Yale Steroid Enhanced Versus Exparel Nerveblock TKA Part 2

Inclusion Criteria:

• American Society of Anesthesiologists status I, II and III, elective, primary,bilateral TKA planned for spinal anesthesia with plain 0.5% bupivacaine.

Exclusion Criteria:

• Refusal of consent

• Pregnancy

• Conditions making the patient unable to fill out questionnaire online, through emailor over the phone including with cognitive dysfunction, psychiatric disorder, ornon-English speaking patients, or lack of internet access which would prevent postdischarge follow-up electronically

• Coagulopathy

• Allergy to or for any other reasons cannot use Acetaminophen, Celebrex, localanesthetic bupivacaine, DEX, MPA or LB

• Patients on any amounts of opioids within one month of the surgery date, anysubstance abuse such as regular marijuana user (more frequent than once per month)

• Insulin dependent or uncontrolled diabetes defined as, day of surgery finger stickglucose >200mg/dl, or HbA1C > 8.0%

• Peripheral Nerve Block site or systemic infection

• Immune compromise (e.g., HIV, chronic glucocorticoid use)

• Severe pre-existing neuropathy

• TKA for indications other than osteoarthritis such as post-traumatic injury orrheumatoid arthritis, history of surgery in the ipsilateral knee joint, revision TKAor bilateral TKA

• Severe hepatic or renal dysfunction (GFR <50 ml/min)

• Actual body weight <60 kg

• Patients with active or latent peptic ulcers, diverticulitis, fresh intestinalanastomoses, and non-specific ulcerative colitis