Adductor Canal Blocks With Bupivacaine and Magnesium After Same-day Discharge Total Knee Arthroplasty Improve Postoperative Pain Relief and Decrease Opioid Consumption: A Prospective Randomized Controlled Trial.

OBJECTIVES: Adequate pain management is a critical component of facilitating same-day discharge for total knee arthroplasty (TKA). Adductor canal blocks (ACB) have been shown to be an effective technique for managing pain after TKA. The objective of this study was to investigate the impact of adding magnesium to local anesthetic in ACB on postoperative pain, opioid consumption, nausea, and overall patient satisfaction. MATERIALS AND METHODS: A sample of 119 adults undergoing elective unilateral TKA were included. Patients were randomly assigned to receive ACB with magnesium and bupivacaine (n=56) or with bupivacaine only (n=63). Primary outcomes were total opioid consumption in the first 48 hours after surgery and pain scores. Secondary outcomes were the incidence of nausea in the first 48 hours after surgery and total overall satisfaction. RESULTS: Opioid consumption decreased significantly in the Mg group compared with the no-Mg group over the first 24 hours (33.2±3.0 vs. 21.3±2.4, P=0.003), the second 24 hours (35.4±2.7 vs. 27.3±2.3, P=0.026), and the first 48 hours total after surgery (68.6±5.1 vs. 48.6±4.3, P=0.004). Pain scores were reduced in the Mg group (24 h: 5.1±2.3 vs. 3.5±2.0, P=0.000; 48 h: 5.1±1.6 vs. 3.9±1.6, P=0.000). Secondary outcomes showed no difference in the incidence of nausea over the first 48 hours and overall satisfaction. CONCLUSION: The addition of magnesium to local anesthetic in ACB decreases pain scores and opioid consumption, without increasing nausea, when compared with ACB with local anesthetic alone.

Are Hip Physical Examination Findings Predictive of Future Lower-Body Injury Rates in Elite Adolescent Female Soccer Athletes at Minimum 5-Year Follow-Up?

CONTEXT: Although elite adolescent female soccer athletes have unique injury risk factors and management challenges, limited epidemiological data exist for this population. OBJECTIVE: To describe lower-body injury patterns and to determine whether a screening hip physical examination is predictive of future injuries in elite adolescent female soccer athletes. DESIGN: Prospective cohort study. SETTING: One US premier soccer club. PARTICIPANTS: One hundred seventy-seven female soccer athletes aged 10-18 years (mean [SD] 14.6 [1.8] y) completed a demographic questionnaire and screening hip physical examination that included range of motion and provocative tests. INTERVENTIONS: At least 5 years after baseline screening, athletes completed an electronic follow-up injury survey. Injury was defined as pain that interfered with sporting activity. MAIN OUTCOME MEASURES: In addition to descriptive analyses of athletes' injury profiles, associations between players' baseline demographics and subsequent injury profiles were evaluated using chi-square tests, and potential predictors of injury based on players' baseline hip examinations were evaluated using multivariable logistic regression. RESULTS: Ninety-four of 177 athletes (53%) were contacted for follow-up, and 88/94 (93.6%) completed the survey. With mean follow-up of 91.9 (9.3) months (range 66-108 mo), 42/88 (47.7%) reported sustaining a new lower-body injury. The low back was the most common injury region (16/42, 38.1%). Almost half of all injured athletes (20/42, 47.6%) sustained overuse injuries, and 16/42 (38.1%) had an incomplete recovery. Higher body mass index and reaching menarche were associated with sustaining an injury (P = .03 and .04, respectively). Athletes' baseline hip examinations were not predictive of their subsequent rate of lower-body, lumbopelvic, overuse, or incomplete recovery injury (all P > .05). CONCLUSIONS: Lower-body injuries were common in elite adolescent female soccer athletes, with over one third of injured athletes reporting permanent negative impact of the injury on their playing ability. Baseline hip physical examinations were not associated with future injury rate.