Does Addition of Adductor Canal Blockade to Multimodal Periarticular Analgesia Improve Discharge Status, Pain Levels, Opioid Use, and Length of Stay after Total Knee Arthroplasty?

Chukwuweike U. Gwam; Jaydev B. Mistry; Ifie V. Richards; Dhrudeep Patel; Nirav G. Patel; Melbin Thomas; Hephzibah Adamu; Ronald E. Delanois

doi:10.1055/s-0037-1602131

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2018; 31(02): 184-188
DOI: 10.1055/s-0037-1602131

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does Addition of Adductor Canal Blockade to Multimodal Periarticular Analgesia Improve Discharge Status, Pain Levels, Opioid Use, and Length of Stay after Total Knee Arthroplasty?

Authors

Chukwuweike U. Gwam

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Jaydev B. Mistry

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Ifie V. Richards

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Dhrudeep Patel

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Nirav G. Patel

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Melbin Thomas

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Hephzibah Adamu

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
Ronald E. Delanois

¹Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland

Abstract

Total knee arthroplasty (TKA) can be associated with substantial postoperative pain that may affect satisfaction and return to function. Various forms of pain control have been used; however, multimodal periarticular analgesia (MPA) and adductor canal block (ACB) have recently gained popularity. The purpose of this study was to compare (1) discharge status, (2) pain levels, (3) postoperative opioid consumption, and (4) length of stay (LOS) between TKA patients who received MPA only and those who received both MPA and ACB. A single surgeon database was reviewed for TKA patients who received MPA with or without ACB between January 2015 and April 2016. This yielded 110 patients who had a mean age of 62 years. Forty-five patients received MPA alone, while 65 patients received both modalities. Patient records were reviewed to obtain demographic and end-point data (discharge status, pain scores, opioid consumption, and LOS). Student's t-test and chi-squared test were used to compare continuous and categorical variables, respectively. There was no significant difference in discharge status (p = 0.304), pain levels (p = 0.343), and postoperative opioid consumption (p = 0.729) between the two cohorts. When compared with MPA patients, TKA patients who received both MPA and ACB demonstrated shorter LOS (2.44 vs. 1.98 days), a value that trended toward significance (p = 0.061). When comparing TKA patients who received MPA with those who received a combination of MPA and ACB, we were unable to elucidate a significant difference in any of the end points of interest. Therefore, MPA alone is comparable to combined MPA and ACB in managing postoperative pain in TKA patients. However, larger studies may be necessary to verify these findings.

Keywords

total knee arthroplasty - multimodal periarticular analgesia - adductor canal block - opioid - pain management

Full Text

References

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