Open AccessCombined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty
Author(s) -
Schittek Gregor A.,
Reinbacher Patrick,
Rief Martin,
Gebauer David,
Leithner Andreas,
Vielgut Ines,
Labmayr Viktor,
Simonis Holger,
Köstenberger Markus,
BornemannCimenti Helmar,
SandnerKiesling Andreas,
Sadoghi Patrick
Publication year - 2022
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-022-06868-w
Subject(s) - medicine , dexmedetomidine , ropivacaine , anesthesia , morphine , interquartile range , opioid , fentanyl , oxycodone , femoral nerve , perioperative , analgesic , arthroplasty , surgery , sedation , receptor
After primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound‐guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA—LIA versus URSA with dexmedetomidine—were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA. Methods Fifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml −1 ) or two single‐shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed. Results In the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5–57.0] mg versus 27.0 [IQR 0.0–33.5] mg ( P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol. Conclusion This is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid‐sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid‐sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.