Continuous Adductor Canal Block Compared to Epidural Anesthesia for Total Knee Arthroplasty
Notice bibliographique
Résumé
Isaac G Freedman,1,2 Michael R Mercier,3,4 Anoop R Galivanche,3,5 Mani Ratnesh S Sandhu,6 Mark Hocevar,7 Harold Gregory Moore,8 Jonathan N Grauer,3 Lee E Rubin,3 Jinlei Li2 1Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; 2Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; 3Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, 06511, USA; 4Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada; 5Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA; 6Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 7Warren Alpert School of Medicine, Brown University, Providence, RI, USA; 8Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Isaac G Freedman, Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, Email igfreedman@mgh.harvard.eduAim: To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).Methods: Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.Results: Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49– 0.84; with steroids: OR = 0.54; 95% CI 0.38– 0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36– 0.48; with steroids: OR 0.22; 95% CI 0.18– 0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=− 290 mmE; 95% CI: − 313 to − 268 mmE; with steroids: β=− 261 mmE; 95% CI: − 289 to − 233 mmE) as well as lower dMME (without steroids: β=− 66 mmE/day; 95% CI − 72 to − 60 mmE/day; with steroids: β=− 48 mmE/day; 95% CI − 55 to − 40 mmE/day).Conclusion: cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.Level of Evidence: Level IIIPlain Language Summary: Anesthesia practice for TKA in the inpatient setting varies widely. Retrospectively compared outcomes for EA and cACB with or without steroids in TKA. cACB is associated with superior perioperative outcomes vs EA. cACB is associated with reduced opioid analgesia requirements vs EA. cACB with steroids was superior to cACB without steroids.Keywords: adductor canal block, knee arthroplasty, complications, length of stay, pain control, milligram morphine equivalents, dexamethasone, methylprednisolone acetate, steroid, NSQIP, MME
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,016 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».