saud N Aldanyowi
- Orthopedic Surgery, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
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8
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El-Boghdadly K, Albrecht E, Wolmarans M, Mariano ER, Kopp S, Perlas A, Thottungal A, Gadsden J, Tulgar S, Adhikary S, Aguirre J, Agur AMR, Altıparmak B, Barrington MJ, Bedforth N, Blanco R, Bloc S, Boretsky K, Bowness J, Breebaart M, Burckett-St Laurent D, Carvalho B, Chelly JE, Chin KJ, Chuan A, Coppens S, Costache I, Dam M, Desmet M, Dhir S, Egeler C, Elsharkawy H, Bendtsen TF, Fox B, Franco CD, Gautier PE, Grant SA, Grape S, Guheen C, Harbell MW, Hebbard P, Hernandez N, Hogg RMG, Holtz M, Ihnatsenka B, Ilfeld BM, Ip VHY, Johnson RL, Kalagara H, Kessler P, Kwofie MK, Le-Wendling L, Lirk P, Lobo C, Ludwin D, Macfarlane AJR, Makris A, McCartney C, McDonnell J, McLeod GA, Memtsoudis SG, Merjavy P, Moran EML, Nader A, Neal JM, Niazi AU, Njathi-Ori C, O'Donnell BD, Oldman M, Orebaugh SL, Parras T, Pawa A, Peng P, Porter S, Pulos BP, Sala-Blanch X, Saporito A, Sauter AR, Schwenk ES, Sebastian MP, Sidhu N, Sinha SK, Soffin EM, Stimpson J, Tang R, Tsui BCH, Turbitt L, Uppal V, van Geffen GJ, Vermeylen K, Vlassakov K, Volk T, Xu JL, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks. Reg Anesth Pain Med 2023:rapm-2023-104884. [PMID: 38050174 DOI: 10.1136/rapm-2023-104884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. METHODS We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. CONCLUSIONS We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.
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Affiliation(s)
| | - Eric Albrecht
- Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Anahi Perlas
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | - Jose Aguirre
- Ambulatory Center Europaallee, City Hospital Zurich, Zurich, Switzerland
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nigel Bedforth
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rafael Blanco
- Anaesthesia and Intensive Care, Corniche Hospital, Abu Dhabi, UAE
| | - Sébastien Bloc
- Anesthesiology Department, Clinique Drouot Sport, Paris, France
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Boston's Children's Hospital, Boston, Massachusetts, USA
| | - James Bowness
- Department of Anesthesia, Oxford University, Oxford, UK
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Margaretha Breebaart
- Department of Health Sciences, University of Antwerp, Antwerpen, Belgium
- Anesthesia, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Jacques E Chelly
- Anesthesiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Ki Jinn Chin
- Duke University Medical Center, Durham, North Carolina, USA
| | - Alwin Chuan
- Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, South West Sydney, New South Wales, Australia
| | - Steve Coppens
- Anesthesiology, KU Leuven University Hospitals, Leuven, Belgium
| | - Ioana Costache
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mette Dam
- Department of Anesthesia and Intensive Care, University Hospital Hvidore, Copenhagen, Denmark
| | | | - Shalini Dhir
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | | | | | | - Ben Fox
- Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Carlo D Franco
- Anesthesiology, John H. Stroger Jr. Hospital of Cook Country, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Stuart Alan Grant
- Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sina Grape
- Anesthesia, Hôpital du Valais, Sion, Switzerland
| | - Carrie Guheen
- Anesthesia, Hospital for Special Surgery, New York, New York, USA
| | | | - Peter Hebbard
- Department of Anesthesia Northeast Health, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary M G Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Margaret Holtz
- Anesthesia, WellStar Health System, Marietta, Georgia, USA
| | - Barys Ihnatsenka
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Brian M Ilfeld
- Anesthesia, University of California, La Jolla, California, USA
- Anesthesia, University of California San Diego, La Jolla, California, USA
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - M Kwesi Kwofie
- Department of Anesthesia, Perioperative Medicine and Pain Managaement, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Le-Wendling
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Philipp Lirk
- Dept. of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Lobo
- Cleveland Clinic, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | | | | | - Colin McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Graeme A McLeod
- Department of Anaesthesia, NHS Tayside, Dundee, UK
- Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - E M Louise Moran
- Anaesthesia and Critical Care, Letterkenny University Hospital, Letterkenny, Ireland
| | - Antoun Nader
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Anesthesiology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Ahtsham U Niazi
- Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Catherine Njathi-Ori
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Matt Oldman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Steven L Orebaugh
- Anesthesiology, University of Pittsburgh Medical Center-Southside, Pittsburgh, Pennsylvania, USA
| | - Teresa Parras
- Anesthesiology, Critical Care, and Pain Medicine, Hospital Quironsalud, Malaga, Spain
| | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's college London, London, UK
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Bridget P Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
- Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Axel R Sauter
- Department of Anaesthesiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Navdeep Sidhu
- Anesthesia and Perioperative Medicine, North shore Hospital, Auckland, New Zealand
| | - Sanjay Kumar Sinha
- Anesthesiology, Woodland Anesthesiology Associates, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - James Stimpson
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Raymond Tang
- Anesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Lloyd Turbitt
- Department of Anesthesia, Belfast Health and Social Care trust, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | | | - Kris Vermeylen
- Anesthesia and Intensive Care, Algemeen Ziekenhuis Turnhout Campus Sint Elisabeth, Turnhout, Belgium
| | - Kamen Vlassakov
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Jeff L Xu
- Anesthesiology, New York Medical College, Valhalla, New York, USA
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nabil M Elkassabany
- Anesthesiology & Critical Care, University of Virginia, Charlottesville, Virginia, USA
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9
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Yuenyongviwat V, Wuttiworawanit B, Panichnantho N, Hongnaparak T, Iamthanaporn K. Efficacy of Periarticular Infiltration with Dexamethasone and Bupivacaine plus Adductor Canal Block Relative to That of Adductor Canal Block Alone for Patients Undergoing Total Knee Arthroplasty: A Retrospective Case-Matched Study. Adv Orthop 2023; 2023:7356192. [PMID: 37868629 PMCID: PMC10586906 DOI: 10.1155/2023/7356192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Periarticular infiltration (PI) is a common procedure during total knee arthroplasty (TKA) for postoperative pain management. This retrospective, case-matched study aimed to evaluate the effectiveness of PI with dexamethasone and bupivacaine in combination with an adductor canal block (ACB) and compare it with that of ACB alone in reducing postoperative pain in patients with TKA. Methods Data were collected from 66 patients who underwent TKA performed by a single surgeon. Thirty-three of them received ACB + PI, and 33 received ACB alone. However, both groups underwent identical surgical techniques and postoperative care protocols. The pain scores and fentanyl consumption of the two groups were compared. Results The ACB + PI group had significantly lower pain scores than the ACB alone group at 8, 16, 24, and 48 hours postoperatively (p=0.033, 0.004, 0.038, and 0.049, respectively). The percentage of patients requiring fentanyl as a rescue medication was significantly higher for the ACB alone group (90.9%) than for the ACB + PI group (69.7%, p=0.03). The total fentanyl consumption was also lower for the ACB + PI group (p < 0.001). Conclusion The periarticular injection of the combination of dexamethasone and bupivacaine plus ACB was more effective than ACB alone in reducing postoperative pain and fentanyl consumption in patients undergoing TKA. Further studies comparing different doses of dexamethasone or other cocktail regimens may provide additional insights into this approach.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Bunyaporn Wuttiworawanit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Nipat Panichnantho
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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10
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Coviello A, Bernasconi A, Balato G, Spasari E, Ianniello M, Mariconda M, Vargas M, Iacovazzo C, Smeraglia F, Tognù A, Servillo G. Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study. Local Reg Anesth 2022; 15:97-105. [PMID: 36601486 PMCID: PMC9807124 DOI: 10.2147/lra.s383601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
Background and Aim Ultrasound-guided continuous adductor canal block (cACB) is a conventional choice in patients undergoing total knee arthroplasty (TKA) for the management of the postoperative pain. This study aims to compare different catheter tip locations for cACB relative to the saphenous nerve (anteriorly vs posteriorly) in terms of efficacy and complications. Methods At the department of Surgical Sciences, Orthopedic Trauma and Emergencies of the University of Naples Federico II (Naples, Italy), between January 2020 and November 2021, retrospective comparative study was executed. Patients planned for TKA were included in the study if they met the follow inclusion criteria: patients undergone TKA; aged 50-85 years; body mass index (BMI) of 18-35 kg/m2; American Society of Anesthesiologists (ASA) physical status classification from I to III; subarachnoid technique for anesthesiology plane; continuous adductor canal block performed by an anesthetist with considerable experience. Patients were assigned to receive cACB with the catheter tip located anteriorly (Group 1, G1) or posteriorly to the saphenous nerve (Group 2, G2). Postoperative pain, ambulation ability, episodes of pump block and rate of catheter dislodgement and leakage were evaluated and analyzed. Results Altogether, 102 patients were admitted to the study (48 in G1 and 54 in G2). After the first 8 postoperative hours, in G1 17 patients (35.4%) had a VAS greater than 4, while in group 2 only 3 patients (5.6%) had a VAS greater than 4 (p-value <0.01). All patients of both groups showed ambulation ability in the postoperative period. No episode of leakage was recorded. While the catheter displacement rate was similar in the two groups (2.1% for G1 vs 3.7% for G2; p-value >0.05), the episodes of pump block were significantly less in G2 than in G1 (3.7% vs 20.8%; p-value <0.01). Conclusion In cACB for TKA, we found that positioning the catheter tip posteriorly to the saphenous nerve may lead to a greater postoperative analgesia and reduce the risk of pump block compared to placing the catheter tip anteriorly to the nerve.
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Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy,Correspondence: Antonio Coviello, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Vitruvio, 3, Naples, 80100, Italy, Email
| | - Alessio Bernasconi
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Giovanni Balato
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Ezio Spasari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy
| | - Marilena Ianniello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy
| | - Massimo Mariconda
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy
| | - Francesco Smeraglia
- Department of Public Health, School of Medicine, University of Naples “Federico II”, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Andrea Tognù
- Department of Anesthesiology and Intensive Care Medicine, Istituto Ortopedico Rizzoli IRCCS, Bologna, 40136, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, 80100, Italy
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11
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Schindler M, Schmitz S, Reinhard J, Jansen P, Grifka J, Benditz A. Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study. J Clin Med 2022; 11:jcm11237204. [PMID: 36498779 PMCID: PMC9741301 DOI: 10.3390/jcm11237204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. METHODS A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. RESULTS The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. CONCLUSIONS The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.
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Affiliation(s)
- Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
- Correspondence:
| | - Stephanie Schmitz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Petra Jansen
- Department of Sport Science, University of Regensburg, 93053 Regensburg, Bavaria, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, 93077 Bad Abbach, Bavaria, Germany
- Department of Orthopedics, Klinikum Fichtelgebirge, 95615 Marktredwitz, Bavaria, Germany
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12
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Johns N, Noye N, Wall C, Martin G, Loch A. Efficacy of Adductor Canal Blocks in Total Knee Arthroplasty. J Knee Surg 2022; 35:1491-1494. [PMID: 33853151 DOI: 10.1055/s-0041-1726417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m2 and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS (p < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; p < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.
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Affiliation(s)
- Nicholas Johns
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Nicholas Noye
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Chris Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Glen Martin
- Department of Anaesthesia, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Department of Orthopaedics, St. Vincent's Private Hospital Toowoomba, Toowoomba, Queensland, Australia
| | - Alan Loch
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Department of Orthopaedics, St. Vincent's Private Hospital Toowoomba, Toowoomba, Queensland, Australia
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13
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Butorphanol as an Adjuvant to Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty Patients: A Randomized, Double, Blind Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7718108. [PMID: 36275396 PMCID: PMC9586814 DOI: 10.1155/2022/7718108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
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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14
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Fujita Y, Mera H, Watanabe T, Furutani K, Kondo HO, Wakai T, Kawashima H, Ogose A. Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty. BMC Musculoskelet Disord 2022; 23:768. [PMID: 35953812 PMCID: PMC9373377 DOI: 10.1186/s12891-022-05735-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background Near-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block. Methods Continuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated. Results A total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3. Conclusion ACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05735-6.
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Affiliation(s)
- Yutaka Fujita
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.,Present Address: Department of Orthopedic Surgery, Nagaoka Chuo General Hospital, 2041, Kawasaki-machi, Nagaoka City, Niigata, 940-8653, Japan
| | - Hisashi Mera
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.
| | - Tatsunori Watanabe
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Kenta Furutani
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.,Present Address: Department of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8211, Japan
| | - Haruna O Kondo
- Division of Rehabilitation, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Takao Wakai
- Division of Rehabilitation, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8211, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
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15
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Comparison of continuous with single-injection regional analgesia on patient experience after ambulatory orthopaedic surgery: A randomised multicentre trial. Br J Anaesth 2022; 129:435-444. [PMID: 35811140 DOI: 10.1016/j.bja.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The optimal approach to improving patient experience and analgesia after ambulatory orthopaedic surgery remains unclear. METHODS This multicentre, randomised clinical trial compared single-injection nerve block analgesia with home delivery of continuous nerve block analgesia by remote-controlled electronic pump. The primary outcome was patient-reported satisfaction (Evaluation du Vecu de l'Anesthesie Generale [EVAN-G]; 0-100) assessed on postoperative Day 2. Secondary outcomes focused on pain, opioid consumption, quality of rehabilitation, activity tracking using a wearable electronic device, and 90-day quality of life. RESULTS We randomly assigned 294 patients to continuous pump delivery or single injection. For subjects with normal level of pain catastrophising (Pain Catastrophizing Scale <30; n=211), median global EVAN-G was higher with the electronic pump compared with the single injection (78 [69-86] vs 72 [63-84]; P=0.03), as were pain satisfaction scores (P=0.01). For the maximum pain levels, the numerical rating scale score was 2.0 (1.0-5.0) in the electronic-pump group vs 5.0 (3.0-7.0) in the single-injection group on the first 2 days after surgery (P<0.0001). Total opioid consumption in morphine equivalent was higher with single injection (mean [standard deviation]): 70.5 [73.8] vs 31.9 [54.2] mg; P<0.01). The groups did not differ in early rehabilitation on Day 1 or quality of life on Day 45. Electronic activity tracking indicated higher activity in the electronic-pump group (P<0.01). CONCLUSIONS Self-reported patient satisfaction at home was better with continuous nerve block analgesia via electronic pump vs single injection, without impairing early rehabilitation. Single-injection analgesia was associated with higher pain levels and opioid consumption and lower satisfaction. Patient catastrophising negatively affected the experience of pain. CLINICAL TRIAL REGISTRATION NCT02720965.
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16
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Sveom DS, Horberg JV, Allen DA, Mann JW, Moskal JT. Ultrasound-Guided Adductor Canal Block Versus Intraoperative Transarticular Saphenous Nerve Block: A Retrospective Analysis. J Arthroplasty 2022; 37:S134-S138. [PMID: 35190244 DOI: 10.1016/j.arth.2021.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The ultrasound-guided adductor canal block (High-ACB) is an effective option for pain control in total knee arthroplasty (TKA), but its use can add substantial cost and preparatory time to a TKA procedure. An intraoperative adductor canal block (Low-ACB) performed by the operative surgeon has been described as an alternative. The hypothesis of this study is that the Low-ACB would achieve noninferior pain control and opioid utilization postoperatively when compared to the High-ACB. METHODS This is a retrospective study of a prospectively maintained database comparing the High-ACB vs the Low-ACB. The primary outcome measure was morphine milligram equivalents consumed. Secondary outcome measures included Visual Analog Scale pain scores, postoperative outcomes (Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, knee range of motion), length of stay, postoperative speed of mobilization, and complications related to the type of block. RESULTS There were 139 patients in the study. There was lower opioid use in the first 24 hours in the Low-ACB compared to the High-ACB group respectively (26.3 vs 30, P = .29) but this did not reach statistical significance. There was a statistically significant difference in Visual Analog Scale score on postoperative day 1 in the Low-ACB vs High-ACB groups respectively (4.6 vs 3.7, P = .02) but this did not reach the level of clinical significance. There was no statistical difference in the Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, or postoperative range of motion. There were no block-related complications in either group. CONCLUSION The Low-ACB is a safe, effective, and cost-saving alternative to the traditional High-ACB for pain control in TKA.
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Affiliation(s)
- Daniel S Sveom
- Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA
| | - John V Horberg
- Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA
| | - Donald A Allen
- Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA
| | - John W Mann
- Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA
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Marty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, Marquis C, De Lussy A, Ferré F, Naudin C, Joshi GP, Delbos A. Combined proximal or distal nerve blocks for postoperative analgesia after total knee arthroplasty: a randomised controlled trial. Br J Anaesth 2022; 129:427-434. [DOI: 10.1016/j.bja.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 11/02/2022] Open
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Yang X, Dong J, Xiong W, Huang F. Early Postoperative Pain Control and Inflammation for Total Knee Arthroplasty: A Retrospective Comparison of Continuous Adductor Canal Block versus Single-Shot Adductor Canal Block Combined with Patient-Controlled Intravenous Analgesia. Emerg Med Int 2022; 2022:1351480. [PMID: 35600565 PMCID: PMC9117079 DOI: 10.1155/2022/1351480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to compare pain control and inflammation among patients who received a continuous adductor canal block (CACB) versus single-shot adductor canal block (SACB) combined with patient-controlled intravenous analgesia (PCIA) for total knee arthroplasty (TKA) analgesia in the first two days after surgery. Design Matched cohort retrospective study. Setting. University hospital. Patients. One hundred fifty-six patient charts were included in this study: 78 patients with CACB in Group A and 78 patients with SACB combined with PCIA in Group B. Patients were matched according to age, body mass index, and American Society of Anesthesiologists class. Measurements. The primary outcome of the study was Visual Analogue Scale (VAS) pain scores before operation (Pre) and at postoperative 6 (POH6), 12 (POH12), 24 (POH24), 30 (POH30), 36 (POH36), and 48 hours (POH48). Secondary outcomes included patient-controlled bolus, time of first postoperative ambulation, range of knee flexion and extension, inflammation cytokines on Pre and POH48, percentage of remedial analgesics treatment, incidence of adverse events and complications, hospital stay and cost, and Numerical Rating Scale (NRS) satisfaction scores at discharge. Main Results. Mean VAS scores at rest and with motion were lower in Group B than in Group A on all postoperative hours. At POH30, compared with Group A (1.1 ± 0.6), mean VAS scores at rest in Group B (0.9 ± 0.4) were lower (P=0.048), and compared with Group A (2.6 ± 0.7), mean VAS scores with motion in Group B (2.2 ± 0.8) were lower (P=0.001). The number of patient-controlled bolus was 4.3 ± 1.6 (95% CI 3.9-4.6) in Group A and 3.1 ± 1.3 (95% CI 2.8-3.4) in Group B, respectively (P < 0.001). Patients in Group B displayed better functional recovery and inflammation results at POH48 than Group A with respect to range of knee flexion and extension (117.8 ± 10.9° vs. 125.2 ± 9.4°, P < 0.001) and inflammation cytokines, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) ((43.8 ± 16.1) vs. (36.8 ± 13.2), P=0.003; (34.9 ± 9.4 mg/L) vs. (29.6 ± 10.6 mg/L), P=0.001; (21.3 ± 8.7 pg/ml) vs. (14.0 ± 7.0 pg/ml), P < 0.001)). Conclusion SACB combined with PCIA in the first two days of patients undergoing TKA has better analgesic and beneficial effects on functional recovery and inflammation.
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Affiliation(s)
- Xiaojuan Yang
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Dong
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Xiong
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fusen Huang
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ming LH, Chin CS, Yang CT, Suhaimi A. Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study. Korean J Pain 2022; 35:191-201. [PMID: 35354682 PMCID: PMC8977207 DOI: 10.3344/kjp.2022.35.2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Abstract
Background This study aimed to assess the efficacy of the adductor canal block (ACB) in comparison to intra-articular steroid-lidocaine injection (IASLI) to control chronic knee osteoarthritis (KOA) pain. Methods A randomized, single-blinded trial in an outpatient rehabilitation clinic recruiting chronic KOA with pain ≥ 6 months over one year. Following randomization, subjects received either a single ACB or IASLI under ultrasound guidance. Numerical rating scale (NRS) scores for pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were recorded at baseline, 1 hour, 1 month, and 3 months post-injection. Results Sixty-six knees were recruited; 2 were lost to follow-up. Age was normally distributed (P = 0.463), with more female subjects in both arms (P = 0.564). NRS scores improved significantly for both arms at 1 hour, with better pain scores for the IASLI arm (P = 0.416) at 1st month and ACB arm at 3rd month (P = 0.077) with larger effect size (Cohen’s d = 1.085). Lower limb function improved significantly in the IASLI arm at 1 month; the ACB subjects showed greater functional improvement at 3 months (Cohen’s d = 0.3, P = 0.346). Quality of life (QoL) improvement mirrored the functional scores whereby the IASLI group fared better at the 1st month (P = 0.071) but at the 3rd month the ACB group scored better (Cohen’s d = 0.08, P = 0.710). Conclusions ACB provides longer lasting analgesia which improves function and QoL in chronic KOA patients up to 3 months without any significant side effects.
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Affiliation(s)
- Lee Hwee Ming
- Department of Rehabilitation Medicine, Taiping Hospital, Perak, Malaysia
| | - Chan Soo Chin
- Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chung Tze Yang
- Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Anwar Suhaimi
- Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Siddiqui R, Bansal S, Puri A, Sinha M. A Comparative Study of Ultrasound-Guided Continuous Adductor Canal Block With Ultrasound-Guided Continuous Femoral Nerve Block in Unilateral Total Knee Arthroplasty for Limb Mobilization and Analgesic Efficacy. Cureus 2022; 14:e22904. [PMID: 35265438 PMCID: PMC8899607 DOI: 10.7759/cureus.22904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background Total knee joint replacement surgery is associated with severe postoperative pain and is amenable to regional anesthesia techniques for pain control. Femoral nerve block (FNB) provides effective analgesia after total knee arthroplasty (TKA) but has been associated with delayed ambulation due to quadriceps muscle weakness. Adductor canal block (ACB) may be a promising alternative, with less effect on the quadriceps muscle and comparable analgesic efficacy. We evaluated the effectiveness, safety, and patient satisfaction of continuous ACB augmented with infiltration between the popliteal artery and capsule of the knee (iPACK) block and compared them with those of continuous FNB amplified with iPACK block in preventing postoperative pain among patients undergoing unilateral total knee replacement (TKR) surgeries. Methodology According to a computer-generated sequence from September 2019 to June 2020, 50 American Society of Anesthesiologists grades I-III patients aged between 35 and 75 years who underwent unilateral TKR surgery were randomized into two equal groups, namely, ACB and FNB. The Timed Up and Go (TUG) and 10-minute walk tests were used to detect early ambulation (impact on quadriceps muscle). The secondary goal was to evaluate and compare opioid consumption and analgesic efficacy between the groups measured using a numeric rating scale (NRS). The demographic characteristics, technical difficulty, efficiency, safety, and comfort were compared between the two groups. Results During the postoperative period, patients in the ACB group could perform all TUG tests significantly faster than those in the FNB group. The mean get-up time in the ACB group was 39.08 ± 5.53 seconds, whereas that in the FNB group was 44.92 ± 7.10 seconds (p < 0.01). The 3-m walk time was 123.16 ± 15.90 seconds in the ACB group and 134.68 ± 13.13 seconds in the FNB group (p < 0.01). The 10-m walk time was 221.24 ± 18.82 seconds in the ACB group and 245.24 ± 21.68 seconds in the FNB group (p < 0.001). No significant difference was observed in NRS scores between the groups after the first 24 hours. The number of opioids available for consumption in both groups was equivalent. Conclusions ACB when augmented with an iPACK block is a good alternative to FNB for unilateral TKR surgeries. ACB may promote early ambulation without a reduction in analgesia when compared with FNB.
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21
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Alsebayel F, Alturki A, Alsheikh K, Aldeghaither S, Alazzam S, Alhandi A. Adductor canal catheter block after total knee arthroplasty in patients with severe osteoarthritis and limited mobility. A single center study in Riyadh, Saudi Arabia. Saudi J Anaesth 2022; 16:29-33. [PMID: 35261585 PMCID: PMC8846258 DOI: 10.4103/sja.sja_501_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/16/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Total knee arthroplasty (TKA) is one of the most performed procedures. Postoperative pain control is an important factor for the improvement of patient's quality of life. The aim of this study is to report pain control results and functional outcome scores associated with adductor canal blockade (ACB) usage post-TKA. Methods: A prospective case series study of patients who underwent TKA for degenerative osteoarthritis with ACB postoperatively from 2018 to 2019 in a single center in Saudi Arabia, Riyadh. Assessment of functional outcome scores and pain level were measured preoperatively and postoperatively respectively using Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analog Scale (VAS). Results: Average KOOS score preoperatively for all 5 domains showed a marked improvement at 3 months compared to preoperative values. Pain score postoperatively was measured at 12, 24, and 48 h with an average of 0.7, 1.2, and 0.6 out of 10 on the VAS scale, respectively. The incidence of associated common side effects with the use of analgesic use was included as an add-on in the postoperative questionnaire. Conclusion: In conclusion, by comparing preoperative and postoperative pain levels and functional outcome scores, our study showed a significant pain control and improved functional outcome scores following TKA using ACB.
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22
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Chaturvedi R, Tram J, Chakravarthy K. Reducing opioid usage in total knee arthroplasty postoperative pain management: a literature review and future directions. Pain Manag 2021; 12:105-116. [PMID: 34551582 DOI: 10.2217/pmt-2020-0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.
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Affiliation(s)
- Rahul Chaturvedi
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Jennifer Tram
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
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Patil SS, Kane D, Dhamangaonkar A, Avhad V. Retrospective Analysis of Pain Relief in Total Knee Replacement Surgeries. Anesth Essays Res 2021; 14:555-560. [PMID: 34349319 PMCID: PMC8294426 DOI: 10.4103/aer.aer_117_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/17/2021] [Accepted: 02/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims The aim of the study is to measure the postoperative adequacy of pain relief and functional recovery after unilateral primary total knee arthroplasty or total knee replacement (TKR) with a multimodal approach. Settings and Design This was a retrospective observational study done in a tertiary care center. Materials and Methods Eighty patients aged 18-65 years (yrs) with ASA Physical Status Classes I, II, and III operated for unilateral primary TKR surgery under suitable Anaesthesia and was administered ultrasound-guided adductor canal block + periarticular infiltration (PI) from January 2018 to January 2019 were included. Thereafter, the patients visual analog scale (VAS) scores at rest, 45° knee flexion, and mobilization as well as additional analgesia given were noted after going through the records at following time points: 12 hourly for 24 h and thereafter on postoperative day 1 (POD1) and POD2. Level of block, adverse events, and functional recovery (time up and go [TUG] test, 10 s walk test) on POD1 and POD2 were also noted. Statistical Analysis and Results The statistical software namely SPSS 18.0 were used for the analysis of the data. The mean VAS score at 12 h was 4.33 ± 1.3 which worsened at 24 h with steady improvement over the next 2 days. Similarly, the case with a mean VAS score at 45° flexion and on mobilization showed a similar trend. At 12 h postadductor block, besides intravenous (i.v.) paracetamol, 32.6% of patients were given tramadol 50 mg i.v. whereas one patient was given a buprenorphine patch in addition to tramadol. The number of patients requiring additional tramadol and buprenorphine patch steadily increased over the next 2 days. The average time taken for the TUG test at 24 h was 30.98 ± 4.77 s, and the average time taken for the 10 s walk test at 24 h was 6.16 ± 1.10 steps with improvement in performance over the next 2 days. Conclusion In our study, our multimodal analgesia model did not provide satisfactory analgesia though mobilization was not hampered.
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Affiliation(s)
| | - Deepa Kane
- Department of Anaesthesiology, GSMC and KEMH, Mumbai, Maharashtra, India
| | - Anoop Dhamangaonkar
- Department of Orthopaedics, LTMMC and LTMG Hospital, Mumbai, Maharashtra, India
| | - Valmik Avhad
- Department of Anaesthesiology, GSMC and KEMH, Mumbai, Maharashtra, India
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Sim JA, Lee MG, Jung WS, Lee BK, Lee BH. Clinical efficacy of adductor canal block in medial open wedge high tibial osteotomy. Knee 2021; 29:9-14. [PMID: 33524659 DOI: 10.1016/j.knee.2020.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/11/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To evaluate the effect of adductor canal block (ACB) on short-term postoperative outcomes in patients who underwent medial open-wedge high tibial osteotomy (MOWHTO) compared to that of a placebo. METHODS 35 patients who underwent unilateral MOWHTO between 2017 and 2019 were prospectively reviewed and randomly divided into two groups: 19 patients who received a single-shot ACB and 16 patients who received a saline injection (a placebo group). Primary outcomes were (1) pain measured using the visual analog scale and range of motion, (2) patient satisfaction, (3) postoperative need for additional opioids, (3) quadriceps strength (the time to straight leg raising [SLR]), (4) clinical outcomes, and (5) complications. RESULTS The pain score was lower in the ACB group than in the placebo group in the first 12 h (p = 0.04). ACB did not exhibit significantly less quadriceps strength weakness postoperatively. There was no statistical difference in the time to SLR (23.5 ± 17.7 h in ACB vs. 27.6 ± 11.4 in placebo, p = 0.520). The opioid consumption rate within postoperative 12 h was significantly decreased after ACB (16.7% in ACB, 70% in placebo, p = 0.017). The proportion of patients with more than 5 opioid injections within 72 h postoperatively was lower in the ACB group (8.3% in ACB, 50% in placebo, p = 0.043). Both groups did not show any localized and systemic complications. CONCLUSION ACB following MOWHTO exhibited better outcomes than a placebo with respect to opioid consumption with no changes in the quadriceps strength and complications. LEVEL OF EVIDENCE II, Prospectively comparative study.
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Affiliation(s)
- Jae Ang Sim
- Department of Orthopaedics Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Mi Geum Lee
- Department of Anesthesiology, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Wol Seon Jung
- Department of Anesthesiology, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Beom Koo Lee
- Department of Orthopaedics Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Byung Hoon Lee
- Department of Orthopaedics Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
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Kaçmaz M, Turhan ZY. The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial. Geriatr Orthop Surg Rehabil 2021; 12:2151459321996632. [PMID: 33708456 PMCID: PMC7907943 DOI: 10.1177/2151459321996632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are
regional analgesic techniques, are successfully used in postoperative pain
control after total knee arthroplasty. This study aimed to compare adductor
canal block method that was preoperatively used and femoral nerve block
method in total knee arthroplasty (TKA) patients who underwent spinal
anesthesia in terms of factors effecting patient satisfaction and determine
whether these methods were equally effective or not. Methods: A total of 80 patients between the ages of 60 and 75 who were in the American
Society of Anesthesia (ASA) physical status of I-III were prospectively
included in this randomized study. Patients (n = 40) who received FNB were
called Group FNB and patients (n = 40) who received Adductor Canal Block
were called Group ACB. Results: Although mean postoperative VAS values were lower in FNB group only in the
first hour (p = 0.02) there was no significant difference between the groups
in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although
Bromage scores were lower in FNB group in the first, second, third, fourth
and fifth hours there was no statistically significant difference between
the groups (p≥0.05). When mobilization time, patient satisfaction level,
time of first analgesia, intraoperative sedation need, and recovery time of
sensorial block were compared no statistically significant difference was
found (p≥0.05). Discussion: When ACB and FNB that are used for postoperative analgesia in patients who
undergo total knee arthroplasty are compared in terms of factors affecting
patient satisfaction it is observed that they result in the same level
(non-inferiority) of patient satisfaction. Conclusion: We recommend the routine use of ACB method with FNB in total knee
arthroplasty. More studies focusing especially on measuring patient
satisfaction are needed.
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Affiliation(s)
- Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey
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Krishnamurthy BK, Aparna B, Chikkegowda S, Kumar KSL. Comparison between Dexmedetomidine and Clonidine as an Adjuvant to Ropivacaine in Ultrasound-Guided Adductor Canal Block for Postoperative Analgesia in Total Knee Replacement: A Randomized Controlled Trial. Anesth Essays Res 2021; 15:245-249. [PMID: 35281352 PMCID: PMC8916127 DOI: 10.4103/aer.aer_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background Total knee replacement (TKR) surgeries are associated with significant postoperative pain. Ultrasound-guided adductor canal block is associated with better pain scores. The addition of Clonidine and Dexmedetomidine as additives to local anesthetics was the recent focus of interest. However, there are minimal studies comparing the duration of analgesia as additives to Ropivacaine in ultrasound-guided adductor canal block for TKRs. Materials and Methods Prospective, randomized, double-blind design was followed. One hundred and two American Society of Anesthesiologists I to III patients undergoing unilateral TKR surgeries were included in the study and randomized into two groups. Group C received Clonidine 150 mcg and Group D received Dexmedetomidine 100 mcg as an add on to 30 mL of 0.2% ropivacaine for adductor canal block. Postoperatively, duration of analgesia, sedation score, rescue analgesic requirement, hemodynamics, and any other adverse effects were monitored. Results The total duration of analgesia in Group D (16.01 h [standard deviation [S. D]-0.5]) was significantly higher as compared to Group C (13.02 h [S. D-0.5]) (P < 0.0001). The numerical rating score (NRS) was significantly lower in Group D compared to Group C (P < 0.05) at multiple postoperative timelines. Group D (2.25(S. D-0.44)) had better sedation scores as compared to Group C (2 [S. D-0]) (P = 0.001). Conclusion Dexmedetomidine has longer duration, lower pain, and better sedation scores as compared to clonidine in adductor canal blocks for postoperative pain relief in TKR surgeries.
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Affiliation(s)
- Bharath Kumar Krishnamurthy
- Department of Anesthesiology, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India
| | - Bathalapalli Aparna
- Department of Anesthesiology, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India
| | - Sangeetha Chikkegowda
- Department of Anesthesiology, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India
| | - K. S. Lokesh Kumar
- Department of Anesthesiology, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India,Address for correspondence: Dr. K. S. Lokesh Kumar, 1025/2, 3rd Cross, Sri Kondandarama Temple Street, M S Nagar, R S Palya, Bengaluru - 560 033, Karnataka, India. E-mail:
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27
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Gurava Reddy AV, Manohar M, Shetty A, Sankineani SR, Ashok Kumar PS, Bose VC, Pichai S, Patil S, Mukartihal R, Dhanasekhara Raja P, Rajkumar N, Rajasekharan S. A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial. Musculoskelet Surg 2020; 104:267-271. [PMID: 31236778 DOI: 10.1007/s12306-019-00616-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.
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Affiliation(s)
- A V Gurava Reddy
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - M Manohar
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - A Shetty
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S R Sankineani
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India.
- South India Arthroplasty Academy (SIAA), Secunderabad, India.
| | - P S Ashok Kumar
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - V C Bose
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Pichai
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Patil
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - R Mukartihal
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - P Dhanasekhara Raja
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - N Rajkumar
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Rajasekharan
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
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Yu R, Wang H, Zhuo Y, Liu D, Wu C, Zhang Y. Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?: An updated meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e22762. [PMID: 33120783 PMCID: PMC7581050 DOI: 10.1097/md.0000000000022762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adductor canal block (ACB) has emerged as an attractive alternative for femoral nerve blocks (FNB) as the peripheral nerve block of choice for total knee arthroplasty (TKA), preserving quadriceps motor function while providing analgesia comparable to FNB. However, its optimal application for TKA remains controversial. The objective of this meta-analysis was to compare continuous-injection ACB (CACB) vs single-injection ACB (SACB) for postoperative pain control in patients undergoing TKA. METHODS This study attempts to identify the available and relevant randomized controlled trials (RCTs) regarding the analgesic effects of CACB compared to SACB in patients undergoing TKA according to electronic databases, including PubMed, Medline, Web of Science, EMbase, and the Cochrane Library, up to September 2019. Primary outcomes in this regard included the use of a visual analogue scale (VAS) pain score with rest or activity, while secondary outcomes were cumulative opioid consumption, length of hospital stay (LOS), complications of vomiting and nausea, and rescue analgesia. The corresponding data were analyzed using RevMan v5.3. ETHICAL REVIEW Because all of the data used in this systematic review and meta-analysis has been published, the ethical approval was not necessary RESULTS:: This research included 9 studies comprised of 739 patients. The analyzed outcomes demonstrated that patients who received CACB had a better at rest-VAS scores at 4 hours (P = .007), 8 hors (P < .0001), 12 hours (P < .0001), 24 hours (P = .02), mobilization-VAS score at 48 hours (P < .0001), and rescue analgesia (P = .03) than those who underwent SACB. Nevertheless, no significant differences were present between the 2 strategies in terms of pain VAS scores 48 hours at rest (P = .23) and 24 hours at mobilization (P = .10), complications of vomiting and nausea (P = .42), and length of hospital stay (P = .09). CONCLUSION This meta-analysis indicated that CACB is superior to SACB in regard to analgesic effect following TKA. However, due to the variation of the included studies, no firm conclusions can be drawn. Further investigations into RCT are required for verification.
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Affiliation(s)
- Rongguo Yu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fujian
| | - Haiyang Wang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fujian
| | - Youguang Zhuo
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fujian
| | - Dongxin Liu
- Hebei North University, Handan Central Hospital Affiliated to Hebei North University, China
| | - Chunling Wu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fujian
| | - Yiyuan Zhang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fujian
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Deiter J, Ponzio D, Grau L, Griffiths S, Ong A, Post Z, Doucette D, Orozco F. Efficacy of adductor canal block protocol implementation in a multimodal pain management protocol for total knee arthroplasty. J Clin Orthop Trauma 2020; 11:118-121. [PMID: 32001998 PMCID: PMC6985008 DOI: 10.1016/j.jcot.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Postoperative pain relief for total knee arthroplasty is an important concern for clinicians who seek to decrease pain, side effects associated with narcotics, increase mobility, and decrease hospital length of stay for total knee arthroplasty (TKA) patients. In today's day in age where patients and clinicians are looking to decrease length of stay and desire to take total knee replacement to the ambulatory surgery setting, appropriate and safe analgesia is paramount. The purpose of this study was to evaluate the analgesic efficacy of implementing a single shot adductor canal block (ACB) protocol in patients undergoing primary TKA by a single surgeon already using a multimodal analgesia protocol at a high volume community hospital. METHODS 75 patients who received a single shot ACB were compared to 75 patients that did not receive an ACB with respect to post-operative NRS pain scores and narcotic consumption. RESULTS After addition of an ACB there was a 90% reduction in NRS pain scores in the PACU and a 38% reduction at 12 and 24-h post-operatively which were all statistically significant. Total post-operative morphine milligram equivalent (MME) decreased by 51%, after addition of an ACB, which was also statistically significant. CONCLUSION The administration of an ACB as an adjunct to a multimodal pain protocol for primary TKA patients is effective at minimizing post-operative pain and narcotic consumption, and plays a critical role in facilitating fast track and same day discharge in our practice.
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Affiliation(s)
- Jessica Deiter
- Wilmington University, 320 N Dupont Hwy, New Castle, DE, 19720, USA
| | - Danielle Ponzio
- The Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ, 08234, USA
| | - Luis Grau
- The Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ, 08234, USA
| | - Sean Griffiths
- Department of Orthopaedic Surgery, Inspira Health, 1505 West Sherman Ave, Vineland, NJ, 08360, USA,Corresponding author.
| | - Alvin Ong
- The Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ, 08234, USA
| | - Zachary Post
- The Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ, 08234, USA
| | - David Doucette
- Wilmington University, 320 N Dupont Hwy, New Castle, DE, 19720, USA
| | - Fabio Orozco
- The Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ, 08234, USA
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Jiang H, Sun Y, Dou F. Reply to a commentary on "Continuous adductor canal block is a better choice compared to single shot after primary total knee arthroplasty: A meta-analysis of randomized controlled trials" [Int J Surg. 2019 Nov 18; 72:192-193]. Int J Surg 2019; 74:65-67. [PMID: 31887418 DOI: 10.1016/j.ijsu.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Housen Jiang
- Department of Orthopedic Surgery, Weifang People's Hospital, Weifang, Shandong, 261000, China
| | - Yanmei Sun
- Department of Pharmacy Intravenous Admixture Service, Weifang People's Hospital, Weifang, Shandong, 261000, China
| | - Fengling Dou
- Department of Infectious Diseases, Weifang People's Hospital, Weifang, Shandong, 261000, China.
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Zhang Z, Wang Y, Liu Y. Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18056. [PMID: 31770220 PMCID: PMC6890367 DOI: 10.1097/md.0000000000018056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in postoperative analgesia and early rehabilitation of patients with total knee arthroplasty (TKA). METHODS The Cochrane Library, PubMed, and EMbase were systematically searched to retrieve literature comparing efficacy of CACB versus CFNB on pain relief and functional recovery in knee replacement patients until December 2018, without language limitation. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 7 clinical randomized controlled trials and 4 retrospective studies were included, involving 484 cases in the CACB group and 491 in the CFNB group. The results of the meta-analysis showed that the visual analogue scores (VAS) at rest were similar between the CACB group and the CFNB group at 8 hours (standard mean difference(SMD) = -0.26, 95% confidence interval(CI): -0.62, 0.11), 12 hours (SMD = -0.02, 95%CI: -0.50, 0.47), 24 hours (SMD = 0.05, 95%CI: -0.22, 0.33), and 48 hours (SMD = -0.10, 95%CI: -0.29, 0.09) after TKA (P > .05 for all). The muscle strength of patients in the CACB group post-operation was significantly improved than those of the CFNB group (SMD = 0.81; 95% CI: 0.35, 1.26; P = .0005). There were no significant differences in the amount of opioids consumption and the incidence of postoperative fall between CACB and CFNB (P > .05). CONCLUSION The analgesic effects of CACB versus CFNB are equivalent after TKA. CACB has less effect on the quadriceps muscle strength, which is beneficial to the early postoperative activities and functional rehabilitation.
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Affiliation(s)
- Zhen Zhang
- Department of Anesthesiology, XiangYang No.1 People's Hospital, HuBei University of Medicine, XiangYang
| | - Yu Wang
- Department of Anesthesiology, ShiYan TaiHe Hospital, HuBei University of Medicine, ShiYan
| | - Yuanyuan Liu
- Department of Anesthesiology, JingMen Second People's Hospital, JingMen, Hubei, PR China
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Canbek U, Akgun U, Aydogan NH, Kilinc CY, Uysal AI. Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: A prospective randomized controlled trial. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:334-339. [PMID: 31056404 PMCID: PMC6819841 DOI: 10.1016/j.aott.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/08/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare single-shot adductor canal block and continuous infusion adductor canal block techniques in total knee arthroplasty patients. METHODS We prospectively randomized 123 patients who were scheduled for unilateral primary total knee arthroplasty surgery into single shot (n = 60; mean age: 67.1 ± 6.9 years) and continuous (n = 63; mean age: 66.9 ± 6.8 years) adductor canal block groups. Postoperative visual analog scale pain scores, need for additional opioids and functional results as; timed up and go test, the 30-s chair stand test, 5 times sit-to-stand test, the 6-min walking test, the time to active straight leg raise, time to walking upstairs, maximal flexion at the time of discharge, duration of stay in hospital were compared between the two groups. RESULTS Pain scores were lower in the continuous adductor canal block group as compared to the single-shot adductor canal block group throughout the postoperative period (p = 0.001). Rescue analgesia was required for 6 (10%) patients in the single shot group and for 1 (1.59%) patient in the continuous group (p = 0.044). Patients in the continuous adductor canal block group displayed better functional results than the single-shot adductor canal block group with respect to active straight-leg rise time (25.52 ± 4.56 h vs 30.47 ± 8.07 h, p = 0.001), 6-min walking test (74.52 ± 29.38 m vs 62.18 ± 33.32 m, p = 0.035) and maximal knee flexion degree at discharge (104.92 ± 5.35° vs 98.5 ± 7.55°, p = 0.001). There was no significant difference between the two groups for other functional and ambulation scores. CONCLUSION Pain control following total knee arthroplasty was found to be better in those patients treated with continuous adductor canal block as compared to those treated with single-shot adductor canal block. Patients treated with continuous adductor canal block also displayed better ambulation and functional recovery following total knee arthroplasty. LEVEL OF EVIDENCE Level I, Therapeutic Study.
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Kim YM, Kang C, Joo YB, Lee SH. The role of ultrasound-guided single-shot femoral and sciatic nerve blocks on pain management after total knee arthroplasty. Knee 2019; 26:881-888. [PMID: 31171426 DOI: 10.1016/j.knee.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/02/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peripheral nerve blocks reduce postoperative pain and opioid consumption after total knee arthroplasty (TKA). The aim of this study was to evaluate the effects of single-shot femoral nerve and sciatic nerve blocks on postoperative pain management and opioid consumption after TKA. METHODS This study included 100 patients who underwent TKA between July 2015 and September 2017. Fifty patients received pre-operative, single-injection, ultrasound-guided femoral and sciatic nerve blocks (Group 1) and 50 did not (Group 2). Multimodal analgesia was otherwise identical, and oxycodone was administered either intravenously or orally if the patients complained of postoperative pain ≥6 on the visual analog scale (VAS). Postoperative VAS scores, opioid consumption, and the fear of future TKA were compared between the groups. RESULTS The mean VAS in the first 18 postoperative hours was significantly lower in Group 1 (P ≤ 0.002). The mean amount of oxycodone taken in the first three postoperative days was significantly lower in Group 1 (P = 0.001). Patient fear of future TKA at 14 days postoperatively was significantly lower in Group 1 (P = 0.027). CONCLUSIONS Pre-operative ultrasound-guided, single-shot femoral and sciatic nerve blocks afforded effective pain control in the first 18 h after TKA, and significantly reduced oxycodone consumption in the first three postoperative days.
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Affiliation(s)
- Young-Mo Kim
- Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, 301-721 Daejeon, South Korea
| | - Chan Kang
- Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, 301-721 Daejeon, South Korea
| | - Yong-Bum Joo
- Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, 301-721 Daejeon, South Korea.
| | - Soong-Hyun Lee
- Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, 301-721 Daejeon, South Korea
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Lan F, Shen Y, Ma Y, Cao G, Philips N, Zhang T, Wang T. Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2019; 19:114. [PMID: 31253086 PMCID: PMC6599333 DOI: 10.1186/s12871-019-0787-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Peripheral nerve block and local infiltration analgesia (LIA) provide good analgesia after knee replacement. This study evaluated the additional analgesic efficacy of continuous adductor canal block (ACB) added to single-dose LIA after medial unicondylar knee arthroplasty (UKA). We hypothesized ACB would lower pain scores and facilitate postoperative ambulation. Methods Forty-six patients were enrolled into this double-blind, randomized, placebo-controlled trial. UKA was performed and all patients received single-dose LIA intraoperatively. Patients were randomized into two groups: Group RP receiving 0.2% ropivacaine or Group Con receiving normal saline. A flow at 6 mL/h was administered for 48 h through a catheter in the adductor canal. Primary outcome was movement pain score at 24 h using the numeric rating scale (NRS-11). Secondary outcomes included serial postoperative pain scores, rate of patients with NRS>3 at rest and movement within 24 and 48 h postoperatively, time to breakthrough pain, quadriceps motor strength, ambulated distance, catheter related infection and patient satisfaction. Results Forty-two patients were analyzed. Pain scores with movement at 24 h postoperatively were significantly lower in Group RP than that in Group Con (3 vs. 5 NRS, P<0.001). Compared with Group Con, breakthrough pain occurred later in Group RP (18.5 vs 10.0 h, P = 0.002), serial pain scores at rest and with movement and rate of patients with NRS>3 with movement after surgery were significantly lower. Quadriceps motor strength was equivalent, however, ambulated distance on postoperative day 1 and 2 in Group Con was significant less (19.7 vs 37.3 m, P = 0.046; 33.4 vs 59.5 m, P = 0.002). Conclusions Continuous adductor canal block added to single-dose LIA offered better analgesia and facilitated ambulation without motor weakness after medial UKA. Trial registration Clinical Trial Registration: ChiCTR-IOR-16008720; Registered 25 June 2016.
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Affiliation(s)
- Fei Lan
- Department of Anesthesiology Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Beijing, 100053, China
| | - Yanyan Shen
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Yanhui Ma
- Department of Anesthesiology Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Beijing, 100053, China
| | - Guanglei Cao
- Department of Orthopedics Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nicole Philips
- Department of Critical Care Medicine St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ting Zhang
- Department of Anesthesiology Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Beijing, 100053, China.
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Franco T, Rupp S, Williams B, Blackmore C. Effectiveness of standardised preoperative assessment and patient instructions on admission blood glucose for patients with diabetes undergoing orthopaedic surgery at a tertiary referral hospital. BMJ Open Qual 2019; 8:e000455. [PMID: 31206054 PMCID: PMC6542547 DOI: 10.1136/bmjoq-2018-000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/04/2022] Open
Abstract
Diabetes and hyperglycaemia affect a significant number of people and are associated with a variety of untoward effects, especially under physiological stress such as surgery. Due, in large part to limited evidence, clinical practice in monitoring blood glucose and treating hyperglycaemic conditions in the perioperative period is variable. We used Lean methodologies to implement a standardised approach to preoperative management of patients undergoing elective surgery in an effort to improve glycaemic control. Overall, we saw an appropriate increase in monitoring and a decrease in the rate of hyperglycaemia on presentation to the operating room. This approach may be useful in other care settings or patient populations, potentially contributing to improved glycaemic control and subsequent decrease in associated complications.
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Affiliation(s)
- Thérèse Franco
- Section of Hospital Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Stephen Rupp
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Barbara Williams
- The Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Craig Blackmore
- The Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
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De Luca ML, Ciccarello M, Martorana M, Infantino D, Letizia Mauro G, Bonarelli S, Benedetti MG. Pain monitoring and management in a rehabilitation setting after total joint replacement. Medicine (Baltimore) 2018; 97:e12484. [PMID: 30290604 PMCID: PMC6200489 DOI: 10.1097/md.0000000000012484] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/24/2018] [Indexed: 12/24/2022] Open
Abstract
Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.
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MESH Headings
- Aged
- Analgesia, Patient-Controlled/methods
- Analgesics/therapeutic use
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Humans
- Male
- Middle Aged
- Pain Management/methods
- Pain Measurement
- Pain, Postoperative/etiology
- Pain, Postoperative/therapy
- Recovery of Function
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
| | - Marcello Ciccarello
- Anesthesia-resuscitation and Intensive care Unit, Rizzoli Sicilia Department, Bagheria
| | | | | | | | | | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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Jenny JY. Minimally invasive unicompartmental knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:793-797. [PMID: 29280006 DOI: 10.1007/s00590-017-2107-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
Abstract
The exact indication for a unicompartmental knee arthroplasty (UKA) remains debated. Minimally invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation, and this technique is well fitted to UKA. However, there are concerns about loss of accuracy with minimally invasive techniques. Furthermore, rapid recovery techniques have been developed in order to reduce the length of hospital stay. Again, UKA is well fitted to these new developments of postoperative care. We combine routinely a minimal invasive operative technique with navigation assistance to ensure proper positioning of the implants as well as an optimal ligamentous balance. Instruments have been adapted for use with a typical 6-cm skin incision with little change from the conventional navigated operating technique. A multimodal pain treatment is implemented immediately after the implantation, with special attention to a routine saphenous nerve blockade. Patients are instructed to stand up on the day of surgery with full weight bearing and to mobilize the knee joint without restriction. They may be discharged at least on the day following surgery, and the most favorable patients may be operated in our day-case surgery unit. These conclusions should be confirmed on a larger scale.
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Affiliation(s)
- Jean-Yves Jenny
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France.
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Seo JH, Seo SS, Kim DH, Park BY, Park CH, Kim OG. Does Combination Therapy of Popliteal Sciatic Nerve Block and Adductor Canal Block Effectively Control Early Postoperative Pain after Total Knee Arthroplasty? Knee Surg Relat Res 2017; 29:276-281. [PMID: 29172388 PMCID: PMC5718797 DOI: 10.5792/ksrr.17.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. Materials and Methods One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. Results The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. Conclusions SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.
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Affiliation(s)
- Jin-Hyeok Seo
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
| | - Seung-Suk Seo
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
| | - Do-Hun Kim
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
| | - Byung-Yoon Park
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
| | - Chan-Ho Park
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
| | - Ok-Gul Kim
- Department of Orthopedic Surgery, Bumin General Hospital, Busan, Korea
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