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  • 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

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Regional Anesthesia and Acute Pain: Original Articles
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
  1. Antoun Nader, MD*,
  2. Mark C. Kendall, MD*,
  3. David W. Manning, MD†,
  4. Matthew Beal, MD†,
  5. Rohit Rahangdale, MD*,
  6. Robert Dekker, MD†,
  7. Gildasio S. De Oliveira Jr, MD, MSCI*,
  8. Eric Kamenetsky, MD* and
  9. Robert J. McCarthy, PharmD*
  1. *Departments of Anesthesiology
  2. †Orthopedics, Northwestern University, Feinberg School of Medicine, Chicago, IL
  1. Address correspondence to: Mark C. Kendall, MD, Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, 251 East Huron St, Suite 5-704, Chicago, IL 60611 (e-mail: m-kendall{at}northwestern.edu).

Abstract

Background and Objectives 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.

Methods 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.

Results 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).

Conclusions 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.

https://doi.org/10.1097/AAP.0000000000000494

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    Footnotes

    • The authors declare no conflict of interest.

      Support was provided solely from institutional and-or departmental sources.

      Presented in part at the American Society of Regional Anesthesia and Pain Medicine (ASRA) 2016 Annual Regional Anesthesia Meeting and Workshops, March 31–April 2, 2016, New Orleans, LA; and the American Association of Hip and Knee Surgeons (AAHKS) 25th Annual Meeting, November 5–8, 2015, Dallas, TX.