Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery - A Randomized Controlled Trial

Abstract

Context: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. Aim: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. Settings and Design: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. Statistical Analysis: Statistical analysis was performed using the Student's t -test, Mann–Whitney test, and Chi-square test. Results: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively ( P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. Conclusion: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.

Changes in Neuraxial Anesthesia Protocols and Improved Efficiency of Same-Day Discharge Total Knee Arthroplasty in an Ambulatory Surgery Center: A Retrospective Cohort Study

“…15 Recent studies have shown that they might not provide much pain relief compared with local PAI alone, but this study found that pain levels at 2 and 3 hours postoperatively were on average two points out of 10 less in those who had a preoperative single-shot ACB in addition to local PAI at the time of wound closure than those who did not. 13,14,25 However, this did not translate into a notable reduction in pain levels at discharge or total MME consumption, nor did it decrease the time to ambulation or discharge from the PACU. A recent study by Than et al found that an anesthesiologist-administered single-shot ACB costs $893; hence, SDD TJA pathways should carefully select the perioperative protocol to improve outcomes and provide the most cost-effective care.…”

“…The addition of a peripheral adductor canal nerve block (ACB) was shown to reduce pain and increase ambulation distance the first 2 days after inpatient TJA, 11,12 although because two recent randomized trials of TKA found no decrease in pain or morphine milligram equivalent (MME) consumption compared with local periarticular injection (PAI). 13,14 Understanding the effect of preoperative ACBs on ambulation is important given the rise of SDD pathways. 15,16…”

“…The addition of a peripheral adductor canal nerve block (ACB) was shown to reduce pain and increase ambulation distance the first 2 days after inpatient TJA, 11,12 although because two recent randomized trials of TKA found no decrease in pain or morphine milligram equivalent (MME) consumption compared with local periarticular injection (PAI). 13,14 Understanding the effect of preoperative ACBs on ambulation is important given the rise of SDD pathways. 15,16 The primary purpose of this study was to compare SDD variables (pain, time to urination, rate of motor function recovery, time to ASC discharge, and complications) in patients receiving bupivacaine or mepivacaine spinal anesthesia for TKA at a free-standing ASC.…”