The Experts below are selected from a list of 534 Experts worldwide ranked by ideXlab platform

Jorgen B Dahl - One of the best experts on this subject based on the ideXlab platform.

  • Adductor Canal block with continuous infusion versus intermittent boluses and morphine consumption a randomized blinded controlled clinical trial
    Anesthesia & Analgesia, 2017
    Co-Authors: Pia Jaeger, Jorgen B Dahl, Johan Klovgaard Sorensen, Bo Gottschau, Brian M. Ilfeld, Jonas Baggesgaard, Ben Graungaard, Anders Odgaard
    Abstract:

    Author(s): Jaeger, Pia; Baggesgaard, Jonas; Sorensen, Johan K; Ilfeld, Brian M; Gottschau, Bo; Graungaard, Ben; Dahl, Jorgen B; Odgaard, Anders; Grevstad, Ulrik | Abstract: BACKGROUND:Based on the assumption that relatively large volumes of local anesthetic optimize an Adductor Canal block (ACB), we theorized that an ACB administered as repeated boluses would improve analgesia without compromising mobility, compared with a continuous infusion. METHODS:We performed a randomized, blinded, controlled study, including patients scheduled for total knee arthroplasty with spinal anesthesia. Patients received 0.2% ropivacaine via a catheter in the Adductor Canal administered as either repeated intermittent boluses (21 mL/3 h) or continuous infusion (7 mL/h). The primary outcome was total (postoperative day [POD], 0-2) opioid consumption (mg), administered as patient-controlled analgesia. Pain, ambulation, and quadriceps muscle strength were secondary outcomes. RESULTS:We randomized 110 patients, of whom 107 were analyzed. Total opioid consumption (POD, 0-2) was a median (range) of 23 mg (0-139) in the bolus group and 26 mg (3-120) in the infusion group (estimated median difference, 4 mg; 95% confidence interval [CI], -13 to 5; P = .29). Linear mixed-model analyses revealed no difference in pain during knee flexion (mean difference, 2.6 mm; 95% CI, -2.9 to 8.0) or at rest (mean difference, 1.7 mm; 95% CI, -1.5 to 4.9). Patients in the bolus group had improved quadriceps sparing on POD 2 (median difference, 7.4%; 95% CI, 0.5%-15.5%). However, this difference was not present on POD 1 or reflected in the ambulation tests (P g .05). CONCLUSIONS:Changing the mode of administration for an ACB from continuous infusion to repeated intermittent boluses did not decrease opioid consumption, pain, nor mobility.

  • Adductor Canal Block for Postoperative Pain Treatment after Revision Knee Arthroplasty: A Blinded, Randomized, Placebo-Controlled Study
    2016
    Co-Authors: Pia Jaeger, M Jenstrup, Jorgen Lund, Maria H Henningsen, Ole Mathiesen, Zbigniew J. Koscielniak-nielsen, Henrik M. Schrøder, Jorgen B Dahl
    Abstract:

    Background: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the Adductor Canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods: We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an Adductor Canal block via a catheter with either ropivacaine or placebo; bolus of 0.75 % ropivacaine/saline, followed by infusion of 0.2 % ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results:We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52622 versus 71625 mm (mean difference 19, 95 % CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55621 versus 69621 mm during knee flexion (P = 0.11) and 39618 versus 45623 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P.0.05)

  • the isolated effect of Adductor Canal block on quadriceps femoris muscle strength after total knee arthroplasty a triple blinded randomized placebo controlled trial with individual patient analysis
    Anesthesia & Analgesia, 2016
    Co-Authors: Johan Klovgaard Sorensen, Pia Jaeger, Jorgen B Dahl, Bo Gottschau, Snorre Stephensen, Ulrik Grevstad
    Abstract:

    BACKGROUND:Using peripheral nerve block after total knee arthroplasty (TKA), without impeding mobility, is challenging. We hypothesized that the analgesic effect of Adductor Canal block (ACB) could increase the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle after TKA

  • The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers.
    Anesthesia and analgesia, 2016
    Co-Authors: Ulrik Grevstad, Pia Jaeger, Johan Klovgaard Sorensen, Bo Gottschau, Brian M. Ilfeld, Martin Ballegaard, Mike Hagelskjaer, Jorgen B Dahl
    Abstract:

    BACKGROUND:Single-injection Adductor Canal block (ACB) provides analgesia after knee surgery. Which nerves that are blocked by an ACB and what influence—if any—local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (whi

  • optimal volume of local anaesthetic for Adductor Canal block using the continual reassessment method to estimate ed95
    BJA: British Journal of Anaesthesia, 2015
    Co-Authors: Pia Jaeger, M Jenstrup, Jorgen Lund, V Brondum, Volkert Siersma, Karen Lisa Hilsted, Jorgen B Dahl
    Abstract:

    Background Theoretically, the ideal volume of local anaesthetic for Adductor Canal block (ACB) would ensure sufficient filling of the Canal and avoid proximal spread to the femoral triangle. In this dose-finding study, we aimed to investigate the minimal effective volume for an ACB needed to fill the Adductor Canal distally in at least 95% of patients (ED95). Methods We performed a blinded trial, enrolling 40 healthy men. All subjects received an ACB with lidocaine 1%. Volumes were assigned sequentially to the subjects using the continual reassessment method followed by Bayesian analysis to determine the ED95. Distal filling of the Adductor Canal was assessed by magnetic resonance imaging (primary outcome). Secondary outcomes were the effect of volume on proximal spread to the femoral triangle (also assessed by magnetic resonance imaging), quadriceps muscle weakness (decrease by ≥25% from baseline) and sensory block. Results The ED95 was 20 ml, with an estimated probability of sufficiently filling the Canal of 95.1% (95% credibility interval: 0.91–0.98). Proximal spread to the femoral triangle was seen in 0/4 (0%), 7/12 (58%), 4/8 (50%), and 8/16 (50%) subjects with the 5, 10, 15, and 20 ml doses, respectively (P=0.25). Seven subjects had a reduction in muscle strength, but there was no difference between groups (P=0.85). Conclusions For an ACB, the dose closest to the ED95 needed to fill the Adductor Canal distally was 20 ml. There was no significant correlation between volume and proximal spread or muscle strength. Clinical trial registration NCT02033356.

Pia Jaeger - One of the best experts on this subject based on the ideXlab platform.

Daniel I Sessler - One of the best experts on this subject based on the ideXlab platform.

  • continuous Adductor Canal blocks does varying local anesthetic delivery method automatic repeated bolus doses versus continuous basal infusion influence cutaneous analgesia and quadriceps femoris strength a randomized double masked controlled split body volunteer study
    Anesthesia & Analgesia, 2016
    Co-Authors: Amanda M Monahan, Pia Jaeger, Jacklynn F Sztain, Bahareh Khatibi, Daniel I Sessler, Timothy Furnish, Edward J Mascha, Jing You, Cindy Wen, Ken A Nakanote
    Abstract:

    BACKGROUND:It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for Adductor Canal perineural catheters. Therefore, we tested the hypothesis that scheduled bolus administration is superior or noninferior to a continuous infusion on cutan

  • continuous Adductor Canal versus continuous femoral nerve blocks relative effects on discharge readiness following unicompartment knee arthroplasty
    Regional Anesthesia and Pain Medicine, 2015
    Co-Authors: Jacklynn F Sztain, Anthony T Machi, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales, Daniel I Sessler
    Abstract:

    Background We tested the hypothesis that, following unicompartment knee arthroplasty, a continuous Adductor Canal block decreases the time to reach 4 discharge criteria compared with a continuous femoral nerve block. Methods Subjects were randomized to either an Adductor Canal or femoral perineural catheter (2-day ropivacaine 0.2% infusion) in an unmasked fashion. The primary outcome was the time to attain 4 discharge criteria: (1) adequate analgesia; (2) intravenous opioid independence; (3) ability to independently stand, walk 3 m, return, and sit down; and (4) ambulate 30 m. Results Subjects with an Adductor Canal catheter (n = 15) reached all 4 criteria in a median of 35 hours (interquartile range, 24–43 hours), compared with 40 hours (interquartile range, 27–69 hours) for those with a femoral catheter (n = 15; Wilcoxon rank sum test: P = 0.46; log-rank test: P = 0.16). However, the percentages of subjects (Adductor Canal: femoral) who reached the 2 mobilization criteria were 27%:0% on postoperative day (POD) 0, 93%:53% on POD 1, and 100%:73% on POD 2. Of Adductor Canal subjects, 100% were discharge ready by POD 2, compared with only 73% of femoral subjects (P Conclusions Compared with a continuous femoral nerve block, a continuous Adductor Canal block did not appreciably decrease the median number of hours to overall discharge readiness, yet did decrease the number of discrete days until discharge readiness. These results are applicable to only unicompartment knee arthroplasty and must be considered preliminary because of the limited sample size of this pilot study.

  • discharge readiness after tricompartment knee arthroplasty Adductor Canal versus femoral continuous nerve blocks a dual center randomized trial
    Anesthesiology, 2015
    Co-Authors: Anthony T Machi, Jacklynn F Sztain, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales, Daniel I Sessler
    Abstract:

    The authors conducted a randomized, controlled, parallel-arm, superiority study to test the hypothesis that a continuous Adductor Canal block decreases the time to attain four discharge criteria compared with a continuous femoral nerve block after tricompartment knee arthroplasty.Subjects undergoing tricompartment knee arthroplasty were randomized using computer-generated lists to either an Adductor Canal or femoral perineural catheter (3-day ropivacaine 0.2% infusion) in an unmasked manner. The primary outcome was the time to attain four criteria: (1) adequate analgesia; (2) intravenous opioids independence; (3) ability to stand, walk 3 m, return, and sit down; and (4) ambulate 30 m.Subjects with an Adductor Canal catheter (n = 39) reached all four criteria in a median of 55 h (interquartile, 42 to 63 h) compared with 61 h (49 to 69 h) for those with a femoral catheter (n = 41; 95% CI, -13 to 1 h; P = 0.12). The percentage of subjects who reached the two mobilization criteria on postoperative days 1 and 2 were 72 and 95% for those with an Adductor Canal catheter (n = 39), but only 27 and 76% in subjects with a femoral catheter (n = 41; both P < 0.001). Differences in pain scores at rest and intravenous opioid requirements were minimal, but femoral infusion improved dynamic analgesia (P = 0.01 to 0.02).Compared with a continuous femoral nerve block, a continuous Adductor Canal block did not appreciably decrease the time to overall discharge readiness even though it did decrease the time until adequate mobilization, primarily because both groups experienced similar analgesia and intravenous opioid requirements that--in most cases--exceeded the time to mobilization.

  • discharge readiness after tricompartment knee arthroplasty Adductor Canal versus femoral continuous nerve blocks a dual center randomized trial
    Anesthesiology, 2015
    Co-Authors: Anthony T Machi, Jacklynn F Sztain, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales, Daniel I Sessler
    Abstract:

    Background:The authors conducted a randomized, controlled, parallel-arm, superiority study to test the hypothesis that a continuous Adductor Canal block decreases the time to attain four discharge criteria compared with a continuous femoral nerve block after tricompartment knee arthroplasty.Methods:

Ole Mathiesen - One of the best experts on this subject based on the ideXlab platform.

  • Adductor Canal Block for Postoperative Pain Treatment after Revision Knee Arthroplasty: A Blinded, Randomized, Placebo-Controlled Study
    2016
    Co-Authors: Pia Jaeger, M Jenstrup, Jorgen Lund, Maria H Henningsen, Ole Mathiesen, Zbigniew J. Koscielniak-nielsen, Henrik M. Schrøder, Jorgen B Dahl
    Abstract:

    Background: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the Adductor Canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods: We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an Adductor Canal block via a catheter with either ropivacaine or placebo; bolus of 0.75 % ropivacaine/saline, followed by infusion of 0.2 % ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results:We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52622 versus 71625 mm (mean difference 19, 95 % CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55621 versus 69621 mm during knee flexion (P = 0.11) and 39618 versus 45623 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P.0.05)

  • effect of Adductor Canal block versus femoral nerve block on quadriceps strength mobilization and pain after total knee arthroplasty a randomized blinded study
    Regional Anesthesia and Pain Medicine, 2015
    Co-Authors: Ulrik Grevstad, Pia Jaeger, Karen Lisa Hilsted, Ole Mathiesen, Laura Staun Valentiner, Jorgen B Dahl
    Abstract:

    Background and Objectives Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the Adductor Canal block (ACB) could increase functional muscle strength. Methods We included 50 TKA patients with severe movement-related pain; defined as having visual analog scale pain score of greater than 60 mm during active flexion of the knee. The ACB group received an ACB with ropivacaine 0.2% 30 mL and a femoral nerve block (FNB) with 30 mL saline. The FNB group received an ACB with 30 mL saline and an FNB with ropivacaine 0.2% 30 mL. We compared the effect of the ACB versus FNB on maximum voluntary isometric contraction of the quadriceps muscle relative to a postoperative baseline value. Secondary end points were differences between groups in ability to ambulate and changes in pain scores (Clinicaltrials.gov identifier NCT01922596). Results After block, the quadriceps maximum voluntary isometric contraction increased to 193% (95% confidence interval [CI], 143–288) of the baseline value in the ACB group and decreased to 16% (95% CI, 3–33) in the FNB group with an estimated difference of 178% (95% CI, 136–226), P Conclusion Adductor Canal block provides a clinically relevant and statistically significant increase in quadriceps muscle strength for patients in severe pain after TKA.

  • Adductor Canal block for postoperative pain treatment after revision knee arthroplasty a blinded randomized placebo controlled study
    PLOS ONE, 2014
    Co-Authors: Pia Jaeger, M Jenstrup, Jorgen Lund, Maria H Henningsen, Ole Mathiesen, Henrik M. Schrøder, Zbigniew J Koscielniaknielsen, Jorgen B Dahl
    Abstract:

    Background Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the Adductor Canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. Methods We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an Adductor Canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. Results We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52±22 versus 71±25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1–8 h/7 h) pain scores were 55±21 versus 69±21 mm during knee flexion (P = 0.11) and 39±18 versus 45±23 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P>0.05). Conclusions The only statistically significant difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. Trial Registration Clinicaltrials.gov NCT01191593

  • Adductor Canal block versus femoral nerve block for analgesia after total knee arthroplasty a randomized double blind study
    Regional Anesthesia and Pain Medicine, 2013
    Co-Authors: Pia Jaeger, Karen Lisa Hilsted, Ole Mathiesen, J S Fomsgaard, T K Larsen, Dusanka Zaric, Jens Bjerregaard, Jens Gyrn, Jorgen B Dahl
    Abstract:

    Background and Objectives Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, Adductor Canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, Adductor muscle strength, morphine-related complications, and mobilization ability. Methods We performed a double-blind, randomized, controlled study of patients scheduled for TKA with spinal anesthesia. The patients were randomized to receive either a continuous ACB or an FNB via a catheter (30-mL 0.5% ropivacaine given initially, followed by a continuous infusion of 0.2% ropivacaine, 8 mL/h for 24 hours). Muscle strength was assessed with a handheld dynamometer, and we used the percentile change from baseline for comparisons. The trial was registered at clinicaltrials.gov (Identifier: NCT01470391). Results We enrolled 54 patients, of which 48 were analyzed. Quadriceps strength as a percentage of baseline was significantly higher in the ACB group compared with the FNB group: (median [range]) 52% [31–71] versus 18% [4–48], (95% confidence interval, 8–41; P = 0.004). There was no difference between the groups regarding morphine consumption (P = 0.94), pain at rest (P = 0.21), pain during flexion of the knee (P = 0.16), or Adductor muscle strength (P = 0.39); neither was there a difference in morphine-related adverse effects or mobilization ability (P > 0.05). Conclusions Adductor Canal block preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain.

  • analgesic efficacy of ultrasound guided Adductor Canal blockade after arthroscopic anterior cruciate ligament reconstruction a randomised controlled trial
    European Journal of Anaesthesiology, 2013
    Co-Authors: Malene Espelund, J S Fomsgaard, Ole Mathiesen, Jorgen Haraszuk, Jorgen B Dahl
    Abstract:

    CONTEXTAnterior cruciate ligament (ACL) reconstruction surgery is associated with moderate to severe postoperative pain, which may be ameliorated by peripheral nerve blocks. The Adductor Canal block (ACB) is an almost exclusively sensory nerve block that has been demonstrated to reduce pain and opio

Amanda M Monahan - One of the best experts on this subject based on the ideXlab platform.

  • proximal versus distal continuous Adductor Canal blocks does varying perineural catheter location influence analgesia a randomized subject masked controlled clinical trial
    Anesthesia & Analgesia, 2018
    Co-Authors: Jacklynn F Sztain, Wendy B Abramson, Amanda M Monahan, Bahareh Khatibi, Engy T Said, Rodney A Gabriel, John J Finneran, Richard H Bellars, Patrick L Nguyen, Scott T Ball
    Abstract:

    BACKGROUND:A continuous Adductor Canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the Adductor hiatus would provide superior analgesia compare

  • Adductor Canal vs femoral continuous peripheral nerve blocks for knee arthroplasty a one year follow up pilot study of 2 randomized controlled clinical trials
    Journal of Anesthesia and Clinical Research, 2018
    Co-Authors: Evan N Davidson, Jacklynn F Sztain, Anthony T Machi, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales
    Abstract:

    Author(s): Davidson, Evan N. | Abstract: For patients undergoing tricompartment or unicompartment knee arthroplasty, previous studies have shown that a continuous femoral block provides superior analgesia in various circumstances compared with a continuous Adductor Canal block during the local anesthetic infusion. However, the long-term outcomes of these two approaches remains unknown. We thus evaluated functional outcomes with each approach 1, 4, and 12 months after surgery.

  • continuous Adductor Canal blocks does varying local anesthetic delivery method automatic repeated bolus doses versus continuous basal infusion influence cutaneous analgesia and quadriceps femoris strength a randomized double masked controlled split body volunteer study
    Anesthesia & Analgesia, 2016
    Co-Authors: Amanda M Monahan, Pia Jaeger, Jacklynn F Sztain, Bahareh Khatibi, Daniel I Sessler, Timothy Furnish, Edward J Mascha, Jing You, Cindy Wen, Ken A Nakanote
    Abstract:

    BACKGROUND:It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for Adductor Canal perineural catheters. Therefore, we tested the hypothesis that scheduled bolus administration is superior or noninferior to a continuous infusion on cutan

  • continuous Adductor Canal versus continuous femoral nerve blocks relative effects on discharge readiness following unicompartment knee arthroplasty
    Regional Anesthesia and Pain Medicine, 2015
    Co-Authors: Jacklynn F Sztain, Anthony T Machi, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales, Daniel I Sessler
    Abstract:

    Background We tested the hypothesis that, following unicompartment knee arthroplasty, a continuous Adductor Canal block decreases the time to reach 4 discharge criteria compared with a continuous femoral nerve block. Methods Subjects were randomized to either an Adductor Canal or femoral perineural catheter (2-day ropivacaine 0.2% infusion) in an unmasked fashion. The primary outcome was the time to attain 4 discharge criteria: (1) adequate analgesia; (2) intravenous opioid independence; (3) ability to independently stand, walk 3 m, return, and sit down; and (4) ambulate 30 m. Results Subjects with an Adductor Canal catheter (n = 15) reached all 4 criteria in a median of 35 hours (interquartile range, 24–43 hours), compared with 40 hours (interquartile range, 27–69 hours) for those with a femoral catheter (n = 15; Wilcoxon rank sum test: P = 0.46; log-rank test: P = 0.16). However, the percentages of subjects (Adductor Canal: femoral) who reached the 2 mobilization criteria were 27%:0% on postoperative day (POD) 0, 93%:53% on POD 1, and 100%:73% on POD 2. Of Adductor Canal subjects, 100% were discharge ready by POD 2, compared with only 73% of femoral subjects (P Conclusions Compared with a continuous femoral nerve block, a continuous Adductor Canal block did not appreciably decrease the median number of hours to overall discharge readiness, yet did decrease the number of discrete days until discharge readiness. These results are applicable to only unicompartment knee arthroplasty and must be considered preliminary because of the limited sample size of this pilot study.

  • discharge readiness after tricompartment knee arthroplasty Adductor Canal versus femoral continuous nerve blocks a dual center randomized trial
    Anesthesiology, 2015
    Co-Authors: Anthony T Machi, Jacklynn F Sztain, Nicholas J Kormylo, Wendy B Abramson, Sarah J Madison, Amanda M Monahan, Bahareh Khatibi, Scott T Ball, Francis B Gonzales, Daniel I Sessler
    Abstract:

    The authors conducted a randomized, controlled, parallel-arm, superiority study to test the hypothesis that a continuous Adductor Canal block decreases the time to attain four discharge criteria compared with a continuous femoral nerve block after tricompartment knee arthroplasty.Subjects undergoing tricompartment knee arthroplasty were randomized using computer-generated lists to either an Adductor Canal or femoral perineural catheter (3-day ropivacaine 0.2% infusion) in an unmasked manner. The primary outcome was the time to attain four criteria: (1) adequate analgesia; (2) intravenous opioids independence; (3) ability to stand, walk 3 m, return, and sit down; and (4) ambulate 30 m.Subjects with an Adductor Canal catheter (n = 39) reached all four criteria in a median of 55 h (interquartile, 42 to 63 h) compared with 61 h (49 to 69 h) for those with a femoral catheter (n = 41; 95% CI, -13 to 1 h; P = 0.12). The percentage of subjects who reached the two mobilization criteria on postoperative days 1 and 2 were 72 and 95% for those with an Adductor Canal catheter (n = 39), but only 27 and 76% in subjects with a femoral catheter (n = 41; both P < 0.001). Differences in pain scores at rest and intravenous opioid requirements were minimal, but femoral infusion improved dynamic analgesia (P = 0.01 to 0.02).Compared with a continuous femoral nerve block, a continuous Adductor Canal block did not appreciably decrease the time to overall discharge readiness even though it did decrease the time until adequate mobilization, primarily because both groups experienced similar analgesia and intravenous opioid requirements that--in most cases--exceeded the time to mobilization.