Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty.
Dexmedetomidine
Local infiltration anaesthesia
Opioid sparing
Postoperative pain
Total knee replacement
Ultrasound-guided regional nerve blocks
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
21
09
2021
accepted:
03
01
2022
pubmed:
4
2
2022
medline:
19
11
2022
entrez:
3
2
2022
Statut:
ppublish
Résumé
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. 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 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. 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.
Identifiants
pubmed: 35112178
doi: 10.1007/s00167-022-06868-w
pii: 10.1007/s00167-022-06868-w
pmc: PMC9668930
doi:
Substances chimiques
Ropivacaine
7IO5LYA57N
Analgesics, Opioid
0
Dexmedetomidine
67VB76HONO
Anesthetics, Local
0
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4046-4053Subventions
Organisme : City of Graz
ID : A16-013786/2010/0043
Informations de copyright
© 2022. The Author(s).
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