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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

David Freccero, MD
UNITED STATES

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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

David Freccero, MD, UNITED STATES Aneesh V Samineni, BA, UNITED STATES Seroos Salavati, MD, UNITED STATES

Boston Medical Center, Boston, MA, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Diagnosis / Condition

Posterior Pain

Treatment / Technique

Arthroplasty Total Joint Replacement

Patient Populations

Elderly

Summary: Combined single-shot IPACK+ACB with dexmedetomidine and dexamethasone was associated with lower total narcotic intake and mean VAS scores during most of the immediate postoperative period following primary, unilateral TKA compared to ACB alone.

Introduction

Total knee arthroplasty (TKA) has been associated with chronic opioid use and postoperative pain that prevents early mobility and prolongs hospital stay. We hypothesized that combined single-shot infiltration between popliteal artery and capsule of the knee (IPACK) and adductor canal blockade (ACB) with bupivacaine, dexmedetomidine and dexamethasone (dex-dex) provides better postoperative pain management compared to ACB alone for patients undergoing unilateral TKA.

Methods

This retrospective cohort study included adult patients who underwent primary, unilateral TKA. Patients were separated into two cohorts: single-shot ACB alone (bupivacaine 0.25% only) and single-shot IPACK+ACB with dex-dex . 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 daily patient-reported pain scores, length of stay, ambulation distance, return to emergency department (ED), hospital readmission and 30-day adverse events. Postoperative outcomes were analyzed and compared between cohorts utilizing chi-squared and t-tests.

Results

One-hundred eighty patients were identified, of which propensity matching used 71% of the set to yield 64 with IPACK+ACB (65 years, 24% male, BMI 32.5) and 64 with ACB only (64 years, 22% male, BMI 32.0). IPACK+ACB group had significantly lower total summative MME throughout entire postoperative stay (160.1 vs 268.8, p=0.002) and cumulatively after the first 24 hours (53.2 vs 100.8, p<0.001). IPACK+ACB also had lower mean VAS scores for 0-8 hours (4.34 vs 5.51, p=0.005) and 8-16 hours (4.62 vs 5.69, p=0.009) after the operation. There were no significant differences in anesthesia-related or surgery-related complications, ambulation distance, length of stay, return to ED, or hospital readmission between cohorts.

Conclusion

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

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Factors Associated With Failure and Survivorship Following Unicompartmental Knee Arthroplasty: A Single-Center Experience ePoster Presentation Anirudh K Gowd, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES Asher Lichtig, MD, UNITED STATES Orhan Yanmis, MD, UNITED STATES Gary G. Poehling, MD, UNITED STATES
Hip-Knee-Ankle Angle Affects Medial and Lateral Tibiofemoral Compressive Forces More Significantly than Joint Line Obliquity in Patients Post Total Knee Arthroplasty ePoster Presentation David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Payam Tarassoli, MBChB, BSc, DipSEM, MD, FRCS, AUSTRALIA Yoong Lim, BEng, PhD, AUSTRALIA
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Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Patellofemoral Arthroplasty In Community Programs: Case Series of 425 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Tibial Morphology for Proper Adjustment of Metal Augmentation in Revision Total Knee Arthroplasty ePoster Presentation Yushi Sakamoto, MD, JAPAN Shinichiro Nakamura, MD, PhD, JAPAN Yugo Morita, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Yusuke Yamawaki, MD, JAPAN Shuichi Matsuda, MD, PhD, JAPAN
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Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF
Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES John Mazzocco, MD, UNITED STATES Lauren Schoeller, BS, UNITED STATES Ruijia Niu, MPH, UNITED STATES Daniel C Sun, UNITED STATES Eric L. Smith, MD, UNITED STATES
Relationship Between The Femoral And Tibial Component Positions And Postoperative Knee Range Of Motion After Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
No Difference In Sports Participation And Patient-Reported Functional Outcomes Between Total Knee Arthroplasty And Unicompartmental Knee Arthroplasty At Minimum 2-Year Follow-Up In A Matched Control Study ePoster Presentation Amit Meena, MBBS, MS, DNB, INDIA Elisabeth Abermann, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Luca Farinelli, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Akshya Raj, MBBS,MS, INDIA Mohit Kumar Patralekh, MBBS, MS(Orthopaedics), DNB(Orthopaedics), MNAMS, INDIA Christian Fink, MD, Prof., AUSTRIA
A Prospective Randomised Study to Compare the Clinical and Radiological Outcomes of Functionally Aligned versus Mechanically Aligned Total Knee Arthroplasty with Robotic Arm Assistance ePoster Presentation Jai Thilak Kailathuvalapil, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
Antibiotic-Loaded Bone Cement with Colistin at Erythromycin Do Not Decrease Chronic TKA Pji at a Long-Term ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Pedro Hinarejos, MD, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
Effect of Altered Knee Joint Loading Pattern in Gait Biomechanics of Total Knee Arthroplasty Patient ePoster Presentation Sang Jin Lee, MD, PhD, KOREA, REPUBLIC OF
Bicruciate Substituting Total Knee Arthroplasty Improved Anteroposterior Displacement in Mid-Flexion Range ePoster Presentation Keinosuke Ryu, Prof., JAPAN Takanori Iriuchisima, MD, JAPAN
Long-Term Results of Per-Operative Knee Arthroscopy in Confirming Suitability for Unicompartmental Arthroplasty ePoster Presentation James Gill, MB BChir, BSc, FRCS, UNITED KINGDOM McMeniman J Peter, AUSTRALIA Timothy John Mcmeniman, MBBS(Med)/MBBS, FRACS FA(Orth)A, AUSTRALIA Daniel Johnson Brimm, BSc, MD, AUSTRALIA Peter T. Myers, AM, MBBS, FRACS, FAOrthA, AUSTRALIA
Changes In CPAK Classification and Its Characteristics before and after Kinematic Alignment TKA ePoster Presentation Manabu Akagawa, MD, PhD, JAPAN ヒデトモサイトウ, MD, PhD, JAPAN Naohisa Miyakoshi, MD, PhD, JAPAN
High Cure Rate In Hematogenous TKA PJI At A Long-Term Follow-Up By Means Of Dair Procedure ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN Pedro Hinarejos, MD, PhD, SPAIN
The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review ePoster Presentation Kyle William Lawrence, BS, UNITED STATES John K Cordero, MD, UNITED STATES Ashley Brown, BS, UNITED STATES Xinning Li, MD, UNITED STATES Brett Hayden, MD, UNITED STATES Robert L Parisien, MD, UNITED STATES
The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Implant Size and Outcome Differences of Knees in Same Patient for Simultaneous vs Staged Bilateral TKA ePoster Presentation Alexander P. Sah, MD, UNITED STATES

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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

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

Introduction

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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

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

Introduction

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content