{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T13:03:50Z","timestamp":1785243830565,"version":"3.55.0"},"reference-count":34,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,7,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is associated with significant postoperative pain; therefore, adductor canal block is commonly used as part of multimodal analgesia. Intravenous lidocaine may provide a practical alternative when regional anesthesia is not feasible. This study compared intravenous lidocaine with ultrasound-guided adductor canal block for postoperative opioid consumption, pain scores, and quality of recovery within the first 24 hours after outpatient TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this non-inferiority trial, 120\u2009patients undergoing TKA were randomized 1:1 to receive either a single injection adductor canal block with saline infusion or intravenous lidocaine infusion with sham block. The primary outcome was opioid consumption 24 hours after surgery, with a prespecified non-inferiority margin of 30\u2009mg oral morphine equivalents (OME). Secondary outcomes included pain scores, time to first analgesic request, quality of recovery, and patient satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median OME consumption was 57.5\u2009mg (IQR 37.5\u201377.5)\u2009in the lidocaine infusion group and 52.5\u2009mg (IQR 30\u201377.5)\u2009in the adductor canal block group, with a median difference of 5.0\u2009mg (95% CI \u221211.2 to 16.2), below the prespecified non-inferiority margin. In post-anesthesia care unit (PACU), median opioid consumption and pain scores at discharge were lower in the adductor canal block group than in the lidocaine group, with a median difference of 10\u2009mg OME (95%\u2009CI 1.0 to 11.2; p=0.02) and two points (95%\u2009CI 0.33 to 4; p=0.02), respectively. There were no study-related adverse events. Time to first analgesic request, quality of recovery, and patient satisfaction were similar between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Continuous intravenous lidocaine was non-inferior to adductor canal block for postoperative analgesia at 24 hours after TKA. Although adductor canal block provided better immediate PACU analgesia, both strategies were comparable thereafter, supporting lidocaine as a useful option when regional anesthesia is not feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-107976","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:20:10Z","timestamp":1785241210000},"page":"rapm-2026-107976","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of systemic lidocaine versus ultrasound-guided adductor canal block for patients undergoing total knee arthroplasty: a randomized, double-blinded, non-inferiority study"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct04828083","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Vendhan","family":"Ramanujam","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvind","family":"Murthy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristopher","family":"Davignon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Frenkel","sequence":"additional","affiliation":[{"name":"Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Antoci","sequence":"additional","affiliation":[{"name":"Orthopedics Institute, Brown University Health, East Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Cohen","sequence":"additional","affiliation":[{"name":"Orthopedics Institute, Brown University Health, East Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander D","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gildasio","family":"De Oliveira","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5641-8674","authenticated-orcid":false,"given":"Mark C","family":"Kendall","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"2026072805200818000_rapm-2026-107976v1.1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00222"},{"key":"2026072805200818000_rapm-2026-107976v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2010.12.003"},{"key":"2026072805200818000_rapm-2026-107976v1.3","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.16769","article-title":"Association of Total Knee Replacement Removal From the Inpatient-Only List With Outpatient Surgery Utilization and Outcomes in Medicare Patients","volume":"6","author":"Schloemann","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026072805200818000_rapm-2026-107976v1.4","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/EJA.0000000000001691","article-title":"PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). 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