A guide to regional analgesia for Total Knee Arthroplasty

Rodriguez-Patarroyo, Fabio; Cuello, Nadin; Molloy, Robert; Krebs, Viktor E.; Turan, Alparslan; Piuzzi, Nicolás S.

doi:10.1302/2058-5241.6.210045

Cited by 16 publications

(10 citation statements)

References 123 publications

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“…No significant differences were found in functional test outcomes at any time point nor LOS. Most of the authors have also reported worse quadriceps strength preservation with the use of FNB [ 6 , 9 – 11 ]. However, different to us, some articles defended that FNB was associated with delayed functional recovery [ 6 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the authors have also reported worse quadriceps strength preservation with the use of FNB [ 6 , 9 – 11 ]. However, different to us, some articles defended that FNB was associated with delayed functional recovery [ 6 , 11 , 12 ]. Based on our experience, despite the FNB was actually associated with an initial higher quadriceps strength loss, it seems not to be of enough magnitude to limit the early functionality.…”

Section: Discussionmentioning

confidence: 99%

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Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

de Arzuaga,

Miguel,

Biarnés

et al. 2023

Arch Orthop Trauma Surg

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Introduction Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. Methods This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. Results Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0.001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0.01), 24 h (p = 0.005) and 48 h (p = 0.01). The highest cumulative opioid requirement was reported in ACB-G3. Conclusion For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. Clinical trial registration This study was registered in clinicaltrials.gov (NCT03518450; https://clinicaltrials.gov/ct2/show/NCT03518450; submitted March 17, 2018).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

de Arzuaga,

Miguel,

Biarnés

et al. 2023

Arch Orthop Trauma Surg

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“…The administration of nonopioid analgesics, such as acetaminophen and cyclooxygenase 2 inhibitors, before surgery and tranexamic acid has also been shown to reduce postoperative pain and/or opioid consumption 67,68 . Regional anesthesia has been shown to improve pain management and decrease the use of opioids 69,70 . Multimodal analgesia and a procedure-specific approach have been shown to affect the limiting use of opioids substantially 61,71 .…”

Section: Team Approach: Role-specific Interventionmentioning

confidence: 99%

Team Approach: Use of Opioids in Orthopaedic Practice

et al. 2023

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The opioid epidemic represents a serious health burden on patients across the United States. » This epidemic is particularly pertinent to the field of orthopaedics because it is one of the fields providing the highest volume of opioid prescriptions.» The use of opioids before orthopaedic surgery has been associated with decreased patient-reported outcomes, increased surgery-related complications, and chronic opioid use.» Several patient-level factors, such as preoperative opioid consumption and musculoskeletal and mental health conditions, contribute to the prolonged use of opioids after surgery, and various screening tools for identifying high-risk drug use patterns are available.» The identification of these high-risk patients should be followed by strategies aimed at mitigating opioid misuse, including patient education, opioid use optimization, and a collaborative approach between health care providers.

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“…Due to the variables at play (temperature, exposure time, and nerve diameter), the block's duration is uncertain, however, it is typically measured in weeks or months. The use of cryoanalgesia in TKA is supported by scant clinical data [ 26 ]. Scientific proof and treatment regimen of postoperative pain treatment aims to give the best analgesia with the fewest side effects.…”

Section: Reviewmentioning

confidence: 99%

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty

Salwan¹,

Pisulkar²,

Taywade³

et al. 2022

Cureus

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Total knee arthroplasty (TKA) patients express minimal comfort regarding postoperative pain management. The use of parenteral opioids or epidural analgesia may have unfavorable adverse impacts that interfere with quick healing and rehabilitation. It is uncertain if periarticular multimodal drug injections (PMDI) are effective at easing pain following total knee or total hip arthroplasty (THA). We conducted this study to assess the effectiveness of PMDI following TKA or THA. Articles were sourced using the following keywords on Pubmed, Google scholar, and the Web of Science: multimodal drug cocktail in total knee arthroplasty OR hip arthroplasty, periarticular injections AND multimodal drug cocktail, epidural versus periarticular injections AND pain management after total joint arthroplasty. After screening 438 articles and abstracts, 200 pertinent studies were found, of which a total of 10 articles were included in the study. From this review, we want to conclude that despite the various ways to address postoperative pain, there is no acknowledged gold standard for postoperative pain management following total joint arthroplasty. To reduce narcotic intake and prevent narcotic-related adverse reactions, multimodal techniques utilizing regional anesthetics appear to be on the rise such as periarticular injections, or patient-controlled analgesia with or without femoral nerve block. Even though the ideal duration and kind of medications are unclear, preoperative pain management or preemptive analgesia with anti-inflammatory drugs and opioid analgesics seem to be useful in lowering postoperative pain.

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A guide to regional analgesia for Total Knee Arthroplasty

Cited by 16 publications

References 123 publications

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block—a randomized controlled double-blinded trial

Team Approach: Use of Opioids in Orthopaedic Practice

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty

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