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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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Central Sensitization is Associated with Persistent Postoperative Pain and Inferior Patient-Reported Outcomes in Patients Undergoing Unicompartmental Knee Arthroplasty ePoster Presentation Yong In, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF
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Quality of Life Following Primary Total Knee Arthroplasty: Factors Predicting Satisfaction in Low-Income Population ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Ahmed Zendeoui, MD, TUNISIA Moatassem Belleh Jelassi, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
Total Knee Arthroplasty Without Patellar Component Replacement. Does it Increase the Risk of Revision? Local Experience Analysis ePoster Presentation Zoy Anastasiadis, MD, CHILE Diego Edwards, MD, CHILE Sergio Arellano, MD, CHILE Andrés Schmidt-Hebbel, MD, CHILE Eduardo Gardella, MD, CHILE Nicolás González-Kusjanovic, MD, MSc, CHILE Alex Vaisman, MD, Prof., CHILE
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
Combined Fixed-Bearing Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction ePoster Presentation Claudio Legnani, MD, ITALY Enrico Borgo, MD, ITALY Vittorio Macchi, MD, ITALY Alberto Ventura, MD, ITALY
Same Complication Rate After Day-Case Procedure Or Fast-Track Procedure After Total Hip And Knee Arthroplasty. A Prospective, Propensity Score-Matched Case-Control Study ePoster Presentation Jean-Yves Jenny, Prof., FRANCE Vincent Gisonni, MD, FRANCE
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
Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees ePoster Presentation Shinichiro Nakamura, MD, PhD, JAPAN Shota Takemoto, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Hiromu Ito, MD, PhD, JAPAN Mutsumi Watanabe, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Shuichi Matsuda, MD, PhD, JAPAN
Influence of Mini Approach Instrumentation on Component Alignment In Unicondylar Knee Replacement ePoster Presentation Vinod Kumar, MBBS, MS, DNB, MNAMS, INDIA Deepak Gupta, MBBS, MS, INDIA Ananya Sharma, MBBS, MS, DNB , INDIA
Association Of Ischemia Time And Serum Lactate Levels With Postoperative Pain In Primary Total Knee Arthroplasty At The Orthopedics And Traumatology Service At The Unidad Médica De Alta Especialidad No. 1 Bajío. ePoster Presentation Juan Antonio García Ramírez, MD, MEXICO
In-Vivo Kinematic Analysis of Evolution® Medial-Pivot Total Knee Arthroplasty during Weight-Bearing Activity ePoster Presentation Eiichi Nakamura, MD, PhD, JAPAN Nobukazu Okamoto, MD, PhD, JAPAN Hitoshi Ito, MD, PhD, JAPAN Tetsurou Masuda, MD, PhD, JAPAN Satoshi Hisanaga, MD, PhD, JAPAN Yasunari Oniki, MD, PhD, JAPAN
Large Reduction In Postoperative Posterior Tibial Slope Risks Anterior Collapse Of The Tibial Component In Fixed-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Kazuhisa Hatayama, MD, PhD, JAPAN Masanori Terauchi, MD, JAPAN Shingo Kurihara, MD, JAPAN Satoshi Nonaka, MD, JAPAN Hibiki Kakiage, MD, JAPAN
Three-Dimensional Evaluation of Distal Femoral Valgus Angle Using Whole Leg CT in Total Knee Arthroplasty ePoster Presentation Atsushi Sato, MD, PhD, JAPAN Jun Oike, MD, PhD, JAPAN Masataka Ota, MD, JAPAN Kanako Izukashi, MD, JAPAN Saki Yagura, MD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Naoki Okuma, MD, JAPAN Takayuki Koya, MD, PhD, JAPAN Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN

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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