title: Does Addition of Multimodal Periarticular Analgesia to Adductor Canal Block Improve Lengths of Stay, Pain, Discharge Status, and Opioid Use After Total Knee Arthroplasty?
abstract: Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately. The purpose of this study was to compare: (1) lengths of stay (LOS), (2) pain level, (3) discharge status, and (4) opioid use in TKA patients who received ACB alone vs patients who received ACB and MPA.
  
  
  
  A single surgeon database was reviewed for patients who had a TKA between January 2015 and April 2016. Patients who received ACB with or without MPA were included. This yielded 127 patients who had a mean age of 63 years. Patients were grouped into having received ACB alone (n = 52) and having received ACB and MPA (n = 75). Patient records were reviewed to obtain demographic and end point data (LOS, pain, discharge status, and opioid use). Student t test and chi-squared test were used to compare continuous and categorical variables respectively.
  
  
  
  There were no significant difference in mean LOS (P = .934), pain level (P = .142), discharge status (P = .077), or total opioid use (P = .708) between the 2 groups.
  
  
  
  There was no significant difference in LOS, pain levels, discharge status, and opiate requirements between the 2 groups. ACB alone may be as effective as combined ACB and MPA in TKA patients for postoperative pain control. Larger prospective studies are needed to verify these findings and to improve generalization.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Chukwuweike U
authors.initials: CU
authors.lastname: Gwam
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Jaydev B
authors.initials: JB
authors.lastname: Mistry
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Melbin
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018482:Muscle, Skeletal; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D010351:Patient Discharge; D011446:Prospective Studies; D012189:Retrospective Studies; D013848:Thigh
keywords: adductor canal block; multimodal periarticular analgesia; opioid consumption; pain management; total knee arthroplasty