Abstract
Introduction: Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In an effort to reduce reliance on opioid pain medications, surgeons are relying on periarticular injections or peripheral nerve blocks. The purpose of this study was to compare numerical rating scale (NRS) pain scores and oral morphine equivalents (OMEs) in patients who underwent primary total knee arthroplasty (TKA) with a periarticular injection alone to those who underwent a collaborative approach with a periarticular injection in the posterior tissue and an adductor canal catheter for anterior knee analgesia.Methods: In this study, 236 patients underwent a primary TKA between December 2017 and April 2018. Forty patients received an adductor canal catheter and 196 underwent a periarticular injection alone.Results: We found no difference in patient demographics between the cohorts (p>0.05). The patients that underwent the collaborative approach with a periarticular injection and adductor canal catheter had lower NRS pain scores on post-operative day 0, 1, and 2 (all P≤0.033). These patients demonstrated a reduction of 43% in opioid consumption during the hospitalization (P<0.001). These patients also demonstrated improved range of motion (ROM) (96 vs. 92 degrees) on the day of discharge (P=0.013).Conclusion: This study provides strong evidence that in patients undergoing TKA, the collaborative approach with the adductor canal catheter and periarticular injection is associated with lower post-operative pain scores, fewer total OMEs per hospital day, and a greater ROM arc prior to discharge compared to patients receiving a periarticular injection alone.
Highlights
Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic
This study provides strong evidence that in patients undergoing total knee arthroplasty (TKA), the collaborative approach with the adductor canal catheter and periarticular injection is associated with lower post-operative pain scores, fewer total oral morphine equivalents (OMEs) per hospital day, and a greater range of motion (ROM) arc prior to discharge compared to patients receiving a periarticular injection alone
These patients were stratified into two cohorts; those who received a periarticular injection alone (196 patients) and those that received a periarticular injection in addition to an adductor canal pain catheter (40 patients) (Ambit; Summit Medical Products, Sandy, Utah)
Summary
Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In 2005, there were 523,000 total knee arthroplasty (TKA) procedures performed in the United States, with these numbers increasingly yearly [4,5,6,7] This large patient population affords orthopedic surgeons an opportunity to help reduce the opioid burden through advancements in post-operative pain control with less reliance on narcotic medications. The adductor canal block (ACB) is a relatively new peripheral nerve block that works on the saphenous nerve in the adductor canal This has the benefit of controlling anterior knee pain without weakening the quadriceps muscle [10,11,12,13]. Previous studies have evaluated pain control with periarticular injections alone compared to peripheral nerve blocks alone [14] It is less clear how patients do when these blocks are combined in a synergistic approach
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