2025/10/28 by Dario Bugada, Edward R. Mariano · 1 voice
Medicine · Veterinary · #Anesthesia and Pain Management #Total Knee Arthroplasty Outcomes #Veterinary Pharmacology and Anesthesia
paper · pdf · doi:10.1111/anae.70053
openalex publication_date 2025/10/28 · openalex created_date 2025/10/29 · openalex updated_date 2026/07/16
We thank Zhang et al. for their correspondence [1] and thoughtful consideration of our work [2]. They note “a potential analgesic gap” between 12 and 24 h after single-injection blocks resolve, based on the expected duration of action of ropivacaine 0.5%. While we agree with the estimated resolution period for ropivacaine, we do not believe there would be undertreated severe acute pain after block resolution based on available data. In the study by Panzenbeck et al., severe postoperative pain after total hip arthroplasty was restricted to the first 6 h after surgery in patients enrolled in clinical trials [3]. This period is covered largely by a single bolus of ropivacaine 0.5%, using either peripheral regional block technique, and we doubt that clinically meaningful differences in analgesia would have manifested beyond 12 h in patients after total hip arthroplasty. ‘Rebound pain’ or pain as regional anaesthesia wears off is not reported as frequently for lower extremity procedures [4], which may be due to incomplete blockade compared with upper extremity procedures [5]. For this reason, we also do not anticipate any advantages with the use of dexamethasone as an adjuvant or liposomal bupivacaine in place of plain local anaesthetic. The lack of representation of patients with severe obesity is a key observation and should be considered a limitation. For the purposes of conducting a randomised clinical trial, we attempted to recruit a homogeneous sample of patients to ensure that either of the two interventions would be feasible. However, we acknowledge that both techniques studied could potentially be more difficult in patients with higher BMI. We did not have an appropriate sample to permit stratified analysis with our study data, but we support future research into the optimal procedure-specific regional analgesic techniques for patients with obesity. In terms of creating “a prospective registry dedicated to regional anaesthesia in joint arthroplasty”, we disagree with Zhang et al. about the potential utility. Regional anaesthesia registries are not novel [6] but tend to be limited by voluntary reporting and lack of a true denominator (all eligible surgical cases, whether patients received a block or not), which prevents estimates of relative risk. We also disagree that ‘zero motor block’ should be the objective of a quality measure. As we state in the conclusion of our article, there may be more than one acceptable regional analgesic technique for patients who undergo total hip arthroplasty [2], and the choice of block may be influenced by a number of factors that may include patient baseline characteristics; ability to position the patient for the block; planned surgical approach; and the regional anaesthesia skills of the anaesthetist.