Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study
Background: Adductor canal blocks (ACBs), typically administered with a local anesthetic such as bupivacaine, help control perioperative pain after total knee arthroplasty. Recently, liposomal bupivacaine (LB) was introduced in an attempt to extend the duration of analgesia, used primarily in periar...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-09-01
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| Series: | Arthroplasty Today |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235234411930041X |
| _version_ | 1828861794611888128 |
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| author | Akshay Lakra, MD Matthew Grosso, MD Emma L. Jennings, BS H. John Cooper, MD Roshan P. Shah, MD Jeffrey A. Geller, MD |
| author_facet | Akshay Lakra, MD Matthew Grosso, MD Emma L. Jennings, BS H. John Cooper, MD Roshan P. Shah, MD Jeffrey A. Geller, MD |
| author_sort | Akshay Lakra, MD |
| collection | DOAJ |
| description | Background: Adductor canal blocks (ACBs), typically administered with a local anesthetic such as bupivacaine, help control perioperative pain after total knee arthroplasty. Recently, liposomal bupivacaine (LB) was introduced in an attempt to extend the duration of analgesia, used primarily in periarticular injections (PAIs). The purpose of this study was to compare pain control and early perioperative outcomes with ACB using LB vs standard bupivacaine (SB). Methods: We retrospectively compared pain control in a group of 75 patients with ACB and PAI with SB to that of a cohort of 75 patients who received ACB and PAI with LB. The primary outcome measure was pain measured using the visual analog score. The secondary outcome measures were morphine equivalents of pain medication (ME), physical therapy distance ambulated, disposition status, and length of stay. Results: There were no significant differences between the two cohorts for age, gender, body mass index, preoperative diagnosis, or American Society of Anesthesiologists. Visual analog scores were significantly lower in the LB group for postoperative day (POD) 0 (2.1 vs 2.8, P = .046), POD 1 (2.2 vs 3.3, P < .001), and POD 2 (2.1 vs 3.7, P = .001) than those in the SB group. The LB group consumed significantly fewer ME on the POD 0 (18.7 vs 25.2, P = .02) and POD 1 (23.4 vs 37.8, P = .003), as well as overall ME/day (24.6 vs 41.7, P < .001). The LB group walked more on POD 0 (261.6 vs 108.2, P < .001) and POD 1 (761.5 vs 372.0, P < .001). Conclusions: We report improved outcomes across all measures for the LB group. There were no adverse events. This study supports the use of LB for ACBs in total knee arthroplasty. Keywords: Total knee arthroplasty, Adductor canal block, Pain, Liposomal bupivacaine, Bupivacaine |
| first_indexed | 2024-12-13T03:09:48Z |
| format | Article |
| id | doaj.art-6566c4d17668444ab9ac4e94f4c3c2a8 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-13T03:09:48Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-6566c4d17668444ab9ac4e94f4c3c2a82022-12-22T00:01:38ZengElsevierArthroplasty Today2352-34412019-09-0153325328Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort studyAkshay Lakra, MD0Matthew Grosso, MD1Emma L. Jennings, BS2H. John Cooper, MD3Roshan P. Shah, MD4Jeffrey A. Geller, MD5Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USACenter for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USACenter for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USACenter for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USACenter for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USACorresponding author. 622 West 168th Street, PH1147, New York, NY 10032, USA. Tel.: +1 212 305 1120.; Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, New York -Presbyterian Hospital, New York, NY, USABackground: Adductor canal blocks (ACBs), typically administered with a local anesthetic such as bupivacaine, help control perioperative pain after total knee arthroplasty. Recently, liposomal bupivacaine (LB) was introduced in an attempt to extend the duration of analgesia, used primarily in periarticular injections (PAIs). The purpose of this study was to compare pain control and early perioperative outcomes with ACB using LB vs standard bupivacaine (SB). Methods: We retrospectively compared pain control in a group of 75 patients with ACB and PAI with SB to that of a cohort of 75 patients who received ACB and PAI with LB. The primary outcome measure was pain measured using the visual analog score. The secondary outcome measures were morphine equivalents of pain medication (ME), physical therapy distance ambulated, disposition status, and length of stay. Results: There were no significant differences between the two cohorts for age, gender, body mass index, preoperative diagnosis, or American Society of Anesthesiologists. Visual analog scores were significantly lower in the LB group for postoperative day (POD) 0 (2.1 vs 2.8, P = .046), POD 1 (2.2 vs 3.3, P < .001), and POD 2 (2.1 vs 3.7, P = .001) than those in the SB group. The LB group consumed significantly fewer ME on the POD 0 (18.7 vs 25.2, P = .02) and POD 1 (23.4 vs 37.8, P = .003), as well as overall ME/day (24.6 vs 41.7, P < .001). The LB group walked more on POD 0 (261.6 vs 108.2, P < .001) and POD 1 (761.5 vs 372.0, P < .001). Conclusions: We report improved outcomes across all measures for the LB group. There were no adverse events. This study supports the use of LB for ACBs in total knee arthroplasty. Keywords: Total knee arthroplasty, Adductor canal block, Pain, Liposomal bupivacaine, Bupivacainehttp://www.sciencedirect.com/science/article/pii/S235234411930041X |
| spellingShingle | Akshay Lakra, MD Matthew Grosso, MD Emma L. Jennings, BS H. John Cooper, MD Roshan P. Shah, MD Jeffrey A. Geller, MD Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study Arthroplasty Today |
| title | Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study |
| title_full | Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study |
| title_fullStr | Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study |
| title_full_unstemmed | Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study |
| title_short | Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study |
| title_sort | improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement a retrospective cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S235234411930041X |
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