title: Efficacy of Adductor Canal Blockade Compared to Multimodal Peri-Articular Analgesia Following Total Knee Arthroplasty.
abstract: BACKGROUND
  Postoperative pain after total knee arthroplasty (TKA) can be an impediment to patient recovery. Many commonly used pain control modalities are effective, but are also associated with adverse effects. Other modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA), have gained popularity due to their efficacy and high safety profile. However, to the best of our knowledge, there are no published studies indicating if a therapeutic advantage exists between the two pain control modalities. Therefore, the purpose of this study was to assess the: 1) length of stay; 2) level of pain; 3) discharge status; and 4) opioid consumption, in TKA patients who received either ACB or MPA.
  
  
  METHODS
  A single hospital, single surgeon database was reviewed for patients who had a TKA between January 2015 and April 2016, and received either ACB or MPA. This search yielded 98 patients who had a mean age of 63 years (range, 38 to 90 years), comprised of 29 men and 69 women. Patients were divided into those who received ACB alone (n= 54) and those who received MPA alone (n= 44). With the use of electronic medical records, demographic and endpoint data were obtained. Pain was quantified using the Visual Analog Scale (VAS). Continuous variables were compared using the student's t-test, while categorical variables were compared utilizing a chi-square test.
  
  
  RESULTS
  The mean length of hospital stay (LOS) was significantly shorter for patients who had ACB when compared to patients who had MPA (2.12 days vs. 2.88 days; p = 0.005). There was no significant difference in VAS scores (p= 0.448), proportion of patients discharged home (p= 0.432), or total opioid consumption (p= 0.247) between the two groups.
  
  
  CONCLUSIONS
  Total knee arthroplasty patients who received an adductor canal block had shorter lengths of stay when compared to those who received multimodal peri-articular analgesia. Shortened hospital stays may be cost-effective for institutions and providers, however, larger studies are needed to further assess the effect on quality of care provided.
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Chukwuweike U
authors.initials: CU
authors.lastname: Gwam
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Jaydev B
authors.initials: JB
authors.lastname: Mistry
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Priya
authors.initials: P
authors.lastname: Jha
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, 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: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
authors.affiliation: Hip, Knee, and Shoulder Surgery, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, 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; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005267:Femoral Nerve / Q000502:physiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000706:statistics & numerical data*; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid