P090: ADDUCTOR CANAL BLOCK AND IPACK BLOCK DURATION OF ANALGESIA SUCCESSFULLY PROLONGED WITH PERINEURAL DEXMEDETOMIDINE AND DEXAMETHASONE (DEX-DEX) FOR TOTAL KNEE ARTHROPLASTY POSTOPERATIVE ANALGESIA: A CASE SERIES
Jared Herman1; Ivan Urits2; Richard Urman3; Alan Kaye4; Omar Viswanath5; Jonathan Eskander6; 1Mount Sinai Medical Center; 2Beth Israel Deaconess Medical Center, Anesthesiology, Critical Care, and Pain Medicine; 3Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine; 4Louisiana State University Health Shreveport, Department of Anesthesiology; 5Valley Anesthesiology and Pain Consultants - Envision Physician Services; 6Portsmouth Anesthesia Associates, Anesthesiology and Pain Medicine
Introduction/Background: Total Knee Arthroplasty (TKA) is amongst the most commonly performed orthopedic procedures. Controlling the pain of this patient population is essential in improving outcomes such as opioid consumption, hospital length of stay, overall function and rehabilitation participation following their procedure. Local anesthetic infiltration of the interspace between the popliteal artery and capsule of the posterior knee, known as the IPACK block, combined with an adductor canal block (ACB), can be used to reduce pain in the challenging area of the posterior knee after knee surgery without compromising motor function of the quadriceps muscles. One limiting factor to this combination of techniques is the duration of analgesia provided. This case series demonstrates the combination of dexmedetomidine and dexamethasone (Dex-Dex) as local anesthetic adjuvants to significantly prolong the analgesic duration of combined ACB and IPACK block in three patients undergoing TKA.
Methods: Preoperative ACB and IPACK blocks were performed for postoperative analgesia in 3 TKA patients. The anesthetic mixture was 25 mcg of dexmedetomidine and 5 mg preservative-free dexamethasone. 10 cc of the injectate was injected for the ACB and 20 cc for the IPACK Block.
Results: Two of the patients reported experiencing 4 days of analgesia and one patient reported 5 days of analgesia following the ACB + IPACK block. Two of the patients required no opioid analgesics postoperatively.
Discussion/Conclusion: An ACB utilizing 0.75% ropivacaine has been demonstrated to provide approximately 10.8 hours of analgesia. Our series demonstrates a significantly prolonged duration of analgesia from this injectate combination. Few studies have utilized the (Dex-Dex) combination. The combination, however, was previously proven to safely increase the analgesic duration of a caudal block prior to hypospadias surgeries in pediatrics. More studies are needed to understand the potential synergistic effect of dexmedetomidine and dexamethasone, which could have a substantial impact on postoperative analgesia for TKA patients.