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4671
Continuous Femoral Nerve Blockade versus Periarticular Liposomal Bupivacaine Infiltration for Analgesia After Total Knee Arthroplasty
Session: MP-04c
Thurs, April 19, 3:30-5:00 pm
Plymouth (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Single-Shot Psoas Compartment Blockade versus Periarticular Liposomal Bupivacaine Infiltration for Total Hip Arthroplasty 

Introduction

 

Total Hip Arthroplasty (THA) can be an extremely painful orthopedic surgical procedure that requires sufficient postoperative analgesia to allow for early mobilization with physical therapy, which may shorten the duration of hospitalization and improve patient satisfaction. This study included two groups; Group A with liposomal bupivacaine (LB) infiltration following shorter-acting psoas compartment block (SSPB), compared to Group B longer-acting psoas compartment block without periarticular infiltration. The primary endpoint was patient reported post-operative pain scores at 24 hours (Numeric Rating Scale 0-10 [NRS]).  Secondary outcomes included NRS pain scores at 12, 36, and 48-hours; time to first opiate dosage; opioid consumption in the first 24 and 48 hours post-operatively; distance ambulated on post-operative day (POD) 1 and 2; and hospital length of stay (LOS) in hours.

Discussion

 

These results suggest that analgesia after THA is equivalent with SPCB as compared to LB infiltration. Aggressive multimodal analgesia and resultant low pain scores may have made it difficult to detect a difference between the two groups. A type II error can not be ruled out. Large variability between the distances ambulated on POD1 made detection of differences  between the two groups unlikely if any existed.  However, patients receiving LB were discharged from the hospital more quickly than when treated with a long acting SPCB. This might have been confounded by the fact that the surgeons switched to LB in an effort to discharge patients earlier.

 

Materials and Methods

 

•This study was an IRB approved retrospective analysis of 82 patients that underwent Total Hip Arthroplasty  
•Two groups of 41 patients in each group: Group A received  a SSPCB with 25 ml of 0.2% ropivacaine with 1:400k epinephrine and infiltration of periarticular LB by the surgeon; Group B received a SSPCB with 25 ml of 0.25% bupivacaine with 1:200k epinephrine and 1.67 mcg/mL cloniidine
•All patients also received spinal anesthesia

 

Results

 

Primary and secondary outcomes can be found in Table 2

•No significant difference was established for the primary endpoint of NRS pain scores at 24 hours
•The following secondary outcomes showed no significant difference: NRS pain scores at 12, 36, or 48 hours; time to fist opiate dose; opiate consumption at 24 or 48 hours; distance ambulated on POD 1 or 2
•There was a statistically significant shorter hospital LOS in the LB group compared to the SPCB group.
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