The effect of continuous adductor canal block combined with distal interspace between the popliteal artery and capsule of the posterior knee block for total knee arthroplasty: a randomized, double-blind, controlled trial.

BACKGROUND: The optimal analgesia for total knee arthroplasty (TKA) requires excellent analgesia while preserving muscle strength. This study aimed to determine the hypothesis that continuous adductor canal block (CACB) combined with the distal interspace between the popliteal artery and the posterior capsule of the knee (IPACK) block could effectively alleviate the pain of the posterior knee, decrease opioids consumption, and promote early recovery and discharge. METHODS: Patients undergoing unilateral, primary TKA were allocated into group CACB+SHAM (receiving CACB plus sham block) or group CACB+IPACK (receiving CACB plus IPACK block). The primary outcome was cumulative opioid consumption. Secondary outcomes included the incidence of postoperative pain originated from the posterior knee, visual analogue scale (VAS) score, range of motion, ambulation distance, and satisfaction for pain management. RESULTS: The incidence of moderate-severe pain of the posterior knee was lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours (17.1% vs. 42.8%; p = 0.019), 8 hours (11.4% vs. 45.7%; p = 0.001), and 24 hours (11.4% vs. 34.3%; p = 0.046) after TKA. The VAS scores of the posterior knee were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours [2 (2) vs. 3 (2-4); p = 0.000], 8 hours [1 (1, 2) vs. 3 (2-4); p = 0.001], and 24 hours [1(0-2) vs. 2 (1-4); p = 0.002] after TKA. The overall VAS scores were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours [3 (2, 3) vs. 3 (3, 4); p = 0.013] and 8 hours [2 (2, 3) vs. 3 (2-4); p = 0.032] at rest and 4 hours [3 (3, 4) vs. 4 (4, 5); p = 0.001], 8 hours [3 (2-4) vs. 4 (3-5); p = 0.000], 24 hours [2 (2, 3) vs. 3 (2-4); p = 0.001] during active flexion after TKA. The range of motion (59.11 ± 3.90 vs. 53.83 ± 5.86; p = 0.000) and ambulation distance (44.60 ± 4.87 vs. 40.83 ± 6.65; p = 0.009) were superior in group CACB+IPACK than that of the group CACB+SHAM in postoperative day 1. The satisfaction for pain management was higher in group CACB+IPACK than that of the group CACB+SHAM [9 (8, 9) vs. 8 (7-9); p = 0.024]. There was no difference in term of cumulative opioids consumption between group CACB+IPACK and group CACB+SHAM [120(84-135) vs. 120(75-135); p = 0.835]. CONCLUSION: The combination of CACB and distal IPACK block could decrease the incidences of moderate-severe posterior knee pain, improve the postoperative pain over the first 24 hours after TKA, as well as promoting recovery of motor function. However, the opioids consumption was not decreased by adding distal IPACK to CACB. TRIAL REGISTRATION: This study was registered at Chinese Clinical Trial Registry ( ChiCTR2200059139 ; registration date: 26/04/2022; enrollment date: 16/11/2020; http://www.chictr.org.cn ).

Effect of flurbiprofen axetil combined with "Cocktail" therapy on opioid dosage in patients after total knee arthroplasty.

Objectives: To investigate the effect of flurbiprofen axetil combined with "cocktail" therapy on opioid dosage in patients after total knee arthroplasty (TKA). Methods: The clinical data of 200 patients who underwent TKA in Baoding No.1 Central Hospital hospital from March 2019 to March 2021 were collected for retrospective analysis. All 200 patients were divided into two groups according to their intraoperative anesthesia methods: the control group (100 cases) and the experimental group (100 cases). Patients in the control group were treated with "cocktail" therapy intraoperatively, while those in the experimental group were treated with flurbiprofen axetil combined with "cocktail" therapy intraoperatively. The hip pain scores in resting state and motion state were compared between the two groups at different postoperative time points, and postoperative pain relief, adverse reactions, and patient satisfaction with analgesia were statistically analyzed to evaluate the postoperative quality of life of the patients. Results: A statistically significant difference was observed in the intergroup and temporal effects of pain scores in resting state and motion state between the two groups (p<0.05). By comparison at each time point, the pain scores in the experimental group were significantly lower than those in the control group at the time point T1-T6 in resting and motion states, with a statistically significant difference (p<0.05). The frequency and dosage of remedial medication per capita in the experimental group were significantly lower than those in the control group, with a statistical significance (p<0.05). There was no significant difference in the scores of life quality items between the two groups preoperatively (p>0.05), while the scores of each item in the experimental group were significantly higher than those in the control group postoperatively (p<0.05). The satisfaction degree of the experimental group was significantly higher than that of the control group, showing a statistically significant difference (p<0.05). Conclusions: Flurbiprofen axetil combined with "cocktail" therapy is a safe treatment regimen that can improve the quality of life and safety of patients. With such a regimen, postoperative pain of patients undergoing TKA can be effectively relieved, and the use of opioids can be reduced.

Prazosin inhibits the growth and mobility of osteosarcoma cells.

BACKGROUND: Osteosarcoma is a primary malignant bone tumor that frequently occurs in adolescents and children, its high aggressiveness and rapid metastasis often resulting in poor prognoses. In previous studies, Prazosin has been shown to possess anti-proliferative properties against prostate cancer and glioblastoma cells. In our study, we investigated Prazosin's underlying mechanisms and its effects on the biological behaviors of osteosarcoma cells. METHODS: Osteosarcoma cell lines MG63 and 143B were treated with different concentrations of Prazosin, and a CCK8 assay assessed its effect on cell viability. Colony formation, Transwell and flow cytometry assays were used to examine its effects on cell proliferation, cell migration, and cell invasion and apoptosis, respectively. The expression of relevant proteins was then examined using western blotting. RESULTS: Our data showed that Prazosin dose-dependently reduced the viability of MG63 and 143B cells and significantly inhibited their clonogenic ability. Moreover, Prazosin attenuated the cell migration and invasion abilities of MG63 and 143B cells when compared with the NC group. It also accelerated cell apoptosis in mitochondrial pathways by regulating Bcl-2/Bax axis and caspase 3. Furthermore, Prazosin treatment inactivated the Akt/mTOR pathway by down-regulating Akt and mTOR phosphorylation (p-Akt, p-mTOR) and the expression of P70 and cyclin D1. CONCLUSIONS: Our data highlights the fact that Prazosin inhibits cell growth, inhibits the motility of osteosarcoma cells, and promotes apoptosis, suggesting that Prazosin is a potential anti-cancer agent in osteosarcoma therapy.