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Ultrasound-guided genicular nerve blocks following total knee arthroplasty: a randomized, double-blind, placebo-controlled trial
  1. Milly Rambhia1,
  2. An Chen1,
  3. Amanda H Kumar2,
  4. W Michael Bullock2,
  5. Michael Bolognesi3 and
  6. Jeffrey Gadsden2
  1. 1Anesthesiology, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
  2. 2Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
  3. 3Orthopaedics, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Jeffrey Gadsden, Anesthesiology, Duke University, Durham, North Carolina 27710, USA; jeff.gadsden{at}duke.edu

Abstract

Introduction Local anesthetic blockade of the genicular nerves, known targets of radiofrequency ablative techniques for knee pain, has not previously been studied in a randomized controlled trial evaluating acute pain after knee arthroplasty. We hypothesized that genicular nerve blockade added to an existing block regimen in total knee arthroplasty would result in a reduction in 24 hours opioid consumption.

Methods Patients (American Society of Anesthesiologists 1–3, aged 18–85 years) undergoing primary total knee arthroplasty were randomized to receive single-injection nerve blocks of the superolateral, superomedial, and inferomedial genicular nerves with injectate (15 mL 0.25% bupivacaine and 2 mg dexamethasone or 15 mL saline placebo). All subjects received a standard oral analgesic regimen, spinal anesthetic with 12.5 mg isobaric bupivacaine, infiltration between the popliteal artery and capsule of the knee with 0.2% ropivacaine, and postoperative adductor canal perineural infusion with 0.2% ropivacaine. The primary outcome was 24 hours opioid consumption (measured in morphine milliequivalents).

Results Forty (40) subjects were enrolled. Opioid consumption at 24 hours was significantly lower in the BLOCK group compared with the SHAM group (23±20 vs 58±35, p<0.001), and this difference remained significant at 48 hours (50±40 vs 98±56, p=0.004). Pain scores were reduced in the BLOCK group at time 6 hours (2.6±1.9 vs 4.3±2.2, p=0.012), but were otherwise similar at remaining time points. Patient satisfaction at 24 hours and 20 m walk test times were similar between groups.

Discussion Genicular nerve blockade was associated with a reduction in opioid consumption at 24 hours in primary total knee arthroplasty patients.

Trial registration number NCT03706313.

  • nerve block
  • pain
  • postoperative
  • lower extremity
  • acute pain

Data availability statement

Data are available upon reasonable request. Deidentified participant data available from corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Deidentified participant data available from corresponding author upon reasonable request.

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Footnotes

  • Twitter @THEsae253616, @jeffgadsden

  • Contributors MR and JG contributed to study conception and design. MR, AC, AHK, WMB, MB and JG contributed to study conduct. MR, AC and JG contributed to data analysis. MR, AC, AHK, WMB and JG contributed to manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AHK reports grants from Pacira Biosciences, outside the submitted work. WMB reports personal fees from Pacira Biosciences, outside the submitted work. MB reports grants and other from Zimmer Biomet, other from TJO, grants from Depuy Synthes, grants from Exactech, grants from Stryker, outside the submitted work. JG reports personal fees from Pacira Biosciences, grants from Mallinckrodt Pharmaeuticals, outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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