Abstract
Adductor canal block (ACB) has gained popularity for postoperative pain control after total knee arthroplasty (TKA). However, its role in TKA has been questioned recently. Our study aimed to clarify the role of ACB in reducing postoperative pain after TKA and to elucidate an optimal timing to perform ACB for better outcomes. We conducted a comprehensive review of the perioperative records of 652 patients undergoing primary TKA from January 2019 to December 2019. Patients were divided into three groups: Group A received general anesthesia without ACB, Group B received ACB before inducing general anesthesia, and Group C received ACB at the post-anesthesia recovery unit (PACU). Patients in Groups B and C had lower pain visual analogue scale (VAS) scores than patients in Group A at the PACU. Opioid consumption was similar among the three groups; however, a slightly higher dose was required by Group A patients. Higher VAS scores were recorded in the ward in Group A than in Groups B and C with the leg at rest. In addition, higher VAS scores were recorded in Group A than in Groups B and C with the leg in continuous passive motion (CPM) training. More patients in Group A (34.9%) quit their first CPM training after a few cycles than those in Groups B (27.0%) and C (20.1%). Group A patients required a higher per kg dose of opioids in the ward than Groups B and C patients. Additionally, the hourly consumption of sevoflurane was similar among the three groups of patients, while Group A and C patients required a higher hourly per kg dose of intraoperative opioids than Group B patients. More patients in Group A (67.6%) and C (61.7%) developed intraoperative hypertension than patients in Group B (52.7%). There was no significant difference in PON (postoperative nausea), POV (postoperative vomiting), postoperative dizziness, or patient satisfaction among the three groups of patients. Group A patients had a longer length of hospital stay compared to Group B and C patients. In conclusion, preoperative ACB could be a better choice for patients undergoing TKA as it decreases intraoperative opioid consumption and facilitates a stable hemodynamic state during surgery.
Highlights
Population aging is a human success story; it is estimated that the number of people aged 65 years and above would be 1.5 billion in 2050—that is, one in six people in the world will be aged 65 years and above in 2050 [1]
One of the interesting findings revealed in this study was that the hourly consumption of sevoflurane was similar among the three groups of patients, despite preoperative Adductor canal block (ACB) being performed in Group B patients
One might consider that total knee arthroplasty (TKA) involves a broader area of bone and tissue destruction, and the associated pain would be more intense compared to that of knee arthroscopic surgery [23]; all TKA patients should require a fairly similar dose of sevoflurane, despite preoperative ACB being performed
Summary
Population aging is a human success story; it is estimated that the number of people aged 65 years and above would be 1.5 billion in 2050—that is, one in six people in the world will be aged 65 years and above in 2050 [1]. Aging is associated with many chronic diseases, including degenerative diseases and cancer [2]. Osteoarthritis (OA) is strongly associated with aging, and OA is one of the leading causes of physical disability in the elderly [3]. Taiwan has been an “aged society” since 2018, as over 14% of the population is 65 years of age or older [4]. A recent retrospective study showed that 154,553 total knee arthroplasties (TKAs) were performed in Taiwan between 1996 and 2010, and the number of TKAs increased from 26.4 to 74.6 per 100,000 citizens during this period [5]. An 85% increase is expected in the number of primary TKAs in the United States by 2030 [6]
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