Adductor canal block as an adjuvant in a multimodal analgesia protocol vs. multimodal analgesia alone for total knee arthroplasty

Abstract

Background & Objective: Effective analgesia is necessary for early postoperative recovery following total knee arthroplasty (TKA). Various combinations of pain relief modalities have been used for postoperative pain in TKA. Adductor canal block (ACB) has been suggested to have a role in this scenario. We evaluated the effectiveness of ACB following spinal anesthesia (SA) in terms of postoperative pain relief, early ambulation and patient satisfaction.
 Methodology: A total of 72 patients were enrolled in the study. Out of these 36 patients (Group A) were randomized to receive ACB in addition to SA, while 36 patients (Group B) received only SA. Postoperative numerical rating scale (NRS) score, and morphine consumption were noted at shifting to PACU, at 6, 12, 18 and 24 h postoperatively as a primary outcome measure. As a secondary outcome measures, quadriceps muscle power, time to ambulation and patient satisfaction were evaluated.
 Results: A statistically significant drop in NRS was noted in Group A, at 6, 12, 18, and 24 h after surgery, but not in the postoperative care unit (P = 0.75), and a decrease in the total morphine use among patients who underwent an ACB. A significant change was noted in ambulation and patient satisfaction in the Group A, with no significant change in quadriceps muscular power among both groups.
 Conclusion: ACB as a part of pain management strategy is successful in reducing postoperative pain, morphine consumption, enabling early ambulation, and elevating patient satisfaction.
 Key words: Adductor canal block; Spinal Anesthesia; Total knee arthroplasty
 Citation: Ahmed RKA, Mohamed AS, John Nader Nassef JN, Abd Elsatar YH, El Fawal SMM. Adductor canal block as a part of multimodal analgesia protocol for total knee arthroplasty. Anaesth. pain intensive care 2022;27(1):31−36; DOI: 10.35975/apic.v27i1.1941
 Received: August 18, 2022; Reviewed: November 5, 2022; Accepted: November 19, 2022