A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty.

IF 2.3 4区医学 Q2 ORTHOPEDICS Arthroplasty Pub Date : 2024-02-01 DOI:10.1186/s42836-023-00226-y

Aurora Quaye, Brian McAllister, Joseph R Garcia, Orion Nohr, Sarah J Laduzenski, Lucy Mack, Christine R Kerr, Danielle A Kerr, Charonne N Razafindralay, Janelle M Richard, Wendy Y Craig, Stephen Rodrigue

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Abstract

Background: Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA.

Methods: This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes.

Results: A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups.

Conclusion: The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research.

Trial registration: This project was retrospectively registered with clinicaltrials.gov ( NCT05635916 ) on 2 December 2022.

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一项前瞻性随机试验，比较脂质体布比卡因与传统布比卡因对成人全膝关节置换术中接受内收肌管阻滞的疼痛控制和术后阿片类药物使用的影响。

背景：全膝关节置换术（TKA）是一种常用的手术，可减轻疼痛并改善终末期关节损伤造成的功能障碍。有效控制 TKA 术后疼痛对预防并发症和促进康复至关重要。使用传统布比卡因（CB）进行内收肌阻滞（ACB）可在 TKA 术后提供充分的镇痛效果，但存在阻滞解除后出现反跳痛的风险。脂质体布比卡因（LB）是一种缓释局麻药，可提供长达 72 小时的镇痛效果。本研究的目的是比较 TKA 术后使用 LB 和 CB 的 ACB 的术后效果：这项单一机构、前瞻性、随机临床试验招募了计划接受 TKA 的患者。参与者被随机分配接受 LB 或 CB ACB。评估的主要结果是术后 72 小时内的疼痛评分。阿片类药物消耗量和住院时间作为次要结果进行评估：结果：共有 80 名患者入选。两组患者的人口统计学特征和临床特征相似。LB 组在 72 小时评估期间的阿片类药物累积用量明显较低（P = 0.016）。两组患者的疼痛评分和住院时间没有差异：该研究表明，枸橼酸阿片类药物可显著降低 TKA 术后几天的阿片类药物用量，而不会影响疼痛评分或住院时间。这一发现对于改善 TKA 患者的术后效果和减少阿片类药物的使用具有重要意义。之前的研究对LB益处的报道结果不一致，这凸显了进一步研究的必要性：该项目于2022年12月2日在clinicaltrials.gov（NCT05635916）进行了回顾性注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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