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;
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
Primary and secondary outcomes can be found in Table 2
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.