Efficacy of adductor canal block combined with infiltration anesthesia for postoperative analgesia in patients undergoing total knee arthroplasty

Abstract

Objective To evaluate the efficacy of adductor canal block combined with infiltration anesthesia for postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Sixty patients of both sexes, aged 65-80 yr, weighing 40-80 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 3 groups (n=20 each) using a random number table: single-injection adductor canal block + infiltration anesthesia group (group A), single-injection femoral nerve block + infiltration anesthesia group (group F), and infiltration anesthesia group (group I). Ultrasound-guided adductor canal block and femoral nerve block were performed with 0.5% ropivacaine 20 ml before induction of anesthesia in A and F groups, respectively.After completion of the block, all the patients were ventilated through the laryngeal mask airway under general anesthesia.After installation of the knee prosthesis, local infiltration anesthesia was conducted with 0.2% ropivacaine 50 ml around the knee joint.Acetaminophen oxycodone capsule was taken orally one pill every 6 h starting from the morning on 1st day after surgery.When visual analogue scale (VAS) score > 5, tramadol 100 mg was injected intramuscularly as rescue analgesic.At 4, 8, 24, 48 and 72 h after surgery, VAS scores at rest and during activity were recorded, the quadriceps strength was measured, and the requirement for analgesic drugs and development of adverse reactions were recorded. Results Compared with group I, VAS scores at rest and during activity were significantly decreased at 4, 8, and 24 h after surgery, and the consumption of tramadol was significantly decreased after surgery in A and F groups (P<0.05). The quadriceps strength at 4 and 8 h after surgery was significantly higher in A and I groups than in group F (P<0.05). No patients developed serious adverse reactions in the three groups. Conclusion Adductor canal block combined with infiltration anesthesia provides reliable efficacy for postoperative analgesia with little influence on the quadriceps strength in the patients undergoing total knee arthroplasty. Key words: Arthroplasty, replacement, knee; Nerve block; Adductor canal; Femoral nerve; Analgesia