Ipack blocks.4/18/2023 ![]() The primary outcome was cumulative opioid consumption in oral morphine equivalents at 24 h after PACU arrival. Perioperative Management: Study Group InterventionsĪll outcomes were collected by blinded researchers. Patients were followed-up twice daily by the acute pain service team, who titrated opioid dose ranges and transitioned opioids from IV to oral when needed. If oral analgesia was insufficient to control pain, IV patient-controlled analgesia with hydromorphone or morphine was offered for rescue. Multimodal analgesia on the ward comprised 650 to 1,000 mg of oral acetaminophen every 6 h and 100 to 200 mg of celecoxib every 12 h, supplemented by immediate-release oral oxycodone (5 to 10 mg) or hydromorphone (1 to 2 mg) every 2 h as needed. The patients were discharged to the ward once they achieved an Aldrete score of 9. Opioid analgesia was administered as required to treat pain scores of 4 or higher on an 11-point numerical rating scale (0 to 10 points) and 25 mg of IV dimenhydrinate and/or 4 mg of ondansetron for postoperative nausea and vomiting. Spinal AnesthesiaĪfter surgery, the patients were managed in the postanesthetic care unit (PACU) by a nurse blinded to group allocation. ![]() After negative aspiration for blood, a bolus of 15 ml of 0.5% ropivacaine (75 mg) in 1:200,000 epinephrine was injected through the tunneled catheter for all patients preoperatively. A 19-gauge catheter was advanced 2 to 3 cm into this fluid “pocket” within the adductor canal and then tunneled subcutaneously to exit the skin proximal to the site of the surgical thigh tourniquet and secured in place with adhesive dressings. ![]() After skin sterilization and infiltration with 1 to 2 ml of 2% lidocaine, an 80-mm, 17-gauge Tuohy needle (Arrow StimuCath kit, Teleflex Medical, USA) was advanced in plane in an anterolateral to posteromedial direction until the needle tip was positioned within the adductor canal deep to the vastoadductor membrane using a hydrodissection technique with up to 10 ml of 5% dextrose solution. The probe was rotated to obtain an oblique view of the superficial femoral artery and adductor canal to allow for a more proximal needle insertion site. The adductor canal was identified using a linear 5 to 12 MHz ultrasound probe (Sonosite Edge, USA). Materials and MethodsĪn adductor canal block catheter was inserted in all patients at the level of the midthigh. In this randomized, double-blind, controlled trial, we hypothesized that adding five novel analgesic interventions to our institutional standard multimodal treatments would further decrease postoperative opioid requirements after total knee arthroplasty. 8 While each of these individual interventions has demonstrable analgesic benefit after total knee arthroplasty when compared to placebo or no intervention, the impact of incorporating these treatments simultaneously into contemporary multimodal analgesic regimen for total knee arthroplasty remains unknown. They include intraoperative administration of intravenous (IV) dexamethasone (steroid), 4 dexmedetomidine (α-2 agonist), 5 and ketamine ( N-methyl- d-aspartate antagonist), 6 as well as peripheral nerve block procedures such as continuous adductor canal block 7 and iPACK block (infiltration between popliteal artery and posterior capsule of the knee). 3 Several new options for multimodal analgesia have recently emerged. The study participants, outcome assessors/researchers, other anesthesia personnel, surgeons, physician assistants, and nurses will be blinded to the treatment arm.Contemporary multimodal analgesic treatment for total knee arthroplasty consisting of oral nonopioid drugs ( e.g., acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids) and surgical periarticular local anesthesia infiltration is only partially effective in regard to opioid sparing. Only the regional anesthesiologist performing the block will know the randomization status. Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information
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