title: Pain Management with Adductor Canal Blockade or Multimodal Periarticular Analgesia in Elderly Total Knee Arthroplasty Patients.
abstract: BACKGROUND
  Post-operative pain management in elderly total knee arthroplasty (TKA) patients has traditionally included opioids, epidurals, and femoral nerve blocks. Although these modalities are effective, they are often associated with adverse side effects, which may have a greater impact on this population. Alternative modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA) have demonstrated great efficacy with a low side effect profile. However, it is unknown if one modality is advantageous over the other in the elderly. Therefore, the purpose of this study is to assess 1) post-operative opioid use, 2) length of stay, 3) pain levels, and 4) discharge status in TKA patients aged 75 years or older who have received either ACB or MPA.
  
  
  METHODS
  A single-hospital, single-surgeon database was reviewed for patients aged 75 years or older who had a TKA with either ACB or MPA between January 2015 and April 2016. This yielded 90 patients with a mean age of 83 years (range, 75 to 90 years) comprised of 31 men and 59 women. Forty-three patients received ACB, whereas 47 patients received MPA. Electronic medical records were reviewed to obtain demographic and endpoint data. Pain was quantified using the visual analog scale (VAS). Continuous variables were compared using the student's t-test and analysis of variance, while categorical variables were compared using chi-square analysis.
  
  
  RESULTS
  No significant difference was observed in opioid consumption between the two groups at post-operative day 0 (p= 0.832) 1 (p= 0.293), or 3 (p= 0.779). While patients in the ACB group had significantly less opioid consumption on post-operative day 2 (p= 0.005), there was no significant difference between groups in total opioid consumption (p= 0.735). There was no significant difference between groups in lengths of stay (2.8 days vs. 3.0 days, p= 0.627) or VAS scores (3.03 vs. 2.96, p= 0.922). The proportion of patients discharged to home did not yield a significant difference as well (55% vs. 45%; p= 0.331).
  
  
  CONCLUSIONS
  Elderly patients may have their post-operative pain well controlled if they receive either ACB or MPA during total knee arthroplasty. Our study demonstrates no significant difference in total opioid consumption, lengths of stay, pain levels, and discharge status between groups. Future studies should utilize larger cohorts and include assessments of post-operative functional recovery.
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: Nequesha
authors.initials: N
authors.lastname: Mohamed
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: 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: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Sabahat
authors.initials: S
authors.lastname: Khan
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: Michael A
authors.initials: MA
authors.lastname: Mont
authors.affiliation: 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: D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005267:Femoral Nerve / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal; D009407:Nerve Block / Q000379:methods / Q000706:statistics & numerical data; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D013848:Thigh / Q000502:physiology
chemical_list: D000779:Anesthetics, Local