AAOS2017: Combined FNB-SNB, PAI with ropivacaine, or PAI with liposomal bupivacaine in TKA

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
165 patients scheduled for total knee arthroplasty were randomized to one of three methods for postoperative analgesia: 1) combined continuous femoral nerve block plus a single-shot sciatic nerve block, 2) periarticular injection analgesia with ropivacaine (PAI Ropi), or 3) periarticular injection analgesia with liposomal bupivacaine (PAI Lipo). In comparison to PAI Ropi, FNB-SNB demonstrated significantly lower pain scores and opioid consumption for the day of surgery, with no significant differences on POD1. In comparison to Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
A number of analgesia methods have been developed for use in total knee arthroplasty. Of these methods, femoral nerve block, with or without additional sciatic nerve block, remains one of the most common. More recently, periarticular infiltration (PAI) analgesia has emerged as a possible alternative. PAI employs local anesthetic, with or without other constituents, within the periarticular tissues to managed pain in the immediate hours following surgery. Liposomal bupivacaine is a newer local anesthetic preparation, developed with the intention of lengthening the duration of analgesia relative to other standard local anesthetics. However, consistent data in support of this claim is lacking. This study sought to compare the analgesic efficacy of these three pain management methods following total knee arthroplasty.
What was the principal research question?
In total knee arthroplasty, what is the comparative efficacy of postoperative analgesia between continuous femoral nerve block plus a single-shot sciatic nerve block, periarticular infiltration analgesia with ropivacaine, ketorolac, and epinephrine, and periarticular infiltration analgesia with liposomal bupivacaine, ketorolac, and epinephrine when assessed on the day of surgery and on postoperative day 1?
Population: 165 patients scheduled for primary unilateral total knee arthroplasty. All patients received standard preoperative and postoperative oral analgesia.
Intervention: PAI Lipo: Patients were administered periarticular injection analgesia with a mixture of liposomal bupivacaine, ketorolac, and epinephrine
Comparison: PAI Ropi: Patients were administered periarticular injection analgesia with a mixture of liposomal bupivacaine, ketorolac, and epinephrine FNB-SNB: Patients received a continuous femoral catheter and a single-shot sciatic nerve block.
Outcomes: Reported outcome measures included pain on a visual analog scale (VAS) and opioid consumption.
Methods: RCT; Single center
Time: Patients were assessed on the day of surgery and on postoperative day 1.
What were the important findings?
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How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.