The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain

2021 ◽  
Author(s):  
Stephen Gerard Zak ◽  
David Yeroushalmi ◽  
Alex Tang ◽  
Morteza Meftah ◽  
Erik Schnaser ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Opioid Consumption ◽  
Perioperative Outcomes ◽  
Computer Assisted ◽  
Surgical Time ◽  
Pain Scores ◽  
Pain Outcomes ◽  
Total Knee

AbstractThe use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.

scholarly journals Tranexamic Acid Increases Early Postoperative Pain and Decreases Time to First Opioid Following Total Knee Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sachin Seetharam ◽  
Sydney Keller ◽  
Mary Ziemba-Davis ◽  
R. Michael Meneghini MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Ex Vivo ◽  
Pain Scores ◽  
Average Pain ◽  
Total Knee

Background and Hypothesis: Tranexamic acid (TXA) decreases blood loss in total knee arthroplasty (TKA). However, TXA evoked pain in rats by inhibiting GABA and glycine receptors in the spinal dorsal horn, and caused cellular death in ex vivo and in vitro human periarticular tissues exposed to clinical concentrations of TXA. We evaluated inpatient postoperative pain and blood loss in TKA performed with and without TXA. Project Methods: 105 consecutive cemented TKAs without TXA were compared to 72 consecutive cemented TKAs with TXA. Procedures were performed by a single surgeon using identical perioperative medical and pain-control protocols. Outcomes included: average of q2-4 hour pain scores during the first 24 hours after PACU discharge, average pain during remainder of stay, final pain score prior to discharge, time in minutes to first opioid after PACU discharge, total opioids in morphine equivalents (MEQs) during the first 24 hours after PACU discharge, average MEQs per remaining days of stay, and mean g/dL pre- to postoperative decrease in hemoglobin. Multivariate analyses accounted for 15 demographics and covariates. Results: The sex (p=0.393), age (p=0.784), and BMI (p=0.930) of the two cohorts were similar. Mean pain during the first 24 hours was greater (4.1 vs. 3.2, p=0.001), MEQs consumed during the first 24 hours were greater (45 vs. 37, p=0.069), and time to first opioid medication was shorter (326 vs. 414, p=0.023) in patients who received TXA. The decrease in hemoglobin was less in patients who received TXA (-2.2 vs. -2.7, p<0.001).   Conclusion and Potential Impact: Our hypothesis based on animal and laboratory studies that TXA may increase early postoperative pain was confirmed by three metrics. Consistent with the effective life of TXA, pain and opioid consumption after 24 hours did not differ based on TXA use. Further work is warranted to investigate the nature consequences associated with TXA, relative to its demonstrated benefits for blood conservation.  

Does the addition of iPACK to adductor canal block in the presence or absence of periarticular local anesthetic infiltration improve analgesic and functional outcomes following total knee arthroplasty? A systematic review and meta-analysis

2021 ◽  
pp. rapm-2021-102705
Author(s):  
Nasir Hussain ◽  
Richard Brull ◽  
Brendan Sheehy ◽  
Michael Dasu ◽  
Tristan Weaver ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Total Knee ◽  
Local Anesthetic Infiltration

BackgroundWhen combined with adductor canal block (ACB), local anesthetic infiltration between popliteal artery and capsule of knee (iPACK) is purported to improve pain following total knee arthroplasty (TKA). However, the analgesic benefits of adding iPACK to ACB in the setting of surgeon-administered periarticular local infiltration analgesia (LIA) are unclear.ObjectivesTo evaluate the analgesic benefits of adding iPACK to ACB, compared with ACB alone, in the setting of LIA following TKA.Evidence reviewWe conducted a meta-analysis of randomized trials comparing the effects of adding iPACK block to ACB versus ACB alone on pain severity at 6 hours postoperatively in adult patients undergoing TKA. We a priori planned to stratify analysis for use of LIA. Opioid consumption at 24 hours, functional recovery, and iPACK-related complications were secondary outcomes.FindingsFourteen trials (1044 patients) were analyzed. For the primary outcome comparison in the presence of LIA (four trials, 273 patients), adding iPACK to ACB did not improve postoperative pain at 6 hours. However, in the absence of LIA (eight trials, 631 patients), adding iPACK to ACB reduced pain by a weighted mean difference (WMD) (95% CI) of −1.33 cm (−1.57 to –1.09) (p<0.00001). For the secondary outcome comparisons in the presence of LIA, adding iPACK to ACB did not improve postoperative pain at all other time points, opioid consumption or functional recovery. In contrast, in the absence of LIA, adding iPACK to ACB reduced pain at 12 hours, and 24 hours by a WMD (95% CI) of −0.98 (−1.79 to –0.17) (p=0.02) and −0.69 (−1.18 to –0.20) (p=0.006), respectively, when compared with ACB alone, but did not reduce opioid consumption. Functional recovery was also improved by a log(odds ratio) (95% CI) of 1.28 (0.45 to 2.11) (p=0.003). No iPACK-related complications were reported.ConclusionAdding iPACK to ACB in the setting of periarticular LIA does not improve analgesic outcomes following TKA. In the absence of LIA, adding iPACK to ACB reduces pain up to 24 hours and enhances functional recovery. Our findings do not support the addition of iPACK to ACB when LIA is routinely administered.

Comparison of Periarticular Infiltration and Combination Delivery of Local Anesthetics for Reducing Pain and Opioid Consumption after Total Knee Arthroplasty

2020 ◽  
Author(s):  
Derek T. Ward ◽  
Eva Grotkopp ◽  
Robert C. Detch ◽  
Hubert T. Kim ◽  
Alfred C. Kuo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Combination Treatment ◽  
Local Anesthetics ◽  
Opioid Consumption ◽  
Duration Of Action ◽  
Pain Scores ◽  
Total Knee ◽  
Periarticular Infiltration

AbstractSurgical-site delivery of local anesthetics decreases pain and opioid consumption after total knee arthroplasty (TKA). The optimal route of administration is unknown. We compared local anesthetic delivery using periarticular soft-tissue infiltration to delivery using a combination of preimplantation immersion and intra-articular injection (combination treatment). The records of patients who underwent unilateral, cemented, primary TKA with spinal anesthesia and adductor canal blocks at a single Veterans Affairs Medical Center were retrospectively reviewed. Three subgroups were compared, including controls who did not receive additional local anesthetics, patients who received periarticular infiltration, and patients who received combination treatment. Mean daily pain scores and mean 24-hour opioid consumption on postoperative days (PODs) 0 and 1 were calculated, and analysis of variance was used to assess for significant differences. Factors that were associated with lower pain scores and opioid consumption were then identified using multivariate stepwise regression. There were 26 controls, 25 periarticular infiltration patients, and 39 combination patients. The periarticular infiltration cohort had significantly lower mean pain scores and opioid consumption than controls on POD 0, but not on POD 1. The combination cohort had significantly lower mean pain scores and opioid consumption than controls on PODs 0 and 1. There were no significant differences between the infiltration and combination groups on either day. Multivariate regression analysis showed that infiltration was associated with significantly decreased opioid consumption on both days and decreased pain on POD 0. Combination treatment was associated with significantly decreased pain and opioid consumption on both days. Both local anesthetic periarticular infiltration and combination treatment are associated with decreased pain and opioid consumption after TKA. The stronger effects of the combination treatment compared with periarticular infiltration on POD 1 suggests that combination delivery may have a longer duration of action.

Knee Position during Surgical Wound Closure in Total Knee Arthroplasty: A Review

2017 ◽  
Vol 31 (01) ◽  
pp. 006-012 ◽  
Author(s):  
Mhamad Faour ◽  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Nicolas Piuzzi ◽  
Kim Stearns ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
Surgical Wound ◽  
Surgical Closure ◽  
Pain Scores ◽  
Knee Position ◽  
Total Knee

AbstractStudy areas concerning maximizing knee range of motion (ROM) following total knee arthroplasty (TKA) have come under focus by surgeons. Among the perioperative factors that were identified to affect ROM after TKAs is knee position during surgical wound closure. Therefore, the aim of this study was to review the impact of knee position during TKA wound closure on: (1) postoperative ROM, (2) wound-related complications, (3) Knee Society Score (KSS), (4) postoperative pain, and (5) muscle strength and home functional recovery. A literature search was performed using PubMed, Ovid, and Google Scholar using various combinations of the following search terms: “wound closure,” “knee position,” “surgical closure,” and “knee arthroplasty.” The studies were evaluated for outcomes after TKA and stratified based on the knee position at surgical closure. After application of inclusion and exclusion criteria, seven studies were analyzed. The total number of patients included was 516 patients (259 patients in the flexion group and 257 patients in the full extension group). Based on the reviewed literature, wound closure in flexion was associated with significant improvement in ROM recovery at earlier follow-ups after TKA (four positive and three neutral studies), better early postoperative pain scores (two positive and one neutral study), and faster physical recovery (two positive studies) (better muscle strength and early achievement of physical therapy milestones) compared with wound closure in extension. No difference was found between wound closure in flexion compared with closure in extension in terms of long-term ROM recovery, long-term postoperative pain scores, wound-related complications (seven neutral studies), knee function measured by KSS (five neutral studies), or patient satisfactions after TKA. Although the current review is limited by the number of studies that are available in the literature, it demonstrates that overall, compared with extension, surgical wound closure in flexion may provide better ROM, faster recovery, comparable patient satisfaction, and no risk of higher wound complications.

Effect of Liposomal Bupivacaine on Postoperative Opioid Requirements for Total Hip Arthroplasty, Total Knee Arthroplasty, Laminectomy, Hysterectomy, and Abdominoplasty Procedures

2019 ◽  
pp. 001857871986764
Author(s):  
J. Lacie Bradford ◽  
Beatrice Turner ◽  
Megan A. Van Berkel
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Opioid Consumption ◽  
Control Group ◽  
Liposomal Bupivacaine ◽  
Pain Scores ◽  
Total Knee

Purpose: Opioid use postoperatively has been linked to adverse events and an increase in opioid dependency. This retrospective study evaluated the effect of using liposomal bupivacaine (LB) for postoperative pain control on total opioid consumption, pain control, serious opioid-related adverse events (ORAEs), and hospital length of stay (LOS) in total knee arthroplasty (TKA), total hip arthroplasty (THA), laminectomy, hysterectomy, and abdominoplasty procedures when compared with a control group. Methods: Patients receiving LB from August 1, 2017, to February 1, 2018, for the aforementioned procedures were included for evaluation, and patients undergoing similar procedures who did not receive LB served as the control group. The principal outcome was opioid consumption through postoperative day 5 or discharge, whichever came first, assessed by morphine milligram equivalents (MMEs). Secondary outcomes included pain scores within 72 hours postoperation, hospital LOS, and serious ORAEs. Results: A total of 323 patients were identified for inclusion in the study: TKA, n = 144; THA, n = 48; laminectomy, n = 73; hysterectomy, n = 30; and abdominoplasty, n = 28. Liposomal bupivacaine use was associated with reduced postoperative opioid consumption compared with alternative therapies with a median 71 MME (25%-75%; interquartile range [IQR] = 32.5-148.5) versus 102 MME (25%-75%; IQR = 57-165), P < .005. However, higher numeric pain scores were reported in the LB group compared with the control group for postoperative day 0 with a median of 5.5 (25%-75%; IQR = 4.5-7.4) versus 5.5 (25%-75%; IQR = 4-7) in the control group ( P < .001) and on postoperative day 1 with a median of 6 (25%-75%; IQR = 4.5-7) versus 5.5 (25%-75%; IQR = 4.3-7), P < .001. There was no difference in hospital LOS or ORAEs. Conclusion: In this retrospective analysis of pain management after TKA, THA, laminectomy, hysterectomy, and abdominoplasty procedures, patients receiving LB consumed significantly less opioid medications. However, this was not associated with clinically meaningful improvements in pain scores, hospital LOS, or serious ORAEs.

Liposomal Bupivacaine Infiltration Versus Bupivacaine Hydrochloride for the Management of Unilateral Total Knee Arthroplasty in Geriatric Patients at a 287-Bed Community Hospital

2020 ◽  
pp. 001857872096542
Author(s):  
Abdus-Samad Syed Minhaj ◽  
Ashley Marie Skipper ◽  
Mckenna Murphy
Keyword(s):  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Geriatric Patients ◽  
Opioid Consumption ◽  
Liposomal Bupivacaine ◽  
Lengths Of Stay ◽  
Pain Scores ◽  
Significant Difference ◽  
Total Knee

Introduction: Geriatric patients receiving total knee arthroplasty (TKA) are found to have similar postoperative complications, functional scores, and perioperative mortality, as compared to younger patients. Conversely, geriatric patients often have longer lengths of stay. Periarticular injection (PAI) of liposomal bupivacaine (LB) as part of the multimodal pain management strategy is thought to improve recovery, however, mixed comparative efficacy data exists for its use in TKA.2-5. Methods: A retrospective, chart review was conducted at a 287-bed community teaching hospital. Orthopedic surgical patients who received an infiltration with liposomal bupivacaine versus bupivacaine HCl for unilateral TKA were compared. Patients identified in the electronic medical record by Diagnosis Related Group (DRG) 470—major joint replacement or reattachment of lower extremity without major complication or comorbidity codes were utilized. Patients who meet the following criteria were included: age 65 and older who underwent a TKA between 8/1/2018 to 7/31/2019 were discharged to home. Patients who have contraindications or hypersensitivity to bupivacaine formulations or a history of opioid dependence were excluded. The primary outcome is to identify whether patients who received an infiltration with liposomal bupivacaine had a lower total opioid consumption during their hospital stay. Results: A total of 114 patients who had a DRG 470 code and were above the age of 65 years were studied. There was no statistically significant difference in mean total opioid consumption (oral morphine equivalents) between the bupivacaine HCl (n = 25) and liposomal groups (n = 85) respectively, 93.76 versus 83.72 mg; P = .569. In addition, patients in both groups had similar lengths of hospital stay, 2.5 versus 3 days; P = .529 and mean pain scores until discharge 3.7 versus 4.34 on VAS; P = .305. Conclusion: The results of this drug utilization evaluation do not support a strong clinical advantage with local infiltration of liposomal bupivacaine over bupivacaine HCl in geriatric patients undergoing primary TKA surgery at this institution. There was not a statistically significant difference in mean total opioid consumption between the 2 groups. Additionally, the use of non-opioid analgesics, mean pain scores, and hospital lengths of stay were similar in both groups.

Efficacy of Liposomal Bupivacaine Compared with Multimodal Periarticular Injections for Postoperative Pain Control following Total Knee Arthroplasty

2018 ◽  
Vol 32 (10) ◽  
pp. 979-983 ◽  
Author(s):  
Tyler Britten ◽  
Jonathan D. Hughes ◽  
Yolanda Munoz Maldonado ◽  
Kirby D. Hitt
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Opioid Use ◽  
Liposomal Bupivacaine ◽  
Periarticular Injection ◽  
Pain Scores ◽  
Time Period ◽  
Total Knee

AbstractSingle-dose long-acting periarticular anesthetics have been shown to be an effective method of postoperative analgesia in total knee arthroplasty (TKA). This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider. We compared 22 patients who were treated with LB intraoperatively (LBG) with 41 matched controls who were treated with HC periarticular injection (HCG). These cases were retrospectively reviewed at 0 to 6, 6 to 12, 12 to 24, 24 to 48, and 48 to 72 hours. We reviewed pain scores and opioid use per the preceding time period, total opioid use, length of stay (LOS), and wound complications between the two groups. The two groups showed no statistical difference in total opioids used. In both the 6- to 12-hour and 12- to 24-hour intervals, the LBG required significantly more opioids than the HCG, with p-values of 0.0039 and 0.0061, respectively. Pain scores were not significantly different for any time period. We found no difference in LOS. The LBG tended to have lower doses of antiemetics than the HCG. No significant difference was found in postoperative pain scores and total opioid use between LB and multimodal periarticular intraoperative injections in TKA. Our data demonstrated decreased opioid consumption in the HC group compared with the LB group in both the 6- to 12-hour and 12- to 24-hour time intervals postoperatively. At our institution, LB costs US$314.99, whereas HC costs US$95.

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