Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 28:25:101292.
doi: 10.1016/j.artd.2023.101292. eCollection 2024 Feb.

Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block With Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis

Melina Shoni  1 , Aneesh V Samineni  2 , Seroos Salavati  1 , Nikhil Mikkilineni  1 , Allen Wang  1 , Ayesha Abdeen  3 , David Freccero  3
Affiliations

Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block With Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis

Melina Shoni et al. Arthroplast Today. .

Abstract

Background: To investigate if combined single-shot adductor canal blockade (ACB) and infiltration between the popliteal artery and capsule of the knee (IPACK) provide better postoperative pain management compared to ACB alone for patients undergoing unilateral total knee arthroplasty (TKA).

Methods: This retrospective cohort study included adult patients who underwent primary, unilateral TKA. Patients were separated into 2 cohorts: single-shot ACB alone (performed with bupivacaine 0.25%) and combined single-shot ACB + IPACK (performed with bupivacaine 0.25%, dexmedetomidine 1 mg/kg, and dexamethasone 4 mg). Patients were propensity-matched 1:1. The primary study outcome was total opioid consumption converted to morphine milligram equivalents (MME) per eight-hour interval and postoperative day. Secondary outcomes included pain scores, length of stay, ambulation distance, return to emergency department, hospital readmission, and 30-day adverse events.

Results: One hundred eighty patients were identified, of which propensity matching used 71% to yield 64 patients receiving ACB alone and 64 receiving combined ACB + IPACK. Combined ACB + IPACK had significantly lower total summative MME throughout the entire postoperative stay (P = .002) and cumulatively after the first 24 hours (P < .001). Combined ACB + IPACK also had lower mean pain scores for 0-8 hours (P = .005) and 8-16 hours (P = .009) postoperatively. There were no significant differences in secondary outcomes.

Conclusions: Combined single-shot ACB + IPACK block was associated with lower total narcotic intake and mean pain scores during most of the immediate postoperative period following primary, unilateral TKA compared to ACB alone. Implementing longer-acting, single-shot ACB + IPACK for TKA can balance effective and more selective pain management with early rehabilitation.

Keywords: ACB; IPACK; Postoperative pain management; Regional anesthesia; Total knee arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean morphine milligram equivalents (MME) during postoperative stay.
Figure 2
Figure 2
Mean visual analog scale (VAS) during postoperative stay.
See this image and copyright information in PMC

References

    1. Grosu I., Lavand'homme P., Thienpont E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc. 2014;22:1744–1758. - PubMed
    1. Sun E.C., Darnall B.D., Baker L.C., Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176:1286–1293. - PMC - PubMed
    1. Kandarian B.S., Elkassabany N.M., Tamboli M., Mariano E.R. Updates on multimodal analgesia and regional anesthesia for total knee arthroplasty patients. Best Pract Res Clin Anaesthesiol. 2019;33:111–123. - PubMed
    1. Gao F., Ma J., Sun W., Guo W., Li Z., Wang W. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a systematic review and meta-analysis. Clin J Pain. 2017;33:356–368. - PubMed
    1. Jenstrup M.T., Jaeger P., Lund J., Fomsgaard J.S., Bache S., Mathiesen O., et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand. 2012;56:357–364. - PubMed

LinkOut - more resources