Journal article
Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty A Randomized Blinded Study
Journal of bone and joint surgery. American volume, Vol.99(15), pp.1274-1281
08/02/2017
DOI: 10.2106/JBJS.16.01266
PMID: 28763413
Abstract
Background: Pain following total knee arthroplasty (TKA) is often severe and can inhibit rehabilitation. Motor-sparing analgesic techniques such as periarticular infiltrations and adductor canal blocks have been popularized for knee analgesia since they preserve motor strength and permit early mobilization. Our primary objective was to compare the duration of analgesia from motor-sparing blocks with that of a standard periarticular infiltration. We used the time to first rescue analgesia as the end point.
Methods: We randomized 82 patients scheduled for elective TKA to receive either the preoperative motor-sparing block (0.5% ropivacaine, 2.5 mg/mL of epinephrine, 10 mg of morphine, and 30 mg of ketorolac) or intraoperative periarticular infiltration (0.3% ropivacaine, 2.5 mg/mL of epinephrine, 10 mg of morphine, and 30 mg of ketorolac). For the motorsparing block, we modified the ultrasound-guided adductor canal block by combining it with a lateral femoral cutaneous nerve block and posterior knee infiltration. The patients, surgeons, anesthetists administering the blocks, and outcome assessors all remained blinded to group allocation. Our primary outcome was duration of analgesia (time to first rescue analgesia). Secondary outcomes included quadriceps strength, function, side effects, satisfaction, and length of hospital stay.
Results: The duration of analgesia was significantly longer (mean difference, 8.8 hours [95% confidence interval = 3.98 to 13.62], p < 0.01) for the motor-sparing-block group (mean [and standard error], 18.1 +/- 1.7 hours) compared with the periarticular infiltration group (mean, 9.25 +/- 1.7 hours). The infiltration group had significantly higher scores for pain at rest for the first 2 postoperative hours and for pain with knee movement at 2 and 4 hours. There were no significant differences between groups with regard to any other secondary outcomes.
Conclusions: In patients undergoing a TKA, a motor-sparing block provides longer analgesia than periarticular infiltration with retention of quadriceps muscle strength, function, patient satisfaction, and a short hospital stay.
Details
- Title: Subtitle
- Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty A Randomized Blinded Study
- Creators
- Olawale A. Sogbein - NOSM UniversityRakesh V. Sondekoppam - Univ Alberta, Dept Anesthesiol & Pain Med, Edmonton, AB, CanadaDianne Bryant - Univ Western Ontario, London, ON, CanadaDavid F. Johnston - Univ Hosp London Hlth Sci Ctr, Dept Anesthesiol & Perioperat Med, London, ON, CanadaEdward M. Vasarhelyi - Univ Hosp London Hlth Sci Ctr, Div Orthopaed Surg, London, ON, CanadaSteven MacDonald - Univ Hosp London Hlth Sci Ctr, Div Orthopaed Surg, London, ON, CanadaBrent Lanting - Univ Hosp London Hlth Sci Ctr, Div Orthopaed Surg, London, ON, CanadaSugantha Ganapathy - Univ Hosp London Hlth Sci Ctr, Dept Anesthesiol & Perioperat Med, London, ON, CanadaJames L. Howard - Univ Hosp London Hlth Sci Ctr, Div Orthopaed Surg, London, ON, Canada
- Resource Type
- Journal article
- Publication Details
- Journal of bone and joint surgery. American volume, Vol.99(15), pp.1274-1281
- DOI
- 10.2106/JBJS.16.01266
- PMID
- 28763413
- NLM abbreviation
- J Bone Joint Surg Am
- ISSN
- 0021-9355
- eISSN
- 1535-1386
- Publisher
- Journal of Bone and Joint Surgery Incorporated
- Number of pages
- 8
- Language
- English
- Date published
- 08/02/2017
- Academic Unit
- Anesthesia
- Record Identifier
- 9984296139802771
Metrics
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