AAOS2017: Adductor canal block versus combined spinal-epidural in total knee arthroplasty

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
145 patients scheduled for total knee arthroplasty were randomized to either combined spinal-epidural anesthesia (CSE), spinal anesthesia plus an adductor canal block, or general anesthesia plus an adductor canal block. Patients were assessed for analgesia outcomes, mobilization, and day of discharge. Results demonstrated lower Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
There are many forms of analgesia that can be used to minimize pain following total knee arthroplasty. While a number of clinical trials have been conducted evaluating these different methods, few have examined the use of adductor canal blocks in combination with spinal and epidural anesthesia.
What was the principal research question?
In total knee arthroplasty, is there any significant difference in analgesic efficacy between combined spinal-epidural analgesia, adductor canal block under spinal anesthesia, or adductor canal block under general anesthesia when assessed over the first three days postoperatively?
Population: 145 patients scheduled for total knee arthroplasty.
Intervention: Spinal+ACB group: Procedure was performed under spinal anesthesia, with a postoperative catheter placed for continuous adductor canal block. General+ACB group: Procedure was performed under general anesthesia, with a postoperative catheter placed for continuous adductor canal block.
Comparison: Spinal-epidural group: Procedure was performed using combined spinal and epidural anesthesia, with an epidural catheter placed postoperatively.
Outcomes: Reported outcomes included pain, opioid consumption, mobilization, and day of discharge.
Methods: RCT
Time: Results reported for postoperative days 1, 2 and 3.
What were the important findings?
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What should I remember most?
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.