Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty
BackgroundThere are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regi...
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Veröffentlicht in: | Journal of orthopaedics 2022-11, Vol.34, p.226-232 |
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description | BackgroundThere are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities.MethodsA consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race.ResultsAfter review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA.ConclusionsThe utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery. |
doi_str_mv | 10.1016/j.jor.2022.09.001 |
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The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities.MethodsA consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race.ResultsAfter review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA.ConclusionsThe utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery.</description><identifier>ISSN: 0972-978X</identifier><identifier>EISSN: 0972-978X</identifier><identifier>DOI: 10.1016/j.jor.2022.09.001</identifier><identifier>PMID: 36120477</identifier><language>eng</language><publisher>Elsevier</publisher><ispartof>Journal of orthopaedics, 2022-11, Vol.34, p.226-232</ispartof><rights>2022 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved. 2022 Professor P K Surendran Memorial Education Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c328t-6fe673224b46455ab6f19aa670491dc05ef41ed0403956b65343863cf95d0e523</cites><orcidid>0000-0002-0972-9717 ; 0000-0002-8449-1040 ; 0000-0002-7062-7584 ; 0000-0001-8728-391X ; 0000-0001-6290-5997 ; 0000-0003-0250-4803</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474319/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474319/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Batko, Brian D.</creatorcontrib><creatorcontrib>Ippolito, Joseph A.</creatorcontrib><creatorcontrib>Gupta, Arjun</creatorcontrib><creatorcontrib>Bukowiec, Lainey</creatorcontrib><creatorcontrib>Potter, James S.</creatorcontrib><creatorcontrib>Joshi, Tej</creatorcontrib><creatorcontrib>Kissin, Yair D.</creatorcontrib><title>Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty</title><title>Journal of orthopaedics</title><description>BackgroundThere are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities.MethodsA consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race.ResultsAfter review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA.ConclusionsThe utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery.</description><issn>0972-978X</issn><issn>0972-978X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNpVkc1uFDEQhC0EIiHwANx85LKD_z2-IEUrAhGRQAIkbpbH0954M2sPtifS8vTMkgjBqUvV1dWHD6HXlHSUUPV23-1z6RhhrCOmI4Q-QefEaLYxuv_x9B99hl7UuieEM6n4c3TGFWVEaH2Ofn09Jii7WFv0GEIA3yrOAZc85JNVl7KDcsQujfj6y-X2E17j94CHKfs7nBMuMC6-xVWtV3mOOY7Y51SXw_zHjQm33NyE7xIAdqXdljxPrrbjS_QsuKnCq8d5gb5fvf-2_bi5-fzhent5s_Gc9W2jAijNGRODUEJKN6hAjXNKE2Ho6ImEICiMRBBupBqU5IL3ivtg5EhAMn6B3j30zstwgNFDasVNdi7x4MrRZhft_5sUb-0u31sjtODUrAVvHgtK_rlAbfYQq4dpcgnyUi3TVOq-F71co_Qh6kuutUD4-4YSe2Jm93ZlZk_MLDF2ZcZ_A1oYjIE</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Batko, Brian D.</creator><creator>Ippolito, Joseph A.</creator><creator>Gupta, Arjun</creator><creator>Bukowiec, Lainey</creator><creator>Potter, James S.</creator><creator>Joshi, Tej</creator><creator>Kissin, Yair D.</creator><general>Elsevier</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0972-9717</orcidid><orcidid>https://orcid.org/0000-0002-8449-1040</orcidid><orcidid>https://orcid.org/0000-0002-7062-7584</orcidid><orcidid>https://orcid.org/0000-0001-8728-391X</orcidid><orcidid>https://orcid.org/0000-0001-6290-5997</orcidid><orcidid>https://orcid.org/0000-0003-0250-4803</orcidid></search><sort><creationdate>20221101</creationdate><title>Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty</title><author>Batko, Brian D. ; Ippolito, Joseph A. ; Gupta, Arjun ; Bukowiec, Lainey ; Potter, James S. ; Joshi, Tej ; Kissin, Yair D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c328t-6fe673224b46455ab6f19aa670491dc05ef41ed0403956b65343863cf95d0e523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Batko, Brian D.</creatorcontrib><creatorcontrib>Ippolito, Joseph A.</creatorcontrib><creatorcontrib>Gupta, Arjun</creatorcontrib><creatorcontrib>Bukowiec, Lainey</creatorcontrib><creatorcontrib>Potter, James S.</creatorcontrib><creatorcontrib>Joshi, Tej</creatorcontrib><creatorcontrib>Kissin, Yair D.</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Batko, Brian D.</au><au>Ippolito, Joseph A.</au><au>Gupta, Arjun</au><au>Bukowiec, Lainey</au><au>Potter, James S.</au><au>Joshi, Tej</au><au>Kissin, Yair D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty</atitle><jtitle>Journal of orthopaedics</jtitle><date>2022-11-01</date><risdate>2022</risdate><volume>34</volume><spage>226</spage><epage>232</epage><pages>226-232</pages><issn>0972-978X</issn><eissn>0972-978X</eissn><abstract>BackgroundThere are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities.MethodsA consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race.ResultsAfter review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA.ConclusionsThe utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery.</abstract><pub>Elsevier</pub><pmid>36120477</pmid><doi>10.1016/j.jor.2022.09.001</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0972-9717</orcidid><orcidid>https://orcid.org/0000-0002-8449-1040</orcidid><orcidid>https://orcid.org/0000-0002-7062-7584</orcidid><orcidid>https://orcid.org/0000-0001-8728-391X</orcidid><orcidid>https://orcid.org/0000-0001-6290-5997</orcidid><orcidid>https://orcid.org/0000-0003-0250-4803</orcidid><oa>free_for_read</oa></addata></record> |
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title | Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty |
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