Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.
Knee
; 26(3): 679-686, 2019 Jun.
Article
en En
| MEDLINE
| ID: mdl-30904327
ABSTRACT
BACKGROUND:
There is a growing interest in avoiding discharging patients to rehab to maximize outcome and minimize complications after total knee arthroplasty (TKA). In addition, use of postoperative pain pathways that minimize opioid use is critical amidst the current opioid epidemic. However, the ideal pain regimen after TKA has yet to be determined.METHODS:
From July 1, 2013 to October 1, 2014 two perioperative pathways were used to address surgical pain. These included either a single shot femoral nerve block plus liposomal bupivacaine pericapsular injection (FNBâ¯+â¯LB-PAI) or adductor canal catheter plus posterior capsule single shot block (ACCâ¯+â¯iPACK), each with an oral analgesic protocol. Little modification occurred with regard to surgical technique, postoperative medications, or postoperative physical therapy (PT).RESULTS:
Overall, 264 unilateral, primary TKA patients (146 FNBâ¯+â¯LB-PAI, 118 ACCâ¯+â¯iPACK) were included. ACCâ¯+â¯iPACK patients had a shorter median length of stay (LOS, 2.0 vs 3.0, pâ¯<â¯0.001), more discharges home (79.7% vs 67.8%, pâ¯=â¯0.002), and less median opioid consumption (IV morphine equivalents, IVME, 20.0 vs 44.1, pâ¯<â¯0.001) than the FNBâ¯+â¯LB-PAI group. In multivariable analysis, use of ACCâ¯+â¯iPACK remained independently associated with shorter LOS, increased discharge home, and less IVME consumed when controlling for confounding variables. ACCâ¯+â¯iPACK patients also had fewer opioid related adverse events (0.8 vs 5.5, pâ¯=â¯0.045) and a lower rate of MUA (0.8% vs 6.2%, pâ¯=â¯0.026).CONCLUSIONS:
We recommend ACCâ¯+â¯iPACK with a multimodal oral analgesic protocol as the primary postoperative analgesia in enhanced recovery TKA protocols. This resulted in an easier recovery with fewer complications. LEVEL OF EVIDENCE Level III.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Dolor Postoperatorio
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Alta del Paciente
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Artroplastia de Reemplazo de Rodilla
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Analgésicos Opioides
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Bloqueo Nervioso
Tipo de estudio:
Guideline
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Observational_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
Idioma:
En
Año:
2019
Tipo del documento:
Article