Comparison of adductor canal block with femoral nerve block for post-operative pain relief after bilateral total knee arthroplasty

Abstract

Background and Aims: Pain perception and pain threshold vary from one individual to another and also differ in the right and left limbs leading to an inter-cerebral pain variability bias and inter-patient pain variability bias. To date, data comparing adductor canal block (ACB) with femoral nerve block (FNB) in the same patient who underwent bilateral total knee arthroplasty (TKA) remain limited. Methods: We performed a prospective, non-randomised, controlled study. Patients scheduled for bilateral TKA with central neuraxial anaesthesia received every 12-hourly intermittent boluses of 15 mL of ropivacaine 0.5% in two different peripheral nerve blocks (ACB and FNB) in either of the lower limbs postoperatively. The primary outcome was to assess postoperative VAS score, and the secondary outcomes were muscle strength of the quadriceps muscle and degree of flexion at the knee joint. Results: Among the 80 patients assessed for eligibility, 72 patients were enroled, and 69 were included in the final analysis. VAS scores after the two blocks during rest at 30 minutes, 6 hours, 12 hours and 48 hours post-operatively had no significant difference. VAS scores during rest at 24 hours and on doing exercise at 24 hours and 48 hours showed a significant difference. Quadriceps muscle strength and degree of flexion of knee at 24 hours and 48 hours post-operatively did show a significant difference in favour of the ACB over FNB. Conclusion: ACB provides equivalent analgesia in comparison with FNB at rest and during passive exercise up to 48 hours post-operatively. ACB significantly preserved motor power of quadriceps muscles when compared with FNB with no added complications.

Pain management In Total Knee Arthroplasty: Which helps in better post-operative outcomes?

“…Knee flexion degree assessment using a goniometer at 24 and 48 hours post-operation revealed statistically significant differences between ACB and FNB, consistent with Grevstad et al's and Govil's study. [23,24] The leg receiving ACB exhibited better knee flexion, potentially attributed to the superior analgesic effects of ACB at 24 and 48 hours during physical exercise and sparing of the tibial nerve.…”

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study

“…The block needle was introduced in plane with the transducer, and the LA mixture was injected under fascia iliaca just lateral to the femoral nerve. [ 8 ] One investigator did all the procedures, while another blinded investigator did the assessment.…”

Comparison of sensory posterior articular nerves of the knee (SPANK) block versus infiltration between the popliteal artery and the capsule of the knee (IPACK) block when added to adductor canal block for pain control and knee rehabilitation after total knee arthroplasty---A prospective randomised trial

“…[ 3 ] ACB has gained immense popularity in the recent past due to its distinct advantage of providing satisfactory postoperative analgesia without any associated quadriceps muscle weakness. [ 4 ] However, ACB has a critical shortcoming that it does not provide analgesia to the posterior articular aspect of the knee joint, in the sciatic nerve territory, which is of moderate to severe intensity after TKA and hence needs to be addressed. [ 5 ]…”