Journal of Pain Research (Aug 2022)

Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty

  • Del Toro-Pagán NM,
  • Dai F,
  • Banack T,
  • Berlin J,
  • Makadia SA,
  • Rubin LE,
  • Zhou B,
  • Huynh P,
  • Li J

Journal volume & issue
Vol. Volume 15
pp. 2537 – 2546

Abstract

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Nicole M Del Toro-Pagán,1,2 Feng Dai,3 Trevor Banack,4 Jill Berlin,4 Satya A Makadia,4 Lee E Rubin,5 Bin Zhou,3 Phu Huynh,6 Jinlei Li4 1Department of Pharmacy, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA; 2Applied Precision Pharmacotherapy Institute, Tabula Rasa HealthCare, Moorestown, NJ, USA; 3Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA; 4Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; 5Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA; 6Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USACorrespondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT, 06520-8051, USA, Tel + 1 475 434 4038, Email [email protected]: Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption.Methods: A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay.Results: Cumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = − 45.3 (− 80.5 to − 10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = − 1.3 (− 2.3 to − 0.4), P = 0.005 and − 0.9 (− 1.8 to − 0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = − 22.5 (− 36 to − 8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups.Conclusion: Compared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC.Level of Evidence: III.Keywords: perineural, arthroplasty, glucocorticoids, total knee arthroplasty, TKA, peripheral nerve block, PNB, methylprednisolone acetate

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