An adductor canal catheter added nothing to a single shot with dexamethasone after knee replacement

The edition in brief

In a participant- and assessor-blinded trial of 94 primary total knee arthroplasties, all patients had iPACK, periarticular infiltration and oral multimodal analgesia. Adding a 50-hour continuous adductor canal ropivacaine infusion to a single-injection block did not reduce 24–48 hour opioid use compared with a single injection with 2 mg perineural dexamethasone (median 30 vs 38.8 mg; 95% CI of difference −22.5 to 7.0), and 7% of catheter patients had transient knee buckling. The Project for Universal Management of Airways has issued extubation guidelines: assess hypoxaemia, aspiration and airway-stimulation risk, and team and situational factors; treat planned extubation as elective and defer it when that lowers risk; and prefer conversion procedures over a continuous guide to replacement when extubation is 'at risk'. A weighted secondary analysis of 1,963 patients in two iPROVE trials found antiemetic-dose intraoperative corticosteroids were not associated with fewer postoperative pulmonary complications (OR 0.86, 0.62 to 1.18), despite a crude difference. A 60-patient double-blind trial after ACL reconstruction found continuous femoral nerve block was not superior to adductor canal block for 48-hour pain (−0.31 NRS points, −1.39 to 0.77).