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Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.

Publication ,  Journal Article
Klement, MR; Bullock, WM; Nickel, BT; Lampley, AJ; Seyler, TM; Green, CL; Wellman, SS; Bolognesi, MP; Grant, SA
Published in: Knee
June 2019

BACKGROUND: There is a growing interest in avoiding discharging patients to rehab to maximize outcome and minimize complications after total knee arthroplasty (TKA). In addition, use of postoperative pain pathways that minimize opioid use is critical amidst the current opioid epidemic. However, the ideal pain regimen after TKA has yet to be determined. METHODS: From July 1, 2013 to October 1, 2014 two perioperative pathways were used to address surgical pain. These included either a single shot femoral nerve block plus liposomal bupivacaine pericapsular injection (FNB + LB-PAI) or adductor canal catheter plus posterior capsule single shot block (ACC + iPACK), each with an oral analgesic protocol. Little modification occurred with regard to surgical technique, postoperative medications, or postoperative physical therapy (PT). RESULTS: Overall, 264 unilateral, primary TKA patients (146 FNB + LB-PAI, 118 ACC + iPACK) were included. ACC + iPACK patients had a shorter median length of stay (LOS, 2.0 vs 3.0, p < 0.001), more discharges home (79.7% vs 67.8%, p = 0.002), and less median opioid consumption (IV morphine equivalents, IVME, 20.0 vs 44.1, p < 0.001) than the FNB + LB-PAI group. In multivariable analysis, use of ACC + iPACK remained independently associated with shorter LOS, increased discharge home, and less IVME consumed when controlling for confounding variables. ACC + iPACK patients also had fewer opioid related adverse events (0.8 vs 5.5, p = 0.045) and a lower rate of MUA (0.8% vs 6.2%, p = 0.026). CONCLUSIONS: We recommend ACC + iPACK with a multimodal oral analgesic protocol as the primary postoperative analgesia in enhanced recovery TKA protocols. This resulted in an easier recovery with fewer complications. LEVEL OF EVIDENCE: Level III.

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Published In

Knee

DOI

EISSN

1873-5800

Publication Date

June 2019

Volume

26

Issue

3

Start / End Page

679 / 686

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Patient Discharge
  • Pain, Postoperative
  • Orthopedics
  • Nerve Block
  • Male
  • Length of Stay
  • Knee
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Klement, M. R., Bullock, W. M., Nickel, B. T., Lampley, A. J., Seyler, T. M., Green, C. L., … Grant, S. A. (2019). Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty. Knee, 26(3), 679–686. https://doi.org/10.1016/j.knee.2019.01.020
Klement, Mitchell R., W Michael Bullock, Brian T. Nickel, Alexander J. Lampley, Thorsten M. Seyler, Cynthia L. Green, Samuel S. Wellman, Michael P. Bolognesi, and Stuart A. Grant. “Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.Knee 26, no. 3 (June 2019): 679–86. https://doi.org/10.1016/j.knee.2019.01.020.
Klement MR, Bullock WM, Nickel BT, Lampley AJ, Seyler TM, Green CL, et al. Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty. Knee. 2019 Jun;26(3):679–86.
Klement, Mitchell R., et al. “Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.Knee, vol. 26, no. 3, June 2019, pp. 679–86. Pubmed, doi:10.1016/j.knee.2019.01.020.
Klement MR, Bullock WM, Nickel BT, Lampley AJ, Seyler TM, Green CL, Wellman SS, Bolognesi MP, Grant SA. Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty. Knee. 2019 Jun;26(3):679–686.
Journal cover image

Published In

Knee

DOI

EISSN

1873-5800

Publication Date

June 2019

Volume

26

Issue

3

Start / End Page

679 / 686

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Patient Discharge
  • Pain, Postoperative
  • Orthopedics
  • Nerve Block
  • Male
  • Length of Stay
  • Knee
  • Humans
  • Female