Intermittent adductor canal block for post-operative pain management and faster rehabilitation following unilateral total knee replacement

Abstract

BackgroundTotal knee arthroplasty (TKA) is usually associated with intense, early postoperative pain thereby interfering with patient’s sleep and rehabilitation activities. To control the post-operative pain various traditional analgesic techniques have been recommended. But due to various systemic side effects, adductor canal blocks (ACBs) have emerged as a newer modality with effective postoperative analgesia and aids in faster rehabilitation. We retrospectively analysed the outcomes of USG guided intermittent adductor canal block in patients undergoing Unilateral TKA as a better mode for pain relief with fast track recovery. Material and methodsA total of 51 patients underwent Unilateral TKA for arthritic knee were included in the study. Post-operatively all patients underwent an USG guided ACB with indwelling catheter. All patients received a standardized multimodal analgesic regimen (unless contraindicated) and intermittent 8th hourly 0.25% 8 ml bupivacaine through ACB catheter. Post-operative VAS score reading was noted twice in a day (morning and evening) on post-operative day 1, 2 and day 3(morning). The readings were recorded in 2 ways-Without movement of knee (at rest) and with passive movement of knee (slight flexion). Post-operative rehabilitation was evaluated in terms of Quadriceps power, ambulation ability with walker or cane, climbing stairs and duration of hospital stay. ResultsVAS score statistically reduced from POD1 to POD2 and POD1 to POD3 both at rest and during movement and post-operative pain management was successful using ACB in 88% patients without any opioid supplementation. ConclusionIn our study we recommend intermittent ACB as a very good modality for post-operative pain management, preserving quadriceps strength, early rehabilitation and short hospital stay with minimal or no bupivacaine related side effects in patients undergoing unilateral total knee replacement.