scholarly journals Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1082-1088
Author(s):  
Kushal Hippalgaonkar ◽  
Vivek Chandak ◽  
Deepesh Daultani ◽  
Praharsha Mulpur ◽  
Krishna Kiran Eachempati ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Analogue Scale ◽  
Breakthrough Pain ◽  
Mean Difference ◽  
Control Group ◽  
Study Group ◽  
Single Shot ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Total Knee

Aims Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone. Methods This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain. Results The study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014). Conclusion Combined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA. Cite this article: Bone Jt Open 2021;2(12):1082–1088.

A Comparison of Single Shot Adductor Canal Block Versus Femoral Nerve Catheter for Total Knee Arthroplasty

2015 ◽  
Vol 30 (9) ◽  
pp. 68-71 ◽  
Author(s):  
Jordan L. Ludwigson ◽  
Samuel D. Tillmans ◽  
Richard E. Galgon ◽  
Tamara A. Chambers ◽  
John P. Heiner ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Nerve ◽  
Single Shot ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Total Knee

A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty

2019 ◽  
Vol 101-B (3) ◽  
pp. 340-347 ◽  
Author(s):  
N. M. Elkassabany ◽  
L. F. Cai ◽  
I. Badiola ◽  
B. Kase ◽  
J. Liu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Single Shot ◽  
Block Group ◽  
Adductor Canal Block ◽  
Female Patients ◽  
Adductor Canal ◽  
Total Knee ◽  
Male Patients

Aims Adductor canal block (ACB) has emerged as an alternative to femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA). The optimal duration of maintenance of the ACB is still questionable. The purpose of this study was to compare the analgesic benefits and physiotherapy (PT) outcomes of single-shot ACB to two different regimens of infusion of the continuous ACB, 24-hour and 48-hour infusion. Patients and Methods This was a prospective, randomized, unblinded study. A total of 159 American Society of Anesthesiologists (ASA) physical status I to III patients scheduled for primary TKA were randomized to one of three study groups. Three patients did not complete the study, leaving 156 patients for final analysis. Group A (n = 53) was the single-shot group (16 female patients and 37 male patients with a mean age of 63.9 years (sd 9.6)), group B (n = 51) was the 24-hour infusion group (22 female patients and 29 male patients with a mean age of 66.5 years (sd 8.5)), and group C (n = 52) was the 48-hour infusion group (18 female patients and 34 male patients with a mean age of 62.2 years (sd 8.7)). Pain scores, opioid requirements, PT test results, and patient-reported outcome instruments were compared between the three groups. Results The proportion of patients reporting severe pain, defined as a pain score of between 7 and 10, on postoperative day number 2 (POD 2) were 21% for the single-shot group, 14% for the 24-hour block group, and 12% for the 48-hour block group (p = 0.05). Cumulative opioid requirements after 48 hours were similar between the groups. Functional outcomes were similar in all three groups in POD 1 and POD 2. Conclusion There was no clear benefit of the 24-hour or 48-hour infusions over the single-shot ACB for the primary endpoint of the study. Otherwise, there were marginal benefits for keeping the indwelling catheter for 48 hours in terms of reducing the number of patients with moderate pain and improving the quality of pain management. However, all three groups had similar opioid usage, length of hospital stay, and functional outcomes. Further studies with larger sample sizes are needed to confirm these findings. Cite this article: Bone Joint J 2019;101-B:340–347.

scholarly journals COMPARISON OF POSTOPERATIVE ANALGESIC EFFICACY OF POST SURGICAL SINGLE SHOT OF ADDUCTOR CANAL BLOCK VERSUS CONTINUOUS EPIDURALANALGESIA IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY -A PROSPECTIVE RANDOMIZED CONTROL STUDY

2020 ◽  
pp. 1-4
Author(s):  
Surya Prakash Garg ◽  
Palash Gupta ◽  
Nandini Bhatt ◽  
Prashant Pandey
Keyword(s):  
Total Knee Arthroplasty ◽  
Muscle Strength ◽  
Epidural Analgesia ◽  
Single Shot ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Continuous Epidural Analgesia ◽  
Group A ◽  
Total Knee ◽  
Group B

Introduction – Total knee arthroplasty is one of the most painful procedures. In this study we intended to compare two analgesic modalities i.e. single shot of Adductor canal block & Continuous epidural analgesia in terms of good post-operative analgesia, minimal motor involvement, good post-operative muscle strength thus allowing faster rehabilitation and recovery thereby improving the final outcome of TKR in long term. Material and method- A total of 60 patients were enrolled, 30 in each group. Group A received Standard General anesthesia & postoperative analgesia with a single shot of adductor canal block with 20cc of 0.25% ropivacaine. Group B received Combined spinal-epidural block & postoperative analgesia was maintained on continuous epidural infusion in the form of a mixture of 0.125% ropivacaine & fentanyl(2microgram/cc) at the rate of 6ml/hour. Result- Group B patients required a greater number of rescue analgesic doses in comparison to Group A patients. The majority of the patients in Group A had early postoperative mobilization in comparison to Group B (p=0.003). Mean preoperative and 6-week postoperative WOMAC scores showed that difference was statistically significant (p=0.034), showing a significantly lower 6-week postoperative WOMAC score in Group A in comparison to Group B. Conclusion – Our study gives us a conclusion that the post-surgical Single Shot of the adductor canal block is a better post-operative analgesic modality when compared with continuous epidural analgesia post-surgically in terms of better pain relief, good post-operative muscle strength, early mobilization of the patient, higher patient acceptability.

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