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.

scholarly journals EVALUATION OF POST-OPERATIVE ANALGESIC EFFICACY OF LOCAL INFILTRATION ANALGESIA IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY -A PROSPECTIVE RANDOMIZED STUDY

2020 ◽  
pp. 1-4
Author(s):  
S P Garg ◽  
Sandeep Chouhan ◽  
Prashant Pandey ◽  
Nandini Bhatt
Keyword(s):  
Total Knee Arthroplasty ◽  
Single Shot ◽  
Adductor Canal Block ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Adductor Canal ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Infiltration Analgesia

Introduction – Total knee arthroplasty is considered as one of the most painful procedures in field of orthopedic surgery. In this study we intended to evaluate the analgesic efficacy of Local Infiltration Analgesia (LIA) with post-surgical single shot of adductor canal block in terms of good post-operative analgesia and early post- operative mobilization thus allowing faster rehabilitation and recovery and thereby improving the final outcome of TKA 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 along with intraoperative local infiltration analgesia. Group B also received Standard General anesthesia & postoperative analgesia with a single shot of adductor canal block with 20cc of 0.25% ropivacaine but intraoperative local infiltration analgesia was not administered in group B. 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 intraoperative Local Infiltration Analgesia along with single shot of adductor canal block provides better post-operative pain relief & allows early mobilization of the patient thus enhancing the rehabilitation thereby improving the final outcome of the Total Knee Arthroplasty.

scholarly journals Is There an Optimal Timing of Adductor Canal Block for Total Knee Arthroplasty?—A Retrospective Cohort Study

2021 ◽  
Vol 11 (7) ◽  
pp. 622
Author(s):  
Yan-Yuen Poon ◽  
Johnson Chia-Shen Yang ◽  
Wen-Yi Chou ◽  
Hsiao-Feng Lu ◽  
Chao-Ting Hung ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Optimal Timing ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Group A ◽  
Vas Scores ◽  
Total Knee ◽  
Group B

Adductor canal block (ACB) has gained popularity for postoperative pain control after total knee arthroplasty (TKA). However, its role in TKA has been questioned recently. Our study aimed to clarify the role of ACB in reducing postoperative pain after TKA and to elucidate an optimal timing to perform ACB for better outcomes. We conducted a comprehensive review of the perioperative records of 652 patients undergoing primary TKA from January 2019 to December 2019. Patients were divided into three groups: Group A received general anesthesia without ACB, Group B received ACB before inducing general anesthesia, and Group C received ACB at the post-anesthesia recovery unit (PACU). Patients in Groups B and C had lower pain visual analogue scale (VAS) scores than patients in Group A at the PACU. Opioid consumption was similar among the three groups; however, a slightly higher dose was required by Group A patients. Higher VAS scores were recorded in the ward in Group A than in Groups B and C with the leg at rest. In addition, higher VAS scores were recorded in Group A than in Groups B and C with the leg in continuous passive motion (CPM) training. More patients in Group A (34.9%) quit their first CPM training after a few cycles than those in Groups B (27.0%) and C (20.1%). Group A patients required a higher per kg dose of opioids in the ward than Groups B and C patients. Additionally, the hourly consumption of sevoflurane was similar among the three groups of patients, while Group A and C patients required a higher hourly per kg dose of intraoperative opioids than Group B patients. More patients in Group A (67.6%) and C (61.7%) developed intraoperative hypertension than patients in Group B (52.7%). There was no significant difference in PON (postoperative nausea), POV (postoperative vomiting), postoperative dizziness, or patient satisfaction among the three groups of patients. Group A patients had a longer length of hospital stay compared to Group B and C patients. In conclusion, preoperative ACB could be a better choice for patients undergoing TKA as it decreases intraoperative opioid consumption and facilitates a stable hemodynamic state during surgery.

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 Comparative study between continuous adductor canal block and intravenous morphine for postoperative analgesia in total knee arthroplasty

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Hithem Mohammed Gamil Mohammed Ali ◽  
Bassel Mohammed Essam Nour Eldin ◽  
Heba Abd Elazim Labib Ahmed ◽  
Ramy Mounir Wahba Gobran ◽  
Diaa Eldin Mahmoud Heiba
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Quadriceps Muscle ◽  
Saphenous Nerve ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Intravenous Morphine ◽  
Group A ◽  
Total Knee

Abstract Background Postoperative pain after total knee arthroplasty (TKA) is known to range from moderate (30% of patients) to severe (60% of patients). Inadequate management for postoperative pain may induce various immobility-related complications, muscle weakness, and chronic pain. Therefore, post-TKA analgesia is crucial, not only for patients’ satisfaction, but for improving surgical outcomes and reducing complications. The present study aims to compare the effect of ultrasound-guided adductor canal block ACB (saphenous nerve block) versus incremental dose of intravenous morphine after total knee arthroplasty surgery. Results The results of this study revealed no difference between group A and group B as regards postoperative quadriceps muscle strength; maximal knee flexion, total distance ambulated, and postoperative vital data (heart rate per minute and respiratory rate per minute). However, group A showed better postoperative pain control, lower doses of intravenous morphine consumption and lower incidence of nausea and vomiting. Conclusion Continuous adductor canal block (saphenous nerve block) is superior to intravenous morphine in decreasing postoperative pain and decreasing total morphine consumption and adverse effects as nausea and vomiting, but both are equivalent in preserving quadriceps muscle power.

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