At this year's American Society of Regional Anesthesia and Pain Medicine (ASRA) annual meeting, HSS presents new research related to the efficacy of different pain relief options for surgery, an increase in nerve block use for hip fracture, reducing opioid use after surgery, and whether patients who recovered from COVID-19 have additional risk for blood clots.

Risk of Blood Clots Does Not Appear Higher in Total Knee Replacement Patients Who Recovered from COVID-19

Anesthesiologist Kethy Jules-Elysee, MD, and colleagues found that there was no significant difference in endothelial function before or after total knee replacement (TKR) surgery in patients who had recovered from COVID-19 versus those who did not have the virus. These results indicate that more aggressive DVT prophylaxis is likely not needed in TKR patients who have fully recovered from COVID-19.

Liposomal Bupivacaine Shows Similar Length of Pain Relief as Standard Bupivacaine With Dexamethasone After Shoulder Surgery

Anesthesiologist David Kim, MD, and colleagues investigated whether liposomal bupivacaine is non-inferior to standard bupivacaine with dexamethasone for pain relief in the days following shoulder surgery. They concluded that bupivacaine with dexamethasone can be used interchangeably with liposomal bupivacaine for pain relief in nerve blocks for these procedures, and that due to cost differences, bupivacaine with dexamethasone is often the better choice.

Addition of Periarticular Injection to Adductor Canal and IPACK Blocks Does Not Affect Pain Relief After Total Knee Arthroplasty

Anesthesiologist Jacques Ya Deau, MD, PhD, and colleagues found that the addition of periarticular injection (PAI) of local anesthetic by surgeons did not appear to reduce pain during ambulation after total knee arthroplasty, nor did it reduce opioid use, in patients who underwent a multimodal analgesia protocol that included an adductor canal block (ACB) and Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block. This research indicates that PAi may be unnecessary in these cases.
 
Use of Nerve Blocks for Hip Fracture Surgical Patients is Increasing Across the United States

Anesthesiologist Stavros Memtstoudis, MD, PhD, MBA, HSS RA/APM Fellow Alex Stone, MD, and colleagues found that the use of presurgical ultrasound guided nerve blocks for emergency hospital admission due to hip fracture are increasing across the United States. This could indicate that positive strides are being made to reduce opioid use in these patients.

Combination of Two Novel Nerve Blocks Reduces Opioid Use After Hip Arthroscopy

Anesthesiologist David Kim, MD, and colleagues found that combined Pericapsular Nerve Group (PENG) and lateral femoral cutaneous nerve (LFCN) blocks were associated with faster discharge from the PACU after hip arthroscopy, as well as a clinically significant reduction in postoperative opioid use. Hip arthroscopy is one of the fastest growing orthopedic procedures in the United States, and despite being minimally invasive, it is a painful procedure for which analgesia can be difficult to manage. It is important to provide optimal analgesia to help combat against the over reliance on opioids for pain relief.