Newly Published
Pain Medicine  |   March 2017
A Three-arm Randomized Clinical Trial Comparing Continuous Femoral Plus Single-injection Sciatic Peripheral Nerve Blocks versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Patients Undergoing Total Knee Arthroplasty
Author Notes
  • From the Department of Anesthesiology (A.W.A., R.L.J., C.B.M., J.K.P., J.R.H., S.L.K.), Department of Orthopedics (M.P.A., M.J.T., M.E.K., M.W.P.), and Division of Biomedical Statistics and Informatics (D.R.S.), Mayo Clinic, Rochester, Minnesota.
  • Submitted for publication July 29, 2016. Accepted for publication January 31, 2017.
    Submitted for publication July 29, 2016. Accepted for publication January 31, 2017.×
  • Acknowledgments: The authors acknowledge and thank the Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, at Mayo Clinic, Rochester, Minnesota, with a special thank you to Suanne M. Weist, R.N., Laurie A. Meade, R.N., Linda S. Weise, R.R.T., Lavonne M. Liedl, R.R.T., Amy L. Amsbaugh, R.R.T., Timothy J. Weister, R.N., and Gregory A. Wilson, R.R.T., for their participant recruitment, enrollment, and data extraction expertise.
    Acknowledgments: The authors acknowledge and thank the Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, at Mayo Clinic, Rochester, Minnesota, with a special thank you to Suanne M. Weist, R.N., Laurie A. Meade, R.N., Linda S. Weise, R.R.T., Lavonne M. Liedl, R.R.T., Amy L. Amsbaugh, R.R.T., Timothy J. Weister, R.N., and Gregory A. Wilson, R.R.T., for their participant recruitment, enrollment, and data extraction expertise.×
  • Research Support: Supported by the Department of Anesthesiology and the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
    Research Support: Supported by the Department of Anesthesiology and the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.×
  • Competing Interests: Dr. Taunton serves as a consultant at DJO Global (Vista, California). He receives royalties from DJO Global (Parsippany, New Jersey). Dr. Pagnano serves as a consultant at Pacira Pharmaceuticals. He receives the following royalties: DePuy intellectual property (IP) royalties, Johnson & Johnson IP royalties, Stryker IP royalties.
    Competing Interests: Dr. Taunton serves as a consultant at DJO Global (Vista, California). He receives royalties from DJO Global (Parsippany, New Jersey). Dr. Pagnano serves as a consultant at Pacira Pharmaceuticals. He receives the following royalties: DePuy intellectual property (IP) royalties, Johnson & Johnson IP royalties, Stryker IP royalties.×
  • Reproducible Science: Full protocol available at: Amundson.Adam@mayo.edu. Raw data available at: Amundson.Adam@mayo.edu.
    Reproducible Science: Full protocol available at: Amundson.Adam@mayo.edu. Raw data available at: Amundson.Adam@mayo.edu.×
  • Correspondence: Address correspondence to Dr. Amundson: Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. Amundson.Adam@mayo.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Pain Medicine / Pharmacology / Regional Anesthesia
Pain Medicine   |   March 2017
A Three-arm Randomized Clinical Trial Comparing Continuous Femoral Plus Single-injection Sciatic Peripheral Nerve Blocks versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Patients Undergoing Total Knee Arthroplasty
Anesthesiology Newly Published on March 2, 2017. doi:10.1097/ALN.0000000000001586
Anesthesiology Newly Published on March 2, 2017. doi:10.1097/ALN.0000000000001586
Abstract

Background: Multimodal analgesia is standard practice for total knee arthroplasty; however, the role of regional techniques in improved perioperative outcomes remains unknown. The authors hypothesized that peripheral nerve blockade would result in lower pain scores and opioid consumption than two competing periarticular injection solutions.

Methods: This three-arm, nonblinded trial randomized 165 adults undergoing unilateral primary total knee arthroplasty to receive (1) femoral catheter plus sciatic nerve blocks, (2) ropivacaine-based periarticular injection, or (3) liposomal bupivacaine-based periarticular injection. Primary outcome was maximal pain during postoperative day 1 (0 to 10, numerical pain rating scale) in intention-to-treat analysis. Additional outcomes included pain scores and opioid consumption for postoperative days 0 to 2 and 3 months.

Results: One hundred fifty-seven study patients received peripheral nerve block (n = 50), ropivacaine (n = 55), or liposomal bupivacaine (n = 52) and reported median maximal pain scores on postoperative day 1 of 3, 4, and 4.5 and on postoperative day 0 of 1, 4, and 5, respectively (average pain scores for postoperative day 0: 0.6, 1.7, and 2.4 and postoperative day 1: 2.5, 3.5, and 3.7). Postoperative day 1 median maximal pain scores were significantly lower for peripheral nerve blockade compared to liposomal bupivacaine-based periarticular injection (P = 0.016; Hodges–Lehmann median difference [95% CI] = −1 [−2 to 0]). After postanesthesia care unit discharge, postoperative day 0 median maximal and average pain scores were significantly lower for peripheral nerve block compared to both periarticular injections (ropivacaine: maximal −2 [−3 to −1]; P < 0.001; average −0.8 [−1.3 to −0.2]; P = 0.003; and liposomal bupivacaine: maximal −3 [−4 to −2]; P < 0.001; average −1.4 [−2.0 to −0.8]; P < 0.001).

Conclusions: Ropivacaine-based periarticular injections provide pain control comparable on postoperative days 1 and 2 to a femoral catheter and single-injection sciatic nerve block. This study did not demonstrate an advantage of liposomal bupivacaine over ropivacaine in periarticular injections for total knee arthroplasty.