Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Gabriel, Rodney A.

doi:10.1016/j.anclin.2018.05.002

Cited by 18 publications

(12 citation statements)

References 65 publications

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“…55 Pain after knee arthroplasty is notoriously challenging to treat and frequently lasts multiple weeks or even months, 93 and consequently may be a suitable procedure for cryoneurolysis. 94 However, application to the femoral nerve at the inguinal ligament or even more distally within the adductor canal has a high probability of inducing quadriceps weakness. 95 Therefore, investigators have targeted exclusively sensory nerves surrounding the knee, including the anterior femoral cutaneous and infrapatellar branch of the saphenous nerve.…”

Section: Percutaneous Application To Acute Painmentioning

confidence: 99%

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

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Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.

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Section: Percutaneous Application To Acute Painmentioning

confidence: 99%

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

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“…However, postoperative pain after TKA is often moderate to severe and limits this goal [3]. Several modalities have been utilised to decrease postoperative pain such as epidural analgesia, systemic analgesia, periarticular injection (PAI), femoral nerve block (FNB) and adductor canal block (ACB) [3][4][5][6]. Whereas, the systemic analgesia through opioids can have systemic side effects like vomiting and sedation [7], the FNB can cause quadriceps weakness [8] and occasional falls [9].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Bagaria

Kulkarni

Valavi

et al. 2020

Knee Surg & Relat Res

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Background Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration. Materials and methods Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas. Results The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8−14°) and 6° (3.8−11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5−10.5°) and 29° (19−43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal. Conclusion The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.

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“…Alternative areas of investigation for pain control following rTHA include additional doses of steroids, IV Tylenol, ibuprofen injections, more robust periarticular injections, ketamine, or cryoanalgesia. [27][28][29][30][31][32] These adjuncts have been investigated with respect to primary arthroplasty, but there is minimal research that has been done into how they can influence postoperative narcotics following revision THA. It is important we understand how to best control pain in our revision THA patients in order to help facilitate mobilisation, recovery, and patient satisfaction as well as to reduce the overall narcotic consumption.…”

Section: Resultsmentioning

confidence: 99%

Revision total hip arthroplasty is associated with significantly higher opioid consumption as compared to primary total hip arthroplasty in the acute postoperative period

Bernstein¹,

Feng²,

Mahure³

et al. 2020

HIP International

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Background: There are currently a lack of investigations that characterised narcotic utilisation following revision total hip arthroplasty (THA). We sought to determine if immediate post-surgical opioid use was different between revision THA and primary THA. Methods: A single institution total joint arthroplasty database was used to identify adult patients who underwent revision THA or primary THA from 2016 to 2019. Morphine milligram equivalents (MME) were calculated for different time periods. Results: 6977 patients were identified, 89.72% primary THA and 10.28% revision THA. Aggregate opioid consumption was higher for revision THA patients (317.40 MME vs. 93.01 MME), as was opioid consumption in the first 24 hour and second 24-hour periods. Visual analogue pain (VAS) scores were significantly higher in the 0–12 hour postoperative and the 12–24 hours postoperative periods in the revision THA group. Conclusions: Patients undergoing revision THA had significantly higher narcotic utilisation than those undergoing primary THA, particularly in the first 24 hours postoperatively.

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Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Cited by 18 publications

References 65 publications

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Revision total hip arthroplasty is associated with significantly higher opioid consumption as compared to primary total hip arthroplasty in the acute postoperative period

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