Single-Dose Adductor Canal Block With Local Infiltrative Analgesia Compared With Local Infiltrate Analgesia After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

• Published in: Regional anesthesia and pain medicine Vol. 41; no. 6; pp. 678 - 684
• Main Authors: Nader, Antoun, Kendall, Mark C, Manning, David W, Beal, Matthew, Rahangdale, Rohit, Dekker, Robert, De Oliveira, Jr, Gildasio S, Kamenetsky, Eric, McCarthy, Robert J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2016
• Subjects: Aged; Amides - administration & dosage; Amides - adverse effects; Analgesics; Analgesics, Opioid - therapeutic use; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Chicago; Double-Blind Method; Double-blind studies; Female; Humans; Joint replacement surgery; Joint surgery; Knee; Knee Joint - innervation; Knee Joint - surgery; Male; Middle Aged; Narcotics; Nerve Block - adverse effects; Nerve Block - methods; Pain; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Patient Satisfaction; Regional anesthesia; Ropivacaine; Surveys and Questionnaires; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional - methods
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1097/AAP.0000000000000494

A single-dose adductor canal block can provide postoperative analgesia for patients undergoing total knee arthroplasty (TKA). The purpose of this study was to assess postoperative opioid consumption after ultrasound-guided single-injection bupivacaine compared with saline adductor canal block for patients undergoing TKA. After institutional review board approval, written informed consent was obtained from patients (>18 years old) undergoing elective TKA. Subjects were randomized into 2 groups as follows: adductor canal blockade with 10 mL of bupivacaine 0.25% with epinephrine 1:300,000 or 10 mL of normal saline. All patients received a periarticular infiltration mixture intraoperatively with scheduled and patient requested oral and IV analgesics postoperatively for breakthrough pain. Personnel blinded to group allocation recorded pain scores and opioid consumption every 6 hours. Pain burden, area under the numeric rating score for pain, was calculated for 36 hours. The primary outcome was postoperative IV/IM morphine (mg morEq) consumption at 36 hours after surgery. Forty (28 women/12 men) subjects were studied. Postoperative opioid consumption was reduced in the bupivacaine 48 (39 to 61) mg morEq compared with saline 60 (49 to 85) mg morEq, difference -12 (-33 to -2) mg morEq (P = 0.03). Pain burden at rest was decreased in the bupivacaine 71 (37 to 120) score · hours compared with saline 131 (92 to 161) score · hours, difference -60 (-93 to -14) score · hours (P = 0.009). Adductor canal blockade with bupivacaine 0.25% with epinephrine 1:300,000 effectively reduces pain and opioid requirement in the postoperative period after TKA. Adductor canal blockade is an effective pain management adjunct for patients undergoing TKA.