Surgeon-Performed High-Dose Bupivacaine Periarticular Injection With Intra-Articular Saphenous Nerve Block Is Not Inferior to Adductor Canal Block in Total Knee Arthroplasty |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Duke University, Durham, NC;2. Department of Orthopaedic Surgery, Durham VA Medical Center, Durham, NC;1. Department of Joint Replacement, Deenanath Mangeshkar Hospital, Pune, India;2. University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK;1. Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA;2. Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA;1. Frank H. Netter School of Medicine at Quinnipiac University, North Haven, Connecticut;2. Department of Orthopaedic Surgery, Panorama Orthopedics & Spine Center, Golden, Colorado |
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| Abstract: | BackgroundPeriarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is insufficient data comparing the efficacy and safety of these methods.MethodsThis is a retrospective two-surgeon cohort study comparing short-term perioperative outcomes after primary total knee arthroplasty, in 50 consecutive patients with surgeon-performed high-dose periarticular injection and intra-articular saphenous nerve block (60 mL 0.5% bupivacaine, 30 mL saline, 30mg ketorolac) and 50 consecutive patients with anesthesiologist-performed adductor canal catheter (0.25% bupivacaine 6 mL/h infusion pump placed postoperatively with ultrasound guidance). Chart review assessed pain scores through POD #1, opioid use, length of stay, and short-term complications, including local anesthetic systemic toxicity. Statistical analysis was performed with two-tailed Student's T-test.ResultsThe high-dose periarticular injection cohort had significantly lower pain scores in the postanesthesia care unit (mean difference 1.4, P = .035), on arrival to the inpatient ward (mean difference 1.7, P = .013), and required less IV narcotics on the day of surgery (mean difference 6.5 MME, P = .0004). There was no significant difference in pain scores on POD #1, total opioid use, day of discharge, or short-term complications. There were no adverse events related to the high dose of bupivacaine.ConclusionCompared with postoperative adductor canal block catheter, an intraoperative high-dose periarticular block demonstrated lower pain scores and less IV narcotic use on the day of surgery. No difference was noted in pain scores on POD #1, time to discharge, or complications. There were no cardiovascular complications (local anesthetic systemic toxicity) despite the high dose of bupivacaine injected.Level of EvidenceIII. |
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| Keywords: | total knee arthroplasty bupivacaine periarticular block adductor canal block postoperative analgesia |
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