Does Addition of Adductor Canal Blockade to Multimodal Periarticular Analgesia Improve Discharge Status, Pain Levels, Opioid Use, and Length of Stay after Total Knee Arthroplasty?

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Total knee arthroplasty (TKA) can be associated with substantial postoperative pain that may affect satisfaction and return to function. Various forms of pain control have been used; however, multimodal periarticular analgesia (MPA) and adductor canal block (ACB) have recently gained popularity. The purpose of this study was to compare (1) discharge status, (2) pain levels, (3) postoperative opioid consumption, and (4) length of stay (LOS) between TKA patients who received MPA only and those who received both MPA and ACB. A single surgeon database was reviewed for TKA patients who received MPA with or without ACB between January 2015 and April 2016. This yielded 110 patients who had a mean age of 62 years. Forty-five patients received MPA alone, while 65 patients received both modalities. Patient records were reviewed to obtain demographic and end-point data (discharge status, pain scores, opioid consumption, and LOS). Student's t-test and chi-squared test were used to compare continuous and categorical variables, respectively. There was no significant difference in discharge status (p = 0.304), pain levels (p = 0.343), and postoperative opioid consumption (p = 0.729) between the two cohorts. When compared with MPA patients, TKA patients who received both MPA and ACB demonstrated shorter LOS (2.44 vs. 1.98 days), a value that trended toward significance (p = 0.061). When comparing TKA patients who received MPA with those who received a combination of MPA and ACB, we were unable to elucidate a significant difference in any of the end points of interest. Therefore, MPA alone is comparable to combined MPA and ACB in managing postoperative pain in TKA patients. However, larger studies may be necessary to verify these findings.

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