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SHR Neuro Cancer Cardio Lipid Metab Microb
Schittek, GA; Reinbacher, P; Rief, M; Gebauer, D; Leithner, A; Vielgut, I; Labmayr, V; Simonis, H; Köstenberger, M; Bornemann-Cimenti, H; Sandner-Kiesling, A; Sadoghi, P.
Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty.
Knee Surg Sports Traumatol Arthrosc. 2022; 30(12):4046-4053
Doi: 10.1007/s00167-022-06868-w
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- Leading authors Med Uni Graz
- Reinbacher Patrick
- Sadoghi Patrick
- Schittek Gregor Alexander
- Co-authors Med Uni Graz
- Bornemann-Cimenti Helmar
- Gebauer David
- Köstenberger Markus
- Labmayr Viktor
- Leithner Andreas
- Rief Martin
- Sandner-Kiesling Andreas
- Simonis Holger
- Vielgut Ines
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- Abstract:
- INTRODUCTION: After primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound-guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA-LIA versus URSA with dexmedetomidine-were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA. METHODS: Fifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml-1) or two single-shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed. RESULTS: In the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5-57.0] mg versus 27.0 [IQR 0.0-33.5] mg (P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol. CONCLUSION: This is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid-sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid-sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Anesthesia, Local - methods
- Arthroplasty, Replacement, Knee - adverse effects, methods
- Ropivacaine - administration & dosage
- Femoral Nerve - administration & dosage
- Analgesics, Opioid - administration & dosage
- Pain, Postoperative - drug therapy, prevention & control, etiology
- Dexmedetomidine - therapeutic use
- Nerve Block - methods
- Anesthetics, Local - therapeutic use
- Find related publications in this database (Keywords)
- Postoperative pain
- Opioid sparing
- Total knee replacement
- Local infiltration anaesthesia
- Ultrasound-guided regional nerve blocks
- Dexmedetomidine