{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:56:49Z","timestamp":1781661409737,"version":"3.54.5"},"reference-count":31,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"MSH-UHN AMO Innovation Fund Competition"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,8,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Total knee arthroplasty (TKA) is a widely performed procedure, with postoperative pain presenting as a major barrier to early mobilization and patient satisfaction. While single-injection adductor canal blocks (SACB) offer effective short-term analgesia, their limited duration often leads to rebound pain. Continuous adductor canal blocks (CACB) extend analgesic effects but are underexplored in outpatient settings. The objective of this study is to assess whether CACB improves quality of recovery and analgesia, in comparison to SACB in an outpatient or short-stay setting for TKA patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Double-blind randomized controlled trial comparing the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 2 (primary outcome) and opioid consumption, pain scores, hospital length-of-stay, and complications (secondary outcomes), between patients receiving CACB and SACB, when undergoing primary TKA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>60 patients were enrolled and randomized to two treatment groups: CACB (30) and SACB (30). Patients in the CACB group had significantly higher QoR-15 scores at PODs 1 (128.83\u00b112.36 vs 109.00\u00b115.90, p&lt;0.001), 2 (131.27\u00b110.23 vs 110.86\u00b115.37, p&lt;0.001) and 3 (131.97\u00b113.94 vs 111.18\u00b118.28, p&lt;0.001). They also had lower opioid consumption and pain scores at rest and with movement during the first three PODs. No major complications or signs of local anesthetic systemic toxicity were observed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In our study, CACB significantly enhanced early postoperative recovery and analgesia following TKA in an outpatient or short-stay setting, compared with SACB, and these results support its broader adoption in fast-track TKA pathways.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2025-106991","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T04:20:15Z","timestamp":1757564415000},"page":"rapm-2025-106991","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Outpatient continuous adductor canal block (CACB) for total knee arthroplasty: a double-blinded randomized placebo-controlled trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct05100706","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1280-6872","authenticated-orcid":false,"given":"Yehoshua","family":"Gleicher","sequence":"first","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9298-6118","authenticated-orcid":false,"given":"Hermann","family":"dos Santos Fernandes","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"Septimio Lanza Oliveira","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlson","family":"Asanghanwa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Carrasco Guariento","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javiera","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Wolfstadt","sequence":"additional","affiliation":[{"name":"Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Peer","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang Y","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6757-0057","authenticated-orcid":false,"given":"Naveed","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Anesthesia & Pain Management, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Management, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"2025092310202144000_rapm-2025-106991v2.1","unstructured":"OECD . Health at a Glance 2023: OECD indicators. OECD Publishing, 2023."},{"key":"2025092310202144000_rapm-2025-106991v2.2","first-page":"281","article-title":"An evidence-based review of enhanced recovery after surgery in total knee replacement surgery","volume":"29","author":"Ghosh","year":"2019","journal-title":"J Perioper Pract"},{"key":"2025092310202144000_rapm-2025-106991v2.3","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000673"},{"key":"2025092310202144000_rapm-2025-106991v2.4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00241"},{"key":"2025092310202144000_rapm-2025-106991v2.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.bjao.2025.100381","article-title":"Adductor canal block in total knee arthroplasty: a scoping review of the literature","volume":"14","author":"Agarwal","year":"2025","journal-title":"BJA Open"},{"key":"2025092310202144000_rapm-2025-106991v2.6","doi-asserted-by":"crossref","first-page":"903","DOI":"10.4103\/ija.IJA_277_17","article-title":"Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine","volume":"61","author":"Goyal","year":"2017","journal-title":"Indian J Anaesth"},{"key":"2025092310202144000_rapm-2025-106991v2.7","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jcot.2018.04.017","article-title":"Influence of early mobilization program on pain, self-reported and performance based functional measures following total knee replacement","volume":"10","author":"Harikesavan","year":"2019","journal-title":"J Clin Orthop Trauma"},{"key":"2025092310202144000_rapm-2025-106991v2.8","doi-asserted-by":"crossref","unstructured":"Gleicher YJ , Kruisselbrink R . Considerations for starting an outpatient adductor canal catheter program. ASRA News 2022;47. doi:10.52211\/asra050122.017","DOI":"10.52211\/asra050122.017"},{"key":"2025092310202144000_rapm-2025-106991v2.9","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-103756"},{"key":"2025092310202144000_rapm-2025-106991v2.10","doi-asserted-by":"crossref","DOI":"10.1186\/s43019-023-00188-0","article-title":"The effects of continuous catheter adductor canal block for pain management in knee replacement therapy: a meta-analysis","volume":"35","author":"Jabur","year":"2023","journal-title":"Knee Surg Relat Res"},{"key":"2025092310202144000_rapm-2025-106991v2.11","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000020320","article-title":"Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?: A GRADE analysis of the evidence through a systematic review and meta-analysis","volume":"99","author":"Sun","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2025092310202144000_rapm-2025-106991v2.12","unstructured":"Banerjee S , Wright MD . Outpatient or short stay total hip or knee arthroplasty versus conventional total hip or knee arthroplasty: a review of clinical effectiveness, cost-effectiveness and guidelines. Ottawa (ON), 2020."},{"key":"2025092310202144000_rapm-2025-106991v2.13","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1302\/2058-5241.5.180101","article-title":"Outpatient total knee arthroplasty: is it worth considering?","volume":"5","author":"Rodr\u00edguez-Merch\u00e1n","year":"2020","journal-title":"EFORT Open Rev"},{"key":"2025092310202144000_rapm-2025-106991v2.14","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jclinane.2016.07.022","article-title":"Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery","volume":"35","author":"Hanson","year":"2016","journal-title":"J Clin Anesth"},{"key":"2025092310202144000_rapm-2025-106991v2.15","doi-asserted-by":"crossref","first-page":"110571","DOI":"10.1016\/j.jclinane.2021.110571","article-title":"Inter-fascial space between SArtorius muscle and FEmoral artery (ISAFE): A suggested approach for Adductor Canal catheter placement","volume":"76","author":"Dos Santos Fernandes","year":"2022","journal-title":"J Clin Anesth"},{"key":"2025092310202144000_rapm-2025-106991v2.16","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2023-104654"},{"key":"2025092310202144000_rapm-2025-106991v2.17","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318289b84b"},{"key":"2025092310202144000_rapm-2025-106991v2.18","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1111\/jocn.13278","article-title":"The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement - a European study","volume":"25","author":"Johansson Stark","year":"2016","journal-title":"J Clin Nurs"},{"key":"2025092310202144000_rapm-2025-106991v2.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.03.006"},{"key":"2025092310202144000_rapm-2025-106991v2.20","doi-asserted-by":"crossref","first-page":"3160","DOI":"10.1016\/j.arth.2018.05.026","article-title":"Single-Injection Adductor Canal Block With Multiple Adjuvants Provides Equivalent Analgesia When Compared With Continuous Adductor Canal Blockade for Primary Total Knee Arthroplasty: A Double-Blinded, Randomized, Controlled, Equivalency Trial","volume":"33","author":"Turner","year":"2018","journal-title":"J Arthroplasty"},{"key":"2025092310202144000_rapm-2025-106991v2.21","doi-asserted-by":"crossref","first-page":"2309499020932037","DOI":"10.1177\/2309499020932037","article-title":"Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial","volume":"28","author":"Lam","year":"2020","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"2025092310202144000_rapm-2025-106991v2.22","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.arth.2017.11.018","article-title":"A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique","volume":"33","author":"Lee","year":"2018","journal-title":"J Arthroplasty"},{"key":"2025092310202144000_rapm-2025-106991v2.23","doi-asserted-by":"crossref","DOI":"10.1136\/rapm-2022-104208","article-title":"Questions remain about efficacy of adductor canal blocks","volume":"48","author":"Gleicher","year":"2023","journal-title":"Reg Anesth Pain Med"},{"key":"2025092310202144000_rapm-2025-106991v2.24","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-104303"},{"key":"2025092310202144000_rapm-2025-106991v2.25","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1111\/anae.14814","article-title":"Comparison of the analgesic effect of an adductor canal block using a new suture-method catheter vs. standard perineural catheter vs. single-injection: a randomised, blinded, controlled study","volume":"74","author":"Lyngeraa","year":"2019","journal-title":"Anaesthesia"},{"key":"2025092310202144000_rapm-2025-106991v2.26","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0000000000003977","article-title":"An Updated Minimal Clinically Important Difference for the QoR-15 Scale","volume":"135","author":"Myles","year":"2021","journal-title":"Anesthesiology"},{"key":"2025092310202144000_rapm-2025-106991v2.27","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001158"},{"key":"2025092310202144000_rapm-2025-106991v2.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.05.007"},{"key":"2025092310202144000_rapm-2025-106991v2.29","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/11101849.2021.1968713","article-title":"Analgesic efficacy of single- shot adductor canal block with levobupivacaine and dexmedetomidine in total knee arthroplasty: A randomized clinical trial","volume":"37","author":"AbdelRady","year":"2021","journal-title":"Egyptian Journal of Anaesthesia"},{"key":"2025092310202144000_rapm-2025-106991v2.30","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jclinane.2016.04.021","article-title":"Addition of buprenorphine to local anesthetic in adductor canal blocks after total knee arthroplasty improves postoperative pain relief: a randomized controlled trial","volume":"33","author":"Krishnan","year":"2016","journal-title":"J Clin Anesth"},{"key":"2025092310202144000_rapm-2025-106991v2.31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s42836-023-00226-y","article-title":"A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty","volume":"6","author":"Quaye","year":"2024","journal-title":"Arthroplasty"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2025-106991","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T17:20:34Z","timestamp":1758648034000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2025-106991"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":31,"alternative-id":["10.1136\/rapm-2025-106991"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2025-106991","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}