Controlling post-operative pain and reducing opioid requirements after total knee arthroplasty (TKA) remains a challenge, particularly in an era stressing rapid recovery protocols and early discharge. A single shot adductor canal block (ACB) has been shown to be effective in decreasing post-operative pain. This requires a specialty-trained Anesthesiologist skilled in ultrasound techniques, which imposes cost, time and skill barriers. Cadaveric studies and magnetic resonance imaging data have shown that access to the adductor canal is possible from within the joint, and thus the potential for intraoperative, intra-articular, surgeon administered ACB through a standard surgical approach is a feasible alternative to ultrasound guided ACB at the time of TKA. The purpose of the present study is to compare the efficacy of surgeon administered intraoperative ACB to anesthesiologist administered ACB. Patients' undergoing primary TKA were prospectively randomized to receive either an Anesthesiologist administered (Group 1) or Surgeon administered (Group 2) ACB using 15 ml of Ropivacaine 0.5%, both in conjunction with spinal anesthesia. Perioperative multimodal anesthesia was standardized for the two groups. Primary outcomes were pain visual analogue scale (VAS), range of motion, and opioid consumption. Secondary outcomes were patient satisfaction scores and length of stay (LOS).Introduction
Methods
Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use.Aims
Patients and Methods
The prescription of opioids has increased in the last two decades. Recently, several states have developed online Prescription Drug Monitoring Programs aimed at preventing overprescribing of controlled substances. Unicompartmental knee arthroplasty (UKA) has been shown to provide improved early functional outcomes, faster recovery, and less postoperative morbidity and pain than total knee arthroplasty (TKA). The aim of this study is to evaluate differences in opioid prescription requirements between patients undergoing TKA and UKA. We retrospectively reviewed consecutive series of primary TKA from January 2017 to July 2017 and primary UKA from January 2016 to July 2017 using standardized perioperative pain protocols. All patients that underwent any other procedure 6 months prior to and after index surgery were excluded, resulting in 740 TKA and 241 UKA. Demographic and comorbidity information was collected for all patients. Opioid prescriptions, morphine milligram equivalents (MME), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring website 6 months prior and after index procedures. Univariate and multivariate analysis were performed for patients that had a second prescription and continued use (defined as more than 6 months postoperatively).Introduction
Methods
