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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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Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases ePoster Presentation Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
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, UNITED STATES Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
Tibia Placement Difference Between The Supine And Prone Position After Total Knee Arthroplasty: The Comparison Of The BCS and PS-TKA ePoster Presentation Takanori Iriuchishima, MD, PhD, JAPAN Keinosuke Ryu, MD, PhD, JAPAN Eiji Cho, MD, JAPAN
Lateral Unicompartmental Knee Arthroplasty (UKA) Showed a Lower Risk of Failure Compared to Medial Unicompartmental Knee Arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO) ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Barbara Bordini, Stat, ITALY Stefano Fratini, MD, ITALY Cristina Ancarani, Stat, ITALY Piero Agostinone, MD, ITALY Alberto Grassi, PhD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
Intraoperative Varus-Valgus Joint Laxity Pattern Was Associated With Postoperative Knee Flexion Angle and Patient-Reported Outcome Measures in Bicruciate-Stabilized Total Knee Arthroplasty. ePoster Presentation Ryota Yamagami, MD, JAPAN Kenichi Kono, MD, PhD, JAPAN Kohei Kawaguchi, MD, JAPAN Tomofumi Kage, JAPAN Ryo Murakami, MD, JAPAN Takahiro Arakawa, MD, JAPAN Hiroshi Inui, PhD, JAPAN Shuji Taketomi, MD, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN
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, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
Total Knee Arthroplasty Outcomes Following Anterior Cruciate Ligament Reconstruction ePoster Presentation Brian Rao, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Eric Milliron, BS, UNITED STATES Parker Cavendish, BS, UNITED STATES James C. Kirven, BS, UNITED STATES Spencer E. Talentino, MD, UNITED STATES Charles Qin, MD, UNITED STATES Ryan H. Barnes, MD, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, MD, UNITED STATES
Compliance and Outcome of Osteoporosis Treatment After Total Knee Arthroplasty ePoster Presentation Yun Seong Choi, MD, KOREA, REPUBLIC OF Seung Hoon Lee, MD, KOREA, REPUBLIC OF Jung Ro Yoon, MD, KOREA, REPUBLIC OF Young Bin Shin, MD, KOREA, REPUBLIC OF Tae Hyuk Yoon, MD, KOREA, REPUBLIC OF
Implant Size and Outcome Differences of Knees in Same Patient for Simultaneous vs Staged Bilateral TKA ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Patellofemoral Arthroplasty In Community Programs: Case Series of 425 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, INDIA Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA

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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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Conclusion

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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