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. 2021 Sep 24;55(5):1111-1117.
doi: 10.1007/s43465-021-00482-7. eCollection 2021 Oct.

Comparison of Efficacy of Adductor Canal Block, Local Infiltration Analgesia and Both Combined in Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial

Natesan Rajkumar  1 , Manickam Karthikeyan  1 , Dhanasekaran Soundarrajan  1 , Palanisami Dhanasekararaja  1 , Shanmuganathan Rajasekaran  1
Affiliations

Comparison of Efficacy of Adductor Canal Block, Local Infiltration Analgesia and Both Combined in Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial

Natesan Rajkumar et al. Indian J Orthop. .

Abstract

Purpose: The aim of our study is to compare the efficacy of adductor canal block (ACB), periarticular local infiltration (PLI) and both combined (ACB + PLI) in multimodal pain management after TKA.

Methods: This is a prospective, randomized controlled double-blinded study undergoing primary unilateral TKA. They were randomized into three groups with fifty patients in each group: ACB alone (30 ml of 0.2% ropivacaine), PLI alone (30 ml 0.5% ropivacaine in 20 ml of normal saline), and both combined (ACB + PLI). The primary outcome studied was pain using visual analog score (VAS) in postoperative days (POD) 1 and 2. The secondary outcomes estimated were the ambulation capacity, the knee range of motion, need for rescue analgesia and length of hospital stay.

Results: The mean VAS score was significantly lower at rest and after mobilization in the combined group (3.51 at POD 1, 2.04 at POD 2), compared with either alone group (ACB = 4.70, 2.86 versus PLI = 4.39, 3.41 at POD 1 and 2 respectively after mobilization, p < 0.001). The ambulation capacity (combined = 103.3 steps versus ACB = 98.1 and PLI = 95.2 steps, p = 0.04) and the knee range of motion (arc of motion 106.7 degrees versus ACB = 104.9 and PLI = 102.2 degrees, p = 0.004) were significantly higher in the combined group compared to the other groups. There was no significant difference in the length of stay between the groups (p = 0.12).

Conclusion: Adductor canal block combined with periarticular local infiltration provides better pain relief, good range of motion, quicker rehabilitation, and reduced opioid consumption.

Keywords: Adductor canal block; Functional outcome; Pain; Periarticular local infiltration analgesia; Total knee arthroplasty.

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Conflict of interest statement

Conflict of interestNatesan Rajkumar, Manickam Karthikeyan, Dhanasekaran Soundarrajan, Palanisami Dhanasekararaja and Shanmuganathan Rajasekaran declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram. (ACB- Adductor Canal Block; PLI- Periarticular Local Infiltration)
Fig. 2
Fig. 2
VAS scores among study participants at rest (N = 150) (ACB- adductor canal block; PLI- periarticular local infiltration)
Fig. 3
Fig. 3
VAS scores among study participants at mobilization (N = 150) (ACB- adductor canal block; PLI- periarticular local infiltration)
See this image and copyright information in PMC

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References

    1. Hebl JR, Kopp SL, Hanssen AD. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Regional Anesthesia and Pain Medicine. 2008;33(6):510–517. doi: 10.1016/j.rapm.2008.04.008. - DOI - PubMed
    1. Samad TA, Moore KA, Sapirstein A, et al. Interleukin-1β-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature. 2001;410(6827):471–475. doi: 10.1038/35068566. - DOI - PubMed
    1. Sun J, Li L, Yuan S, Zhou Y. Analysis of early postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: a retrospective controlled study. PLoS ONE. 2015;10(6):e0129973. doi: 10.1371/journal.pone.0129973. - DOI - PMC - PubMed
    1. Kornilov N, Lindberg MF, Gay C, et al. Factors related to postoperative pain trajectories following total knee arthroplasty: a longitudinal study of patients admitted to a Russian orthopaedic clinic. Pain Research and Treatment. 2016 doi: 10.1155/2016/3710312. - DOI - PMC - PubMed
    1. Kwofie MK, Shastri UD, Gadsden JC, et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Regional Anesthesia and Pain Medicine. 2013;38(4):321–325. doi: 10.1097/AAP.0b013e318295df80. - DOI - PubMed

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