Harvey Dakota, Chafin Andrew, Kazior Michael, Karmarkar Amol M, Kanani Charmi, Trainer Brooke
Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, USA.
Department of Anesthesiology, Richmond Virginia Veterans Affairs Medical Center, Richmond, USA.
Cureus. 2024 Aug 14;16(8):e66891. doi: 10.7759/cureus.66891. eCollection 2024 Aug.
Background As total knee arthroplasty is one of the most common surgeries in the United States, it is important to identify regional anesthesia methods that optimize patient recovery. This study evaluates the effectiveness of adductor canal (AC) blocks with liposomal bupivacaine (LB) compared to other regional anesthesia techniques. We hypothesized that patients receiving single-shot (SS) AC blocks with LB would have lower postoperative opioid consumption compared to other groups. Methods A retrospective cohort analysis was conducted on patients from a single institution between January 2014 and December 2021. The primary outcome assessed was postoperative opioid use, with secondary outcomes including postoperative pain scores and hospital length of stay. Results The final analysis included 280 patients: 41 received an SS AC block with plain local anesthetic, 76 received a peripheral nerve catheter (PNC) with continuous ropivacaine, 79 received an SS AC block with LB, and 84 received no block. In fully adjusted models, postoperative opioid consumption on day one was significantly lower in the SS AC block with LB group compared to the no block group (b = 23.2, SE = 5.7, p < 0.0001), the PNC group (b = 15.5, SE = 5.7, p = 0.01), and the SS AC block with plain local anesthetic group (b = 18.9, SE = 6.9, p = 0.01). Additionally, hospital length of stay was significantly reduced in the LB group compared to the no block group (b = 1.5, SE = 0.3, p < 0.0001), the PNC group (b = 1.1, SE = 0.3, p < 0.0001), and the SS AC block with plain local anesthetic group (b = 1.5, SE = 0.3, p < 0.0001). Conclusions Patients who received an AC block with LB had higher pain scores on postoperative day 0 (POD0) but required less opioid medication on postoperative day 1 (POD1) and had a shorter hospital stay compared to patients who received other types of AC blocks or no block.
全膝关节置换术是美国最常见的手术之一，识别能优化患者恢复的区域麻醉方法很重要。本研究评估了脂质体布比卡因（LB）用于收肌管（AC）阻滞与其他区域麻醉技术相比的有效性。我们假设与其他组相比，接受单次（SS）AC阻滞联合LB的患者术后阿片类药物消耗量更低。
对2014年1月至2021年12月期间来自单一机构的患者进行回顾性队列分析。评估的主要结局是术后阿片类药物使用情况，次要结局包括术后疼痛评分和住院时间。
最终分析纳入280例患者：41例接受单纯局部麻醉药的SS AC阻滞，76例接受连续罗哌卡因外周神经导管（PNC），79例接受LB的SS AC阻滞，84例未接受阻滞。在完全调整模型中，与未阻滞组（b = 23.2，SE = 5.7，p < 0.0001）、PNC组（b = 15.5，SE = 5.7，p = 0.01）和单纯局部麻醉药的SS AC阻滞组（b = 18.9，SE = 6.9，p = 0.01）相比，LB的SS AC阻滞组术后第1天的阿片类药物消耗量显著更低。此外，与未阻滞组（b = 1.5，SE = 0.3，p < 0.0001）、PNC组（b = 1.1，SE = 0.3，p < 0.0001）和单纯局部麻醉药的SS AC阻滞组（b = 1.5，SE = 0.3，p < 0.0001）相比，LB组的住院时间显著缩短。
与接受其他类型AC阻滞或未接受阻滞的患者相比，接受LB的AC阻滞的患者术后第0天（POD0）疼痛评分更高，但术后第1天（POD1）所需阿片类药物更少，住院时间更短。
