Mauras Jeffrey, McMahon Michael, Petrie Jaudé, Roubion Ryan, Bronstone Amy, Leonardi Claudia, Dasa Vinod
Physical Medicine and Rehabilitation Pain Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner J. 2025 Summer;25(2):99-106. doi: 10.31486/toj.24.0137.
Newer analgesic techniques to reduce opioid use and pain after total knee arthroplasty (TKA) include preoperative cryoneurolysis, adductor canal block (ACB), and local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block. The purpose of this study was to evaluate whether changing the regional analgesic from ropivacaine to liposomal bupivacaine would provide superior pain relief and reduce opioid requirements at 2 and 12 weeks following TKA.
We conducted a retrospective medical records review of 140 consecutive patients who underwent primary TKA at a single site and received ACB with ropivacaine (multimodal-ropivacaine [MM-R] group, n=70) or ACB/iPACK with liposomal bupivacaine (multimodal-liposomal bupivacaine [MM-LB] group, n=70). The primary outcomes were the morphine milligram equivalent (MME) of filled opioid prescriptions at discharge and during the first 12 weeks after TKA, as well as the Knee injury and Osteoarthritis Outcome Score and the Patient-Reported Outcomes Measurement Information System pain intensity and pain interference scores at 2 and 12 weeks postsurgery.
The median MMEs for discharge opioid prescriptions and all opioid prescriptions were, respectively, 65% (<0.0001) and 48% (<0.0001) lower for patients in the MM-LB group vs the MM-R group. The MM-LB group had significantly better patient-reported outcomes 2 weeks after TKA compared to the MM-R group.
Compared with ropivacaine-based regional analgesia, liposomal bupivacaine-based regional analgesia in the context of a modern multimodal pain regimen may reduce opioid requirements and improve patient-reported outcomes during acute and short-term recovery after TKA.
全膝关节置换术（TKA）后，减少阿片类药物使用和疼痛的新型镇痛技术包括术前冷冻神经lysis、内收肌管阻滞（ACB）以及在腘动脉与膝关节囊之间进行局部麻醉药浸润（iPACK）阻滞。本研究的目的是评估在TKA术后2周和12周时，将区域镇痛药物从罗哌卡因改为脂质体布比卡因是否能提供更好的疼痛缓解并减少阿片类药物的需求。
我们对140例在单一地点接受初次TKA并接受罗哌卡因ACB（多模式 -罗哌卡因[MM - R]组，n = 70）或脂质体布比卡因ACB/iPACK（多模式 -脂质体布比卡因[MM - LB]组，n = 70）的连续患者进行了回顾性病历审查。主要结局指标为出院时以及TKA术后前12周开具的阿片类药物处方的吗啡毫克当量（MME），以及术后2周和12周时的膝关节损伤和骨关节炎结局评分、患者报告结局测量信息系统疼痛强度和疼痛干扰评分。
MM - LB组患者出院时阿片类药物处方的MME中位数和所有阿片类药物处方的MME中位数分别比MM - R组低65%（<0.0001）和48%（<0.0001）。与MM - R组相比，MM - LB组在TKA术后2周时患者报告的结局明显更好。
与基于罗哌卡因的区域镇痛相比，在现代多模式疼痛方案中，基于脂质体布比卡因的区域镇痛可能会减少TKA术后急性和短期恢复期间的阿片类药物需求，并改善患者报告的结局。
