New TKA Pain Management Data From NYU/Columbia Universities

A team of researchers from the New York University Hospital for Joint Diseases and Columbia University set out to determine which was more effective: adductor canal blocks or periarticular anesthetic injections (PAI)—both with bupivacaine—for managing the pain associated with total knee arthroplasty (TKA).

Their work, “Adductor Canal Block Compared with Periarticular Bupivacaine Injection for Total Knee Arthroplasty: A Prospective Randomized Trial,” appears in the July 5, 2018 edition of The Journal of Bone and Joint Surgery.

Co-author Matthew Grosso, M.D., an orthopedic surgeon with the Center for Hip and Knee Replacement at Columbia University in New York, told OTW, “Pain control in total knee arthroplasty is continually evolving. Changes in the last decade have led to decreased pain, shorter length of hospital stay, faster return to activity, and overall improved outcomes.”

“However, there is still controversy regarding the optimal multimodal pain management strategy. Both adductor canal blocks and peri-articular injections have gained popularity for reducing pain in the perioperative period.”

“In this study, we wanted to determine which of these pain management strategies was more powerful, and whether there was any benefit to combining them.”

The authors wrote, “One hundred and fifty-five patients undergoing primary total knee arthroplasty under spinal anesthesia were randomized to 1 of 3 group: ADDUCTOR CANAL BLOCKS alone (15mL of 0.5% bupivacaine), PAI alone (50 mL of 0.25% bupivacaine with epinephrine), and ADDUCTOR CANAL BLOCKS +PAI.”

“We found that adductor canal block alone (without a peri-articular injection) was least effective in controlling pain and reducing opioid consumption. This suggested that peri-articular injections are very effective in managing post-operative pain following TKA and should be used in almost all cases.”

“There seemed to be a small benefit from combining adductor canal blocks with a peri-articular injection, although the results were not statistically significant.”

“Peri-articular injections are an effective method for improving perioperative pain control and should be used as standard practice in TKA. This will result in decreased pain and reduced opioid consumption for patients in the post-operative period. Adductor canal blocks can be considered as an adjunct to PAIs, but not as a stand-alone treatment.”

“Peri-articular injections and adductor canal blocks should be part of the standard discussion with patients regarding multi-modal pain management following TKA. Patients should be counseled that utilizing peri-articular injections or adductor canal blocks with peri-articular injections will result in more comfort following surgery. This will allow them to take less opioid medication and have higher activity levels in the post-operative period.”