Efficacy of Combined Spinal Epidural With Adductor Canal Block for Total Knee Arthroplasty
Clinical Science Research
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Introduction: Combined Spinal Epidural (CSE) is often used as the primary anesthetic for Total Knee Arthroplasties (TKA) (4). Intrathecal morphine (ITM) is associated with pruritus, post-operative nausea and vomiting (PONV), and respiratory depression(3). Our institutional preference for TKA includes an opioid free CSE with Adductor Canal (AC) block. The objective of this study is to ascertain if CSE with AC block is beneficial as compared to CSE with ITM for TKA. We hypothesized improved side-effect profile and non-inferior pain control.
Methods: We reviewed 20 patients that received a CSE and AC block for TKA in 2018 and compared them to patients that had received CSE with ITM. The primary outcomes were pruritus, respiratory depression, and PONV. Secondary outcomes were time until first narcotic and morphine equivalents (ME). AC Block was performed under ultrasound guidance. Most patients received Celecoxib, Tylenol, Decadron, Scopolamine Patch, and Gabapentin pre-operatively. The comparison study patients all received a peri-articular injection of 0.5% ropivacaine, 30mg toradol, 0.5mg epinephrine, and 0.08mg clonidine in normal saline. An Unpaired T Test was used to compare the means of our control population (n= 1022 patients) versus our sample group (n=20 patients).
Results: Sample group: 4 (20%), 6 (30%), and 1 (5%) experienced respiratory depression (P=0.07955), PONV (P=0.034129), and pruritis (P<0.0001) respectively. (100%) required narcotics in the first 24hrs, the average time until first narcotic was 251.8 minutes; the average ME was 56.25. Control group: (3%), (54%), and (46%) experienced respiratory depression, PONV, and pruritis respectively. (96%) required narcotics in the first 24hrs, the average ME was 32.3.
Conclusion: CSEs with AC blocks instead of CSEs with ITM for TKA results in non-inferior pain control post-operatively, as well as decreased incidence of PONV and pruritus. There was similar incidence of respiratory depression. Overall, this may provide an alternative analgesic pathway for TKA.
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