Adductor Canal Block versus Intravenous Patient Controlled Analgesia for Postoperative Pain Control for Primary Total Knee Arthroplasty

Abstract

Abstract Background Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response. Aim of the Work to compare efficacy, hemodynamic effects, opiate consumption and side effects of Adductor canal block and intravenous patient-controlled analgesia (PCA) in terms of postoperative primary total knee arthroplasty analgesia. Patients and Methods The study was performed upon 60 patients, randomly distributed into two equal groups: Group I: Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery and before extubation with 20 ml of bupivacaine 0.5% and Group II: Patients of this group received intravenous patientcontrolled analgesia (PCA) with Nalbuphine after the end of surgery and before extubation. For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, VAS, Nalbuphine extradoses consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension were recorded. Orthopedic rehabilitation indices were assessed by physiotherapy staff. Results ACB provided more effective analgesia for the first 6 hours but PCA with nalbuphine was superior after and for the rest of 24 postoperative hours. Conclusions Adductor canal block had good control of pain for the first 6 postoperative hours. However, the conventional use of intravenous PCA containing opioids was more effective for the rest of the first 24 postoperative hours.