title: Single-Dose Adductor Canal Block With Local Infiltrative Analgesia Compared With Local Infiltrate Analgesia After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.
abstract: A single-dose adductor canal block can provide postoperative analgesia for patients undergoing total knee arthroplasty (TKA). The purpose of this study was to assess postoperative opioid consumption after ultrasound-guided single-injection bupivacaine compared with saline adductor canal block for patients undergoing TKA.
  
  
  
  After institutional review board approval, written informed consent was obtained from patients (>18 years old) undergoing elective TKA. Subjects were randomized into 2 groups as follows: adductor canal blockade with 10 mL of bupivacaine 0.25% with epinephrine 1:300,000 or 10 mL of normal saline. All patients received a periarticular infiltration mixture intraoperatively with scheduled and patient requested oral and IV analgesics postoperatively for breakthrough pain. Personnel blinded to group allocation recorded pain scores and opioid consumption every 6 hours. Pain burden, area under the numeric rating score for pain, was calculated for 36 hours. The primary outcome was postoperative IV/IM morphine (mg morEq) consumption at 36 hours after surgery.
  
  
  
  Forty (28 women/12 men) subjects were studied. Postoperative opioid consumption was reduced in the bupivacaine 48 (39 to 61) mg morEq compared with saline 60 (49 to 85) mg morEq, difference -12 (-33 to -2) mg morEq (P = 0.03). Pain burden at rest was decreased in the bupivacaine 71 (37 to 120) score · hours compared with saline 131 (92 to 161) score · hours, difference -60 (-93 to -14) score · hours (P = 0.009).
  
  
  
  Adductor canal blockade with bupivacaine 0.25% with epinephrine 1:300,000 effectively reduces pain and opioid requirement in the postoperative period after TKA. Adductor canal blockade is an effective pain management adjunct for patients undergoing TKA.
authors: From the Departments of *Anesthesiology, and †Orthopedics, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors: Antoun
authors: A
authors: Nader
authors: Mark C
authors: MC
authors: Kendall
authors: David W
authors: DW
authors: Manning
authors: Matthew
authors: M
authors: Beal
authors: Rohit
authors: R
authors: Rahangdale
authors: Robert
authors: R
authors: Dekker
authors: Gildasio S
authors: GS
authors: De Oliveira
authors: Eric
authors: E
authors: Kamenetsky
authors: Robert J
authors: RJ
authors: McCarthy
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002641:Chicago; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000294:innervation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine