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Additive effect of continuous adductor canal block and liposomal bupivacaine periarticular injection in total knee arthroplasty

  • Original Article • KNEE - ARTHROPLASTY
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Abstract

Background

Novel methods of postoperative analgesia for total knee arthroplasty (TKA) have demonstrated improved functional outcomes and decreased narcotic consumption. These approaches include continuous adductor canal blocks (CACB) and periarticular injection (PAI). There is a lack of current understanding regarding the effect of these modalities on narcotic usage, functionality, and pain when both PAI and CACB are utilized compared to PAI alone.

Methods

TKAs were performed unilaterally by a single surgeon with a standardized protocol. Patients were divided into two groups: those receiving PAI alone (n = 54) and those receiving PAI and CACB (n = 37). Patient outcomes including, narcotics usage, pain scale, and distance walked, were recorded on postoperative day (POD) zero through three.

Results

When compared with PAI alone, it was identified that concurrent use of PAI and CACB results in a statistically significant decrease in narcotics usage on POD 0, 1, 3, and total narcotic usage while admitted. Patients in the PAI and CACB group walked significantly farther than patients in the PAI only group on POD 1, 2, and 3. On POD 0, patients in the PAI and CACB reported significantly less pain with activity when compared to the PAI only group.

Conclusion

Here we identify an additive effect when utilizing both PAI and CACB for postoperative TKA analgesia. Our findings demonstrate significant decrease in patient total narcotic usage, pain scores, and an increase in walking distance when utilizing PAI and CACB compared with PAI alone. This analgesic technique may help reduce patients’ narcotic use while also increasing functional outcomes.

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Authors and Affiliations

  1. Department of Orthopedics, Northwell Health Plainview Hospital, 888 Old Country Rd, Plainview, NY, 11803, USA

    Evan Green, Nicholas Frane, Maximillian Ganz, Robert Stockton, Erik Stapleton & Jonathan Mallen

  2. Medical Education, Plainview Hospital, 25 Central park road, Plainview, 11803, NY, USA

    Maximillian Ganz

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  1. Evan Green
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Correspondence to Maximillian Ganz.

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Green, E., Frane, N., Ganz, M. et al. Additive effect of continuous adductor canal block and liposomal bupivacaine periarticular injection in total knee arthroplasty. Eur J Orthop Surg Traumatol 29, 1525–1532 (2019). https://doi.org/10.1007/s00590-019-02452-0

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