Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty

Kulkarni, Mahesh; Dadheech, Ankit N.; Wakankar, Hemant; Ganjewar, Niranjan V.; Hedgire, Snehal S.; Pandit, Hemant

doi:10.1016/j.arth.2019.05.049

Cited by 23 publications

(12 citation statements)

References 27 publications

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“…In contrast to the other randomised trials [8,9,15], we noted that the PLI-alone group has inferior pain control compared with the other two groups. In our study, a single senior surgeon consistently gave the PLI to all the patients compared with the other studies, where multiple surgeons were involved.…”

Section: Discussioncontrasting

confidence: 99%

“…Grosso et al [9] also performed a three-arm study with ACB, PLI and combined, but they used bupivacaine for ACB and PLI. The PLI cocktail used was ropivacaine, morphine and ketorolac in some studies [8,15], whereas other studies used bupivacaine, morphine and adrenaline [10,20]. Some studies [15,21] added clonidine in their PLI cocktail and reported that it helps in synergistic action with local anaesthetics through α-2 adrenergic action.…”

Section: Discussionmentioning

confidence: 99%

“…The PLI cocktail used was ropivacaine, morphine and ketorolac in some studies [8,15], whereas other studies used bupivacaine, morphine and adrenaline [10,20]. Some studies [15,21] added clonidine in their PLI cocktail and reported that it helps in synergistic action with local anaesthetics through α-2 adrenergic action. The addition of steroids in the cocktail is still controversial [22].…”

Section: Discussionmentioning

confidence: 99%

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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

Rajkumar

Karthikeyan

Soundarrajan

et al. 2021

IJOO

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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. ResultsThe 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.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

Rajkumar

Karthikeyan

Soundarrajan

et al. 2021

IJOO

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“…After minimizing these 3 confounders, we demonstrated that there is no benefit of an ACB compared with LIA of the anterior aspect of the knee with respect to pain control in patients undergoing unilateral TKA, which is in agreement with the study by Kulkarni et al 32 .…”

Section: Discussionsupporting

confidence: 91%

No Benefit of Adductor Canal Block Compared with Anterior Local Infiltration Analgesia in Primary Total Knee Arthroplasty

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Macabeo

Waissi

et al. 2022

Journal of Bone and Joint Surgery

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Background: An adductor canal block (ACB) performed by an anesthesiologist is an established component of analgesia after total knee arthroplasty. Alternatively, surgeons may perform periarticular local infiltration analgesia (LIA) intraoperatively. We hypothesized that ACB would be superior to anterior LIA in terms of morphine consumption in the first 48 hours after primary total knee arthroplasty under spinal anesthesia.Methods: This prospective controlled and blinded trial included 98 patients; 48 received an ACB plus sham (saline solution) anterior LIA, and 50 received a sham (saline solution) ACB plus anterior LIA. Both groups received posterior LIA with local anesthetic. The primary outcome was cumulative morphine consumption at 48 hours after surgery. Secondary outcomes were pain while resting, standing, and walking, rehabilitation scores, opioid-related side effects, and patient satisfaction.Results: No difference in the primary outcome was found, and the 48-hour morphine consumption was low in both arms (28.8 ± 17.6 mg with ACB, 26.8 ± 19.2 mg with anterior LIA; p = 0.443). Pain scores were significantly better in the anterior LIA arm, but the differences were not clinically relevant. There were no differences in any other secondary outcome measures.Conclusions: LIA may be used as the primary option for multimodal postoperative pain management in patients undergoing primary total knee arthroplasty with spinal anesthesia.

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“…areas around the knee for optimal analgesia; however, no single technique has been determined to be superior. [1][2][3][4] Similarly, an adductor canal block (ACB) is an adjunct method of providing analgesia at the time of TKA. This can be performed by an anesthesiologist before or after the procedure or may be performed intraoperatively by the surgeon.…”

mentioning

confidence: 99%

Posteromedial Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study

Christopher,

Clarke,

Spangehl

et al. 2024

JAAOS Glob Res Rev

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Achieving optimal pain control in total knee arthroplasty has improved with the use of regional anesthesia and periarticular injections (PAIs). When performing a PAI, the relative location of the anesthetic spread is not well defined in comparison with an adductor canal block (ACB). In this study, our aim was to evaluate the location of posteromedial PAI spread compared with a surgeon administered ACB. One PAI and one surgeon-administered ACB were performed in the contralateral limbs of four human cadavers. The injectate was composed of methylene blue dye to visually inspect the dye spread from the tip of the needle. Dissections were performed on each cadaver to quantify the dye spread from the tip of the needle and compare the location of the dye spread. Dye spread location was characterized as either entering the adductor canal or including the posterior capsule. The mean distance of dye spread from the needle tip to the proximal most aspect of the dyed tissue was 10.125 cm in the ACB group compared with 6.5 cm in the posteromedial PAI group. In the ACB group, 4 of 4 injections were present in the adductor canal block group compared with 3 of 4 in the posteromedial PAI group. The posteromedial PAI group also had 3 of 4 injections involve the area around the posterior capsule compared with 0 of 4 in the ACB group. Posteromedial PAI appears to provide local delivery to both the adductor canal and the posterior capsule. Intraoperative, surgeon-administered ACB reliably delivers injectate to the adductor canal only but may allow for more proximal dye spread. Posteromedial PAI may provide a benefit in delivering injectate to the posterior capsule in addition to the ACB. Additional clinical studies are necessary to determine the clinical effects of this finding.

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Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty

Cited by 23 publications

References 27 publications

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

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

No Benefit of Adductor Canal Block Compared with Anterior Local Infiltration Analgesia in Primary Total Knee Arthroplasty

Posteromedial Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study

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