Postoperative continuous adductor canal block for total knee arthroplasty improves pain and functional recovery: A randomized controlled clinical trial
Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter. Double-blinded randomized placebo-controlled trial. Inpatient setting in tertiary care teac...
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| Published in | Journal of clinical anesthesia Vol. 49; pp. 46 - 52 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.09.2018
Elsevier Limited |
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| Online Access | Get full text |
| ISSN | 0952-8180 1873-4529 1873-4529 |
| DOI | 10.1016/j.jclinane.2018.06.004 |
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| Abstract | Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter.
Double-blinded randomized placebo-controlled trial.
Inpatient setting in tertiary care teaching hospital with outpatient follow-up.
One-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty.
Patients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization.
Primary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores.
Seventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: −43.1 to −1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: −15.5 – −0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: −17.3 to −0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1–20.5°, P = 0.01).
A postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392.
•Total opioid consumption and pain scores were reduced with a continuous adductor canal block compared to sham catheter•Adductor canal block is a viable option to decrease opioid consumption in the post-operative period after TKA•A postoperative continuous adductor canal block is a viable option to decrease opioid consumption in the acute post-operative period after TKA |
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| AbstractList | AbstractStudy objectiveInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter. DesignDouble-blinded randomized placebo-controlled trial. SettingInpatient setting in tertiary care teaching hospital with outpatient follow-up. PatientsOne-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty. InterventionsPatients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization. MeasurementsPrimary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores. Main resultsSeventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: −43.1 to −1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: −15.5 – −0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: −17.3 to −0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1–20.5°, P = 0.01). ConclusionA postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392. Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter. Double-blinded randomized placebo-controlled trial. Inpatient setting in tertiary care teaching hospital with outpatient follow-up. One-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty. Patients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization. Primary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores. Seventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: −43.1 to −1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: −15.5 – −0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: −17.3 to −0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1–20.5°, P = 0.01). A postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392. •Total opioid consumption and pain scores were reduced with a continuous adductor canal block compared to sham catheter•Adductor canal block is a viable option to decrease opioid consumption in the post-operative period after TKA•A postoperative continuous adductor canal block is a viable option to decrease opioid consumption in the acute post-operative period after TKA Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter.STUDY OBJECTIVEInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter.Double-blinded randomized placebo-controlled trial.DESIGNDouble-blinded randomized placebo-controlled trial.Inpatient setting in tertiary care teaching hospital with outpatient follow-up.SETTINGInpatient setting in tertiary care teaching hospital with outpatient follow-up.One-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty.PATIENTSOne-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty.Patients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization.INTERVENTIONSPatients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization.Primary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores.MEASUREMENTSPrimary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores.Seventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: -43.1 to -1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: -15.5 - -0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: -17.3 to -0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1-20.5°, P = 0.01).MAIN RESULTSSeventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: -43.1 to -1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: -15.5 - -0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: -17.3 to -0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1-20.5°, P = 0.01).A postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392.CONCLUSIONA postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392. Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter. Double-blinded randomized placebo-controlled trial. Inpatient setting in tertiary care teaching hospital with outpatient follow-up. One-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty. Patients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization. Primary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores. Seventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: -43.1 to -1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: -15.5 - -0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: -17.3 to -0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1-20.5°, P = 0.01). A postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392. Study objectiveInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter.DesignDouble-blinded randomized placebo-controlled trial.SettingInpatient setting in tertiary care teaching hospital with outpatient follow-up.PatientsOne-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty.InterventionsPatients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization.MeasurementsPrimary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores.Main resultsSeventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: −43.1 to −1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: −15.5 – −0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: −17.3 to −0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1–20.5°, P = 0.01).ConclusionA postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.gov NCT02121392. |
| Author | Denduluri, Sahitya K. Mohammed, Maryam K. Lu, Min Anitescu, Magdalena Leung, Patrick Luu, Hue H. Dickerson, David M. |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29890381$$D View this record in MEDLINE/PubMed |
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after total knee arthroplasty a meta-analysis of randomized controlled trials publication-title: Anesthesiology doi: 10.1097/ALN.0b013e3181f4b18 |
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| Snippet | Investigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual... AbstractStudy objectiveInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption... Study objectiveInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and... |
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| SubjectTerms | Anesthesia Catheters Clinical trials Continuous adductor canal block Drug administration Epidural Joint surgery Medical personnel Narcotics Pain Pain Medicine Patient satisfaction Postoperative period Recovery (Medical) Surgery Total knee arthroplasty Ultrasonic imaging |
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| Title | Postoperative continuous adductor canal block for total knee arthroplasty improves pain and functional recovery: A randomized controlled clinical trial |
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