Additional nerve blocks are not superior to multiple-site infiltration analgesia in total knee arthroplasty under adductor canal block

Qianhao Li,Qiuru Wang,Mohammed Alqwbani,Pengde Kang,Zhouyuan Yang,Donghai Li,Qinsheng Hu

doi:10.1186/s13018-021-02769-9

Abstract

BackgroundAdductor canal block (ACB) with additional nerve blocks (ANBs) is reported to provide adequate analgesia and enhanced functional rehabilitation in total knee arthroplasty (TKA). The present study aims to evaluate whether ANBs are superior to multiple-site infiltration analgesia (MIA) in patients undergoing TKA under ACB.MethodsWe enrolled 530 patients undergoing primary TKA from 2015 to 2019 at our institution in this retrospective cohort study. Patients were divided into two groups: Group A was treated with ANBs + ACB; Group B was treated with MIA + ACB. Primary outcomes were pain scores and morphine consumption. Functional recovery was the secondary outcome. Other outcomes included satisfaction score, cost-effectiveness, adverse events, and length of hospital stay (LOS).ResultsPain scores at rest and morphine consumption were slightly lower in the ANBs + ACB group than in the MIA + ACB group. No significant difference was found in functional recovery, post-operative complications or LOS between the groups. Meanwhile, the cost of analgesic intervention in the MIA + ACB group was less than that in the ANBs + ACB group.ConclusionThe present study suggests that ANBs do not provide superior pain relief compared to MIA for patients undergoing TKA under ACB.Trial registrationChinese Clinical Trial Registry, ChiCTR2100043227. Registered 9 February 2021, https://www.chictr.org.cn/showproj.aspx?proj=121745.

Highlights

Total knee arthroplasty (TKA) is currently the most effective treatment for alleviating persistent pain in patients with end-stage knee arthritis [1]
Since little is known about whether additional nerve blocks (ANBs) + Adductor canal block (ACB) is superior to multiple-site infiltration analgesia (MIA) + ACB, this study aims to determine whether ANBs + ACB is superior to MIA + ACB by comparing patients’ post-operative pain, functional rehabilitation, cost-effectiveness and complications during total knee arthroplasty (TKA) for the two approaches
A total of 530 patients undergoing primary unilateral TKA were divided into two groups depending on analgesic strategies

Summary

Introduction

Total knee arthroplasty (TKA) is currently the most effective treatment for alleviating persistent pain in patients with end-stage knee arthritis [1]. Multimodal pain management includes oral analgesics, patient-controlled analgesia (PCA), peripheral nerve block (PNB) and multiple-site infiltration analgesia (MIA). Among these pain management methods, adductor canal block (ACB), which is regarded as a promising alternative to femoral nerve block (FNB), demonstrates gains in quadricep muscle strength and pain relief [6, 7]. Adductor canal block (ACB) with additional nerve blocks (ANBs) is reported to provide adequate analgesia and enhanced functional rehabilitation in total knee arthroplasty (TKA). The present study aims to evaluate whether ANBs are superior to multiple-site infiltration analgesia (MIA) in patients undergoing TKA under ACB

Objectives

Methods

Results

Discussion

Conclusion