Reducing Narcotic Usage With 0.5% Bupivacaine Periarticular Injections in Total Knee Arthroplasty

Hagar, Andrew; Fang, Christopher; Dannenbaum, Joseph H.; Smith, Eric L.; Bono, James V.; Talmo, Carl T.

doi:10.1016/j.arth.2022.01.026

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…40 This finding has further been supported in a randomized control trial by Pic et al, 41 who found that PAI was noninferior to ACB. This has important implications that ACBs may be eliminated without compromising pain control, provided the local anesthetic dose in the PAI is adjusted in the absence of ACB as described by Hagar et al 40 This may also enhance the safety profile of anesthetic protocols as the surgical and anesthesia teams must be mindful of total anesthetic dosage, although a study of serum ropivacaine after combined subarachnoid, ACB, and PAI application maintained levels well below the 3.0 µg/mL toxicity levels. 42 The pharmacokinetic properties of local anesthetics are complex, and while cleared primarily through renal processing, nonrenal clearance is often able to accommodate.…”

Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 63%

“…The authors found that patients receiving a higher concentration of bupivacaine in the PAI alone group had lower hospital narcotic usage compared with a lower concentration used for combined PAI and ACB. 40 This finding has further been supported in a randomized control trial by Pic et al, 41 who found that PAI was noninferior to ACB. This has important implications that ACBs may be eliminated without compromising pain control, provided the local anesthetic dose in the PAI is adjusted in the absence of ACB as described by Hagar et al 40 This may also enhance the safety profile of anesthetic protocols as the surgical and anesthesia teams must be mindful of total anesthetic dosage, although a study of serum ropivacaine after combined subarachnoid, ACB, and PAI application maintained levels well below the 3.0 mg/mL toxicity levels.…”

Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 63%

“…38 However, studies have also shown that the combination of ACB and PAI does not have improved efficacy when compared with PAI alone. 39 Hagar et al 40 retrospectively reviewed three cohorts of patients who received either PAI alone (0.5% bupivacaine or 0.25% bupivacaine) or PAI (0.25% bupivacaine) with ACB. The authors found that patients receiving a higher concentration of bupivacaine in the PAI alone group had lower hospital narcotic usage compared with a lower concentration used for combined PAI and ACB.…”

Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 99%

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Periarticular Injection in Total Knee Arthroplasty

Schwartz

Cochrane

Jiranek

et al. 2023

J Am Acad Orthop Surg

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Optimal pain management after total knee arthroplasty (TKA) can expedite postoperative recovery, improve perioperative outcomes, and increase patient satisfaction. Periarticular injections (PAIs) have become increasingly used to improve pain management after TKA. Similar to peripheral nerve blocks, the use of intraoperative PAIs can lower pain scores and expedite discharge from the hospital. However, there is notable variability in the ingredients and administration techniques of PAIs. Currently, no standard of care exists for PAIs, especially in the setting of adjuvant peripheral nerve blocks. This study seeks to evaluate the ingredients, administration techniques, and outcomes of PAIs used during TKA. Pain control is an important component of recovery after total knee arthroplasty (TKA) and, when managed effectively, can expedite functional recovery and, ultimately, improve patient satisfaction. Evidence suggests that patients with poor pain control in the initial 48 hours postoperatively are limited in their ability to achieve long-term pain relief. 1 Efforts to improve pain control and avoid adverse effects of analgesic medications have led to the widespread use of multimodal analgesia to help facilitate rapid mobilization of TKA patients. Multimodal pain control modalities, including oral opioids, nonsteroidal anti-inflammatory medications, acetaminophen, and local or regional anesthetics including peripheral nerve blocks (PNBs) and periarticular injections (PAIs), have become the standard of care. 2 Still, notable variability exists with the use of local and regional anesthesia. Thus, this review will compare current pain management strategies after TKA and focus on the delivery and efficacy of PAIs. History of Periarticular InjectionsIn the past several decades, pain management after TKA has evolved markedly. During the 1980s, the cornerstone of pain management after TKA consisted of intramuscular injections of opioids. This slowly transitioned to patient-controlled analgesia in the 1990s, PNBs in the early 2000s, and finally, multimodal analgesia with the addition of PAIs in the late 2000s. The first prospective, randomized control trial on PAIs was published by Busch et al 3 in 2006. The authors randomized 64 patients undergoing TKA to receive a PAI containing ropivacaine, ketorolac, morphine, and adrenaline or to receive no

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Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 63%

Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 63%

Section: Periarticular Injection and Peripheral Nerve Blockmentioning

confidence: 99%

See 1 more Smart Citation

Periarticular Injection in Total Knee Arthroplasty

Schwartz

Cochrane

Jiranek

et al. 2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

“…The dose of bupivacaine in LIA used in our study was also less than in some other studies. Hagar et al injected bupivacaine at a dose ranging from 125 mg to 250 mg in their studies ( 3 ). Moreover, amounts as high as 300 mg of bupivacaine have also been reported in a study from Peterson et al without any occurrence of LAST ( 4 ).…”

mentioning

confidence: 99%