Comparative study of the influence of adductor canal block plus multimodal periarticular infiltration versus combined adductor canal block, multimodal periarticular infiltration and intra-articular epidural catheter ropivacaine infiltration on pain relief after total knee arthroplasty: a prospective study

Dannana, Chandra Sekhar; Apsingi, Sunil; Ponnala, Vinay Kishore; Bollavaram, V R; Boyapati, Giridhar; Eachempati, Krishna Kiran

doi:10.1007/s12306-019-00613-2

Cited by 6 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A RCT by Beausang et al 28 compared the independent use of ACB versus intra-articular local anaesthetic infusions, and showed the superiority of ACB in reducing pain and opiate consumption 24 hours after TKA. Dannana et al 10 evaluated pain relief after TKA with ACB with periarticular infiltration of the knee, versus ACB combined with local infiltration and intra-articular ropivacaine boluses. They concluded that the additional use of intra-articular ropivacaine was associated with significant reduction in pain after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-articular catheter (IAC) with infusion of a local anaesthetic (ropivacaine) has also been reported to provide adequate analgesia following surgery without any systemic effects. 9 Dannana et al 10 studied the efficacy of ACB+ multimodal periarticular infiltration (MPI) with and without local anaesthetic infusion via IAC, reporting increased pain relief in the group with additional local anaesthetic infusion. However, this was a non-randomized prospective study.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

et al. 2021

View full text Add to dashboard Cite

Aims Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone. Methods This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain. Results The study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014). Conclusion Combined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA. Cite this article: Bone Jt Open 2021;2(12):1082–1088.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Deep injection before cementation: 30 ml 0.5% bupivacaine with 1:3000.000 epinephrine plus methylprednisolone 40 mg/l plus cefazolin 500 mg in 10 ml and normal saline 22 ml The superficial injection, before closure: 20 ml 0.25% bupivacaine Sankineani et al [24], 2018 30 ml 0.2% ropivacaine, 40 mg ketorolac, 0.5 ml of adrenaline, 4mg of morphine sulfate and 30ml of distilled water Dannana et al [25], 2020 30 ml 0.2% ropivacaine, 30 mg ketorolac, inj. adrenaline 0.5 ml 1:1000 solution, inj.…”

Section: Buprenorphinementioning

confidence: 99%

“…Recent studies have shown that LIA combined with ACB [24,25] or FNB [1] has addictive effects on pain relief and opioid consumption after TKA. On the other hand, Mayr et al, [43] evaluated that there is no significant difference in pain relief comparing LIA to continuous peripheral nerve blocks in perioperative pain management.…”

Section: Buprenorphinementioning

confidence: 99%

Pain management in total knee arthroplasty. A comprehensive review

Domagalska¹,

Reysner²

2022

Chir. Narzadow Ruchu Ortop. Pol.

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end-stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for the perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and urine retention, which limit their application in daily clinical practice. This review aimed to discuss the current postoperative pain management regimens for TKA. Our review of literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications, including preemptive analgesia, especially local infiltration analgesia and peripheral nerve blockade. Multimodal analgesia provides superior pain relief, promotes knee recovery, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

show abstract

Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial

et al. 2020

View full text Add to dashboard Cite

Cited by 6 publications

References 28 publications

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

Pain management in total knee arthroplasty. A comprehensive review

Contact Info

Product

Resources

About