{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T19:30:44Z","timestamp":1778009444459,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Different concentrations and volumes of local anesthetic boluses are used for continuous adductor canal block. We hypothesized that a 10\u2009mL 0.15% bupivacaine bolus would provide non-inferior pain relief to a 20\u2009mL 0.25% bupivacaine bolus for continuous adductor canal block as part of comprehensive multimodal analgesia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>140 patients undergoing total knee arthroplasty were randomly allocated to receive either a 20\u2009mL bolus of 0.25% bupivacaine (20\/0.25 bupi group) or a 10\u2009mL bolus of 0.15% bupivacaine (10\/0.15 bupi group). Both groups received continuous adductor canal block with 0.15% bupivacaine (5\u2009mL\/hour), local infiltration analgesia, and interspace between the popliteal artery and capsule of the knee block. The primary outcomes were average knee-pain scores 6 and 12\u2009hours postoperatively; the non-inferiority margin was a score difference of 1. Secondary outcomes included rest and movement pain scores, morphine consumption, and time to first rescue analgesia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The median knee-pain scores for the 20\/0.25 and 10\/0.15 bupi groups were 0 (0 to 1) and 0 (0 to 2), respectively, after 6\u2009hours and 2 (1 to 2) and 2 (1 to 3), respectively, after 12\u2009hours. The median treatment difference (10\/0.15 bupi \u0336 20\/0.25 bupi) was 0 (95% CI \u22120.45 to 0.45) at both time points, with neither interval exceeding the non-inferiority margin. No clinical differences were observed in secondary outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>A 10\u2009mL 0.15% bupivacaine bolus in continuous adductor canal block offers comparable average knee-pain relief 6 and 12\u2009hours after total knee arthroplasty to a 20\u2009mL 0.25% bupivacaine bolus.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06179628\">NCT06179628<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2025-106587","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T10:50:19Z","timestamp":1747738219000},"page":"rapm-2025-106587","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of 10 mL 0.15% vs 20 mL 0.25% bupivacaine boluses for continuous adductor canal block in total knee arthroplasty: a randomized non-inferiority trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct06179628","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06179628","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9311-3722","authenticated-orcid":false,"given":"Wirinaree","family":"Kampitak","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aree","family":"Tanavalee","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srihatach","family":"Ngarmukos","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nattanit","family":"Wanasrisant","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanlaya","family":"Homsuwan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"2025101113442112000_rapm-2025-106587v1.1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ijsu.2019.07.024","article-title":"Comparison of adductor canal block with local infiltration analgesia in primary total knee arthroplasty: A meta-analysis of randomized controlled trials","volume":"69","author":"Zhao","year":"2019","journal-title":"Int J Surg"},{"key":"2025101113442112000_rapm-2025-106587v1.2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s00402-020-03606-0","article-title":"Local infiltration 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