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Continuous Adductor Canal 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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Continuous Adductor Canal Blockade versus Periarticular Liposomal Bupivacaine Infiltration for Analgesia After Total Knee Arthroplasty

Sean Dobson, MD PhD; Kyle Sebastian; Nathan Stouffer; Robert Weller, MD; James D. Turner, MD; J Douglas Jaffe, DO; Christopher Edwards, MD; Daryl S. Henshaw, MD; J. Wells Reynolds, MD; 

Introduction

Total Knee Arthroplasty (TKA) is a commonly performed orthopedic surgical procedure that can result in significant postoperative pain.   Many approaches to postoperative analgesia have been described, with the goal to provide sufficient analgesia and preserve motor strength so that the patient can participate in physical therapy with the hope that length of stay can be minimized, therefore reducing costs.   We compared infiltration of liposomal bupivacaine (LB) by the surgeon after a short acting single injection femoral nerve block  to continuous adductor canal blockade (cACB). The primary outcome was patient reported pain scores at 24-hours (Numeric Rating Scale 0-10 [NRS]). We hypothesized that cACB would be superior to LB.  Secondary outcomes included NRS pain scores at 12, 36, and 48-hours, opioid consumption, time-to-first-opioid-administration, distance ambulated on post-operative day (POD) 1 and 2, and LOS in hours

Materials and Methods

•This was an IRB approved retrospective analysis of 182 patients that underwent total knee arthroplasty. The need for informed consent was waived.
•Patients that received a cACB (92 patients) with 25 ml of 0.25% bupivacaine with 1:200k epi and 1:600k clonidine followed by an infusion of 0.125% bupivacaine at 10 ml/hr were compared to patients (90 patients) that received a single injection femoral nerve block with 0.2% ropivacaine with 1:400k epi and infiltration of periarticular LB by the orthopedic surgeon. All patients also received a single injection sciatic nerve block and a spinal anesthetic.
•Primary outcome –NRS pain rating recorded by nursing staff at 24 hours
•Secondary outcomes: NRS pain scores recorded by the nursing staff at 12, 36, and 48hrs; greatest ambulatory distance achieved with PT on postoperative days 1 and 2; time to first administration of opioid on the post-surgical ward; cumulative opioid consumption at 24 and 48 hours; and total time to readiness to discharge in hours.

Results

Primary and secondary outcomes can be found in Table 2

•NRS pain scores at 24 hours were significantly lower in the cACB group compared to LB group
•The following secondary outcomes favored cACB over infiltration with LB: lower NRS pain scores at 12-hours and 36-hours, prolonged time-to-first-opioid-administration, decreased cumulative opioid consumption at 24 and 48-hours, and distance ambulated on POD1.                          
•There was no statistical difference between the two groups in regards to ambulation on POD2, NRS pain scores at 48-hours, or hospital LOS.

Discussion

These results suggest that analgesia following TKA is superior with cACB and single shot sciatic block as compared to LB infiltration with a single shot femoral nerve block and sciatic block.  The use of cACB resulted in lower pain scores at 12, 24, and 36-hours, lower opioid consumption through both 24-hours and 48-hours, a longer time-to first-opioid-administration, and a farther distance ambulated on POD1.  However, time to hospital discharge was not impacted.

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