title: Addition of buprenorphine to local anesthetic in adductor canal blocks after total knee arthroplasty improves postoperative pain relief: a randomized controlled trial.
abstract: OBJECTIVE
  For the hundreds of thousands of patients who undergo total knee arthroplasty (TKA) in the United States each year, early mobilization has been demonstrated to improve functional outcomes and reduce complications. Management of postoperative pain is a critical factor in achieving early mobilization. Recent studies have shown that the use of an adductor canal block (ACB) after TKA results in increased preservation of quadriceps muscle strength, without significant difference in postoperative pain when compared to femoral nerve block. This increased preservation of quadriceps muscle strength leads to earlier mobilization. Studies have also demonstrated a prolongation of analgesia with the addition of buprenorphine to local anesthetic for regional block placement. This study examined the effect on postoperative opioid consumption when adding buprenorphine to an ACB vs an ACB with local anesthetic alone, for postoperative analgesia after unilateral TKA.
  
  
  METHODS
  A total of 100 patients scheduled for TKA were randomized to receive postoperative ACB with local anesthetic alone or with local anesthetic and buprenorphine. The primary outcome examined was total opioid analgesic (milligrams of hydrocodone equivalent) consumption in the first 24 hours postsurgery. The secondary outcomes examined were the reported incidence of the opioid side effects nausea, vomiting, and pruritis.
  
  
  RESULTS
  Postoperative opioid consumption decreased significantly in the group that received an ACB with local anesthetic and buprenorphine compared to an ACB with local anesthetic only (25.34±2.62 vs 35.84±2.86; P=.0076). Secondary outcomes showed no statistical difference between the 2 groups in terms of the incidence of nausea, vomiting, or pruritus.
  
  
  CONCLUSIONS
  The addition of buprenorphine to an adductor canal block decreases postoperative opioid consumption when compared to an ACB with local anesthetic alone. This reduction in opioid consumption, without significant increase in side effects, makes this an attractive anesthetic adjunct for TKA.
authors.affiliation: Department of Anesthesiology, Wayne State University School of Medicine, St Joseph Mercy Oakland Medical Office Building, 44555 Woodward Avenue, Suite 308, Pontiac, MI 48341. Electronic address: sakrishna@med.wayne.edu.
authors.forename: Sandeep H
authors.initials: SH
authors.lastname: Krishnan
authors.affiliation: Department of Anesthesiology, Wayne State University School of Medicine, St Joseph Mercy Oakland Medical Office Building, 44555 Woodward Avenue, Suite 308, Pontiac, MI 48341. Electronic address: Lisa.gilbert@stjoeshealth.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Gilbert
authors.affiliation: Department of Anesthesiology, Wayne State University School of Medicine, University Health Decter (UHC) Bldg, Section 4J, Room #28, Detroit, MI 48201. Electronic address: fghoddoussi@med.wayne.edu.
authors.forename: Farhad
authors.initials: F
authors.lastname: Ghoddoussi
authors.affiliation: Department of Anesthesiology, Wayne State University School of Medicine, St Joseph Mercy Oakland Medical Office Building, 44555 Woodward Avenue, Suite 308, Pontiac, MI 48341. Electronic address: dapplefi@med.wayne.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Applefield
authors.affiliation: Department of Orthopedic Surgery, St Joseph Mercy Oakland Hospital, Orthopedic Specialists of Oakland County, 44038 Woodward Avenue, Suite 200, Bloomfield, MI 48302. Electronic address: safakassab@gmail.com.
authors.forename: Safa S
authors.initials: SS
authors.lastname: Kassab
authors.affiliation: Department of Anesthesiology, Wayne State University School of Medicine, St Joseph Mercy Oakland Medical Office Building, 44555 Woodward Avenue, Suite 308, Pontiac, MI 48341. Electronic address: tellis@med.wayne.edu.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Ellis
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002047:Buprenorphine; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011537:Pruritus / Q000139:chemically induced / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002047:Buprenorphine
keywords: Adductor canal block; Buprenorphine; Postoperative opioid consumption; Postoperative pain; Total knee arthroplasty