Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

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

LinkOut - more resources