Adductor canal block with or without added magnesium sulfate following total knee arthroplasty: a multi-arm randomized controlled trial

Zoratto, Dana; Phelan, Rachel; Hopman, Wilma M.; Wood, Gavin; Shyam, Vidur; DuMerton, Deborah; Shelley, Jessica; McQuaide, Sheila; Kanee, Lauren; Ho, Anthony M.‐H.; McMullen, Michael; Armstrong, Mitch; Mizubuti, Glenio B.

doi:10.1007/s12630-021-01985-5

Cited by 4 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with our results, Dana et al, didn't find any analgesic benefit of adding magnesium sulfate to ACB in total knee arthroplasty patients under spinal anesthesia [12].…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

Ibrahim¹

2023

Rev. chil. anest.

View full text Add to dashboard Cite

Background: Arthroscopic knee surgery refers to different surgical interventions in the knee joint and many studies investigated postoperative pain control, Adductor canal block (ACB) as a new alternative technique to femoral nerve block (FNB) provides post-operative pain control with a multimodal analgesic regimen after knee surgery with better quadriceps muscle strength, Many adjuvants have been added to local anesthetics to prolong the analgesic duration of ACB like dexamethasone and dexmedetomidine. Patients and Methods: A prospective, randomized, double-blind, parallel-four groups trial. A total of 120 patients scheduled for elective ACL repair; American society of anesthesiologists-physical status I and II patients, aged 18 to 60 years, 155-170 cm height, both sexes. Patients were randomized into four groups dexamethasone group (DX)group in which dexamethasone was added to bupivacaine in ACB, dexmedetomidine (Dm) group in which dexmedetomidine added to bupivacaine in ACB, magnesium sulfate (m) group in which magnesium sulfate was added to bupivacaine in ACB and control group with normal saline added to bupivacaine in ACB. The main outcome measure was the duration of postoperative analgesia. Results: The results revealed that the addition of 8 mg dexamethasone or 25 µg dexmedetomidine to 0.5% bupivacaine solution during ACB improved the duration and the quality of postoperative analgesia but the addision of magnesium sulfate had no role. Conclusions: We concluded that the addition of dexamethasone or dexmedetomidine to bupivacaine in ACB after arthroscopic ACL repair under spinal anesthesia provided longer postoperative analgesia and less analgesic consumption.

show abstract

“…In line with our results, Dana et al, didn't find any analgesic benefit of adding magnesium sulfate to ACB in total knee arthroplasty patients under spinal anesthesia [12].…”

Section: Discussionsupporting

confidence: 91%

“…Many adjuvants have been added to local anesthetics to prolong the analgesic duration of ACB like dexamethasone, dexmedetomidine [11], and magnesium sulfate [12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

Ibrahim¹

2023

Rev. chil. anest.

View full text Add to dashboard Cite

show abstract

“…The full reference list of all excluded citations can be viewed in Appendix B (https://links.lww.com/ALN/D182). Thus, a total of 27 studies 3,4,30–54 satisfied the inclusion criteria and were included in this review. The full flow diagram for study inclusion can be viewed in figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Across all studies, 3,4,30–54 a total of 2,317 patients were assessed, of which 5 regional anesthetic strategies were investigated: 613 patients received LIA alone, 30–34,37,41,42,44,45,48,49,51–53,56 939 received LIA with single-injection ACB, 3,31,33,35,36,38–42,44–46,48,49,51–55 585 received LIA with continuous ACB, 3,4,30,32,34–38,40,43,46,51,55 58 received LIA with single-injection ACB and single-injection iPACK, 39,47 and 122 received LIA with continuous ACB and single-injection iPACK. 4,43,54 The primary anesthetic was general anesthesia in 6 studies, 35,39,49,50,53,55 spinal in 20 studies, 4,30–34,36–38,40–48,52,54 and general or spinal in 1 study. 3 Regarding outcome assessment, 25 studies 3,4,30–35,37–41,43–54 assessed early postoperative pain (within 24 h), and 23 studies 3,4,30–35,37–40,42,44,45,47–54 assessed late postoperative pain (after 24 h).…”

Section: Resultsmentioning

confidence: 99%

Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis

et al. 2023

View full text Add to dashboard Cite

Background The analgesic effectiveness of contemporary motor-sparing nerve blocks used in combination for analgesia in total knee arthroplasty (TKA) is unclear. We conducted this network meta-analysis to evaluate the analgesic effectiveness of adding single-injection or continuous adductor canal block (ACB) with or without infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (iPACK) to intraoperative local infiltration analgesia (LIA), compared to LIA alone, following TKA. Methods Randomized trials examining the addition of single-injection or continuous ACB with or without single-injection iPACK to LIA for TKA were considered. The two primary outcomes were area under the curve (AUC) pain scores and postoperative function over 24-48 hours. Secondary outcomes included rest pain scores at 0, 6, 12, and 24 hours, opioid consumption (0-24- and 25-48-hours), and incidence of nausea/vomiting. Network meta-analysis was conducted using a frequentist approach. Results Twenty-seven studies (2,317 patients) investigating the addition of i) single-injection ACB, ii) continuous ACB, iii) single-injection ACB and single-injection iPACK, and iv) continuous ACB and single-injection iPACK to LIA, compared to LIA alone, were included. For AUC 24–48-hour pain, the addition of continuous ACB with single-injection iPACK displayed the highest p-score probability (89%) of being most effective for pain control. The addition of continuous ACB without single-injection iPACK displayed the highest p-score probability (87%) of being most effective for postoperative function. Conclusions Our results suggest that continuous ACB, but not single-injection ACB and/or single-injection iPACK, can provide statistically superior analgesia when added to LIA for TKA compared to LIA alone. However, the magnitude of these additional analgesic benefits is clinically questionable.

show abstract

“…27 Despite significant evidence supporting the use of magnesium in peripheral nerve blocks, not all reports support using magnesium as an adjunct. Zoratto et al, 28 in a prospective randomized control trial studying the addition of magnesium to ropivacaine in ACBs for TKA, reported no analgesic benefit when compared with the control group that only received a ropivacaine ACB. However, all patients in this trial received intrathecal morphine and the primary outcome was time to first analgesic (patient-controlled analgesia with morphine), so these results must be interpreted with some caution.…”

Section: Discussionmentioning

confidence: 99%

Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption

Choi

Lahori

Merlo

et al. 2022

The Clinical Journal of Pain

View full text Add to dashboard Cite

Objectives: Adequate pain management is a critical component of facilitating same-day discharge for total knee arthroplasty (TKA). Adductor canal blocks (ACB) have been shown to be an effective technique for managing pain after TKA. The objective of this study was to investigate the impact of adding magnesium to local anesthetic in ACB on postoperative pain, opioid consumption, nausea, and overall patient satisfaction. Materials and Methods: A sample of 119 adults undergoing elective unilateral TKA were included. Patients were randomly assigned to receive ACB with magnesium and bupivacaine (n=56) or with bupivacaine only (n=63). Primary outcomes were total opioid consumption in the first 48 hours after surgery and pain scores. Secondary outcomes were the incidence of nausea in the first 48 hours after surgery and total overall satisfaction. Results: Opioid consumption decreased significantly in the Mg group compared with the no-Mg group over the first 24 hours (33.2±3.0 vs. 21.3±2.4, P=0.003), the second 24 hours (35.4±2.7 vs. 27.3±2.3, P=0.026), and the first 48 hours total after surgery (68.6±5.1 vs. 48.6±4.3, P=0.004). Pain scores were reduced in the Mg group (24 h: 5.1±2.3 vs. 3.5±2.0, P=0.000; 48 h: 5.1±1.6 vs. 3.9±1.6, P=0.000). Secondary outcomes showed no difference in the incidence of nausea over the first 48 hours and overall satisfaction. Conclusion: The addition of magnesium to local anesthetic in ACB decreases pain scores and opioid consumption, without increasing nausea, when compared with ACB with local anesthetic alone.

show abstract

Adductor canal block with or without added magnesium sulfate following total knee arthroplasty: a multi-arm randomized controlled trial

Cited by 4 publications

References 17 publications

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis

Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption

Contact Info

Product

Resources

About