Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?

Kwon

et al. 2022

JCM

Peripheral nerve block (PNB) for patients with total knee arthroplasty (TKA) is one of the recommended interventions in ERAS protocols. However, most existing studies involved unilateral TKA (UTKA). As such, this study aimed to evaluate the effectiveness of PNB in terms of immediate postoperative analgesia, length of hospital stays (LOS), and early functional outcomes in both UTKA and simultaneous bilateral TKAs (BTKAs). We reviewed 236 patients who underwent primary TKA with PNB, with 138 and 98 being UTKA and BTKAs, respectively; those in the PNB group underwent femoral nerve and adductor canal block. The matched control and PNB groups—who received intravenous/epidural patient-controlled analgesia (IVPCA/PCEA) alone or IVPCA in addition to PNB after surgery, respectively—were compared. The VAS scores at rest until 48 h after surgery were significantly lower in PNB groups compared to those in the IVPCA groups. At 0– 6 h of activity, VAS scores of the UTKA with PNB group were also lower than the IVPCA group. Compared to PCEA groups, VAS scores at 0–6 h of activity were higher in both the UTKA and BTKAs with PNB groups. However, at 24–48 h at rest, the scores of those in the UTKA with PNB group were lower than those in the PCEA group. The control and experimental UTKA and BTKAs groups had similar LOS and functional outcomes at 90 days postoperatively. In primary TKA, PNB has great analgesic effects for immediate postoperative pain control, and represents a similar analgesic effect to epidural PCA.

Section: Discussionmentioning

confidence: 99%

Effectiveness of ERAS (Enhanced Recovery after Surgery) Protocol via Peripheral Nerve Block for Total Knee Arthroplasty

Kwon

et al. 2022

JCM

“…ACB could also reduce the risk of quadriceps weakness and falling risk 25 . ACB had both single and continuous techniques, but the advantages of each technique are debatable 26 . By blocking the saphenous nerve and the posterior branch of the obturator nerve, SACB provided satisfied analgesic effects on the anteromedial part of the knee.…”

Section: Discussionmentioning

confidence: 99%

IPACK (Interspace between the Popliteal Artery and the Capsule of the Posterior Knee) Block Combined with SACB (Single Adductor Canal Block) VersusSACB for Analgesia after Total Knee Arthroplasty

Tang

Jiang

Lei

et al. 2022

Orthopaedic Surgery

Objectives To evaluate the combination of the infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block and single adductor canal block (SACB) versus SACB for motor‐sparing knee analgesia effects after total knee arthroplasty (TKA). Methods PubMed, Ovid, Cochrane Library, and other databases were searched from the inception to January 2021. Randomized controlled trials (RCTs) comparing patients receiving iPACK plus SACB with patients receiving SACB after TKA were included. The included studies were assessed by two reviewers according to the Cochrane risk of bias criteria. Meta‐analysis was performed with STATA 13.0 software, the risk ratios (RR) and mean differences (MD) were used to compare dichotomous and continuous variables. The primary outcome was ambulation pain and secondary outcomes were rest pain, opioid consumption, function ability, clinical outcomes, and complications. Results Seven RCTs (304 knees in iPACK + SACB group; 305 knees in SACB group) were included. The follow‐up periods ranged from 2 days to 3 months. Pooled data indicated lower pain scores at ambulation (p < 0.0001) for iPACK + SACB. When comparing the pain scores of subgroups analyzed at specific periods, lower scores in subgroups within 12 h (at rest and ambulation) and after 48 h (at ambulation) were observed in the iPACK + SACB group. Analysis demonstrated greater reduction in morphine consumption (p = 0.007) in the iPACK + SACB group. The iPACK + SACB group is also superior to the SACB group regarding function ability, which included range of motion (ROM) (p = 0.001), time up to go (TUG) test (p = 0.030), and ambulation distance (p < 0.0001). No difference was found in clinical outcomes or complications. Conclusions With the iPACK added to SACB, pain scores, morphine consumption, functional ability were improved. Additional high‐quality studies are required to further address this topic.

“…Concomitantly, the efficacy of nerve blocks in alleviating pain is mirrored by a reduced need to consume opioids [31,49,[58][59][60][61][62][63][64][65]. More specifically, these assertions have been verified for the analgesic power of AC [66][67][68][69][70], femoral [71,72], femoral triangle [70], ESP [73], transverse abdominis plane (TAP) [74,75], and other nerve blocks. Despite exerting a protracted analgesic effect compared to sPNBs, cPNBs have been restricted to inpatient settings for safety purposes secondary to the possible complications arising from the use of catheters [49].…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Multiple Single-Shot Peripheral Nerve Blocks on Postoperative Short-Term Opioid Usage and Clinical Outcomes in a Suburban Hospital Setting

et al. 2022

Background: Preoperative single-shot peripheral nerve blocks (sPNBs) represent promising candidates for controlling postoperative pain, reducing dependence on opioid medications, and reducing postoperative constipation and ileus. However, there is not yet complete consensus regarding their efficacy. The primary aim of this study was to assess the impact of various sPNBs on patient short-term opioid demands and pain management parameters.Methods: This single-center study retrospectively reviewed a cohort of 94 adult, elective surgery inpatients (ASA physical status I-III) scheduled for different operations. Sixty-four (68.1%) were selected for sPNB administration (group 1) and compared to the untreated group (group 0) for different clinical parameters.Results: Contrary to the starting hypothesis, a higher proportion of group 1 patients experienced increasing pain intensities during the immediate postoperative period (P < 0.05, Fisher's exact test), while requiring more bowel care medications (P < 0.05, χ 2 test). Multiple linear regression modeling, however, showed that recovery time positively correlated with the opioid amount consumed (P < 0.01). Although limited, the results obtained in this study do not support an analgesic efficacy for sPNBs. Conclusion:In conclusion, even though our data must be viewed within the limitations of our retrospective study and small group size, we did not find any compelling evidence for the efficacy of sPNB administration in the perioperative period.