Ultrasound-guided Adductor Canal Block Research Articles

To Compare the Effects of 0.2% Ropivacaine Continuous Infusion versus Programmed Intermittent Bolus on Postoperative Analgesia with Adductor Canal Block, in Patients Undergoing Unilateral Knee Arthroplasty: A Randomized Controlled Trial

Background: Multimodal regimens are the mainstay of postoperative analgesia. Analgesic effectiveness of programmed intermittent bolus (PIB) versus continuous infusion (CI) in ultrasound-guided adductor canal block (ACB) for unilateral knee arthroplasty, were compared. Materials and Methods: Following Ethical and Clinical Trials Registry approval, eligible patients were administered pericapsular infiltration, intraoperatively and ACB with catheter, postoperatively. As per randomization, the PIB group received 10 ml 0.2% ropivacaine every 3 hourly while the CI group received 6mL/h. In addition, both groups received patient controlled boluses of 5mL with lockout interval of 30 minutes. The numerical rating score (NRS) score, plasma concentration of ropivacaine, use of rescue analgesics, quadricep strength by Straight Leg Rising Test (SLRT), Medical Research Council (MRC) scale for motor power, were monitored at 0, 1, 4, 24, 48 h, and Likert Scale for patient satisfaction, was measured at 72 h. To be clinically meaningful, sample size calculation, was according to a difference in NRS, for a power of 0.80, and σ‐standard deviation of two points, thus requiring at least 17 patients in each group. Results: In PIB group, patients experienced better analgesia in the first 24 h (rest - 95% CI - 0.089–0.669, P = 0.010 and movement - 95% CI - 0.82–0.884, P = 0.018) and motor power, in the first (P = 0.051) and 4th h (P = 0.034), after recovery, along with improved patient satisfaction (P = 0.001). Ropivacaine plasma concentration, at regular intervals, was independent of the pain scores with rest and movement. Rescue analgesia was inconclusive in both groups. Conclusion: The PIB option provided better analgesia in the postoperative period.

Comparative Evaluation of the Effectiveness of Adductor Canal Block versus Conservative Treatment for the Management of Anteromedial Knee Pain in Knee Osteoarthritis: A Prospective Study

Abstract Context: Knee osteoarthritis (KOA) is the most common type of lower extremity osteoarthritis (OA), with pain being the predominant symptom, leading to significant morbidity and impaired quality of life. Objectives: This study was designed to ascertain the effectiveness of ultrasound-guided adductor canal block (ACB), ensuing functional improvement and change in the quality of life in KOA patients with anteromedial knee pain and compare it with conservative treatment. Materials and Methods: A total of 196 patients were recruited for this trial and initially treated conservatively with oral analgesics and exercise. At the end of 2 and 4 weeks from the inclusion date, they were offered a crossover to the intervention with ACB for the saphenous nerve. The outcome measures, such as Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Timed Up and Go test, number of analgesics ingested per day and World Health Organization Quality of Life-BREF (WHOQoL-BREF) scores, were recorded at pre-decided time points. Results: After multiple structured follow-ups, 76 and 86 patients were analysed in the intervention and conservative groups, respectively. The two groups had no significant differences in the demographic and clinical patterns. The intervention group showed improvements in VAS (at week 2) (P < 0.05), WOMAC and the number of analgesics ingested per day (weeks 2 and 4) (P < 0.05). At ‘week 8’ follow-up, most patient outcomes including physical health and psychological domains of WHOQoL-BREF scores were better for conservative group (P < 0.05). The rest of the outcome measures were comparable for both groups at all time points. No adverse events were reported. Conclusion: This study suggests that ACB is effective only for a short duration and does not offer any significant advantage over conservative management in the long run.

Comparison of Analgesic Efficacy of Continuous Adductor Canal Block versus Single-shot Adductor Canal Block Using Ropivacaine for Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract Context: Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. Aims: The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. Settings and Design: It was a prospective randomized controlled trial carried out in a tertiary care hospital. Materials and Methods: Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Statistical Analysis: Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant. Results: In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. Conclusions: ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.

Effectiveness of Ultrasound-guided Adductor Canal Block for Postoperative Pain Management in below Knee Orthopaedic Surgeries: A Randomised Controlled Study

Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2 , respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries.

Meta-analysis of the analgesic effect and adverse reactions of ultrasound-guided adductor canal block combined with popliteal artery and posterior capsule space block in patients undergoing total knee arthroplasty

Meta-analysis of the analgesic effect and adverse reactions of ultrasound-guided adductor canal block combined with popliteal artery and posterior capsule space block in patients undergoing total knee arthroplasty

Incidence and Etiology of Rare Saphenous Nerve Injury After Knee Surgery with Adductor Canal Block: A Retrospective Observational Study

Background: Adductor canal block (ACB) is commonly included in multimodal analgesia regimens for knee surgery. Nonetheless, the incidence, etiology, and procedure-specific risk of saphenous nerve injury after knee surgery with ACB have not been established. Purpose: We sought to identify the risk of saphenous nerve injury during knee surgery with ACB. Methods: We conducted a retrospective cohort study of patients at a single institution who underwent elective knee surgery with ultrasound-guided ACB between January 1, 2014, and December 31, 2018, and had subsequent saphenous nerve injury. The primary outcome was the incidence of saphenous nerve injury within 3 months of surgery, by surgical type and approach. Secondary outcomes included attribution of the most likely etiology and clinical outcome of the injury. Results: In 28,196 cases of knee surgery with ACB, we identified 18 cases (0.06%) of saphenous nerve injury. The most common surgery associated with saphenous nerve injury was anterior cruciate ligament (ACL) reconstruction with autograft (8/18 cases); 3 cases of injury were seen after TKA, 2 after medial patellofemoral ligament reconstruction, 2 after arthroscopy/meniscal surgery, and 1 after patellar fixation. The most likely etiology of nerve injury was attributed to ACB in 5 of 18 cases (28%) and to non-ACB cause in 13 of 18 (72%). Prognosis was rated as unknown in 11 of 18, poor in 2 of 18, favorable in 3 of 18, and full recovery in 2 of 18. Conclusions: This 5-year retrospective, single-institution cohort study found a low overall incidence of saphenous nerve injury after knee surgery with ACB, but the injury likelihood varied based on surgery and approach. Although not statistically significant, ACL reconstruction with hamstring autograft and ACB performed for postoperative rescue analgesia were most frequently associated with nerve injury.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p < 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p < 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Effect of Adding Infiltration between The Popliteal Artery and Capsule of The Knee Block (IPACK) to Continuous Adductor Canal Block after Total Knee Arthroplasty

ABSTRACT Background Total knee arthroplasty (TKA) is a major surgical procedure that can be extremely upsetting. There are several methods available for postoperative pain management after knee surgery. One commonly used method is multimodal analgesia based on continuous adductor canal block. Aim of The Work Comparing the effect of the addition of posterior knee block, known as the infiltration between the popliteal artery and capsule of the knee (IPACK) block, to continuous adductor canal block (CACB) after total knee arthroplasty. Patients and Methods A total of 52 patients who underwent total knee arthroplasty were included and randomly divided into two groups receiving ultrasound-guided continuous adductor canal block or a combination of continuous ultrasound guided adductor canal block and the Infiltration between the popliteal artery and capsule of the knee block at the end of the surgery. Results Regarding the criteria for pain control, there was a statistically significant difference between the two groups regarding the postoperative visual analog score at 2, 4, 8, and 12 h after following up, which was not reported at 16 or 24 h postoperatively. The total nalbuphine consumption on the first day postoperative also showed a significant difference. A comparison of the basic demographic data, the onset of ambulation, the Timed Up and Go (TUG) test, and the straight leg raising test revealed no significant difference between the two groups. Conclusion Our study found that the use of continuous ultrasound guided adductor canal block and the Infiltration between the popliteal artery and capsule of the knee block together resulted in better postoperative pain management and reduced the need for nalbuphine. Despite this, there were no significant differences between the groups in terms of motor power or ambulation abilities. Trial registration number: PACTR202301536928551

Safety and Satisfaction of Outpatient Versus Inpatient Care for Arthroscopic Knee Surgery in Thailand

Background: Although outpatient surgery volume has rapidly grown in the western counties. However, the rate of growth for outpatient surgery has been slow in Thailand. There are limited studies comparing outcomes and cost analysis in outpatient arthroscopic knee surgery in Thailand. Objective: To compare the 24-hour postoperative pain score, side-effects and the total cost associated between inpatient and outpatient care following arthroscopic knee surgery. Materials and Methods: A retrospective cohort study of 42 patients undergoing elective arthroscopic knee surgery under general anesthesia and receiving ultrasound guided adductor canal block for post-operative analgesia. The two cohorts were matched with a 1:1 ratio for age, sex, body mass index, type of surgery and operation time. The primary outcome was the 24-hour postoperative pain score. Secondary outcomes included: the incidence of inadequate analgesia, adverse events, cost associated with outpatient versus inpatient care, and patient satisfaction score. Results: The 24-hour postoperative pain score was median 2 (IQR 0, 3) versus 2 (IQR 1, 3) in the outpatient and inpatient groups, respectively. No major complications, reoperation, or readmission after surgery was seen in either group. The total hospital cost between outpatient versus inpatient showed not significant difference (1,871.09±555.53 USD versus 1,966.49±549.70 USD, p=0.58). The costs related to perioperative service, inpatient surgery ward service, and room and food service were significantly different. Satisfaction score was comparable between groups. Conclusion: In Thailand, outpatient arthroscopic knee surgery provided the same 24-hour postoperative pain control scores and clinical outcomes when compared to inpatient setting. There was no significant difference in total hospital cost between outpatient and inpatient care. However, costs related to perioperative period (e.g., inpatient room and food service) were significantly different. Keywords: Ambulatory surgery; Arthroscopic knee surgery; Adductor canal block; Safety and satisfaction; Medical cost

Comparison of the Effectiveness of Ultrasound-Guided Proximal, Mid, or Distal Adductor Canal Block after Knee Arthroscopy.

Adductor canal block has been used for effective post-operative analgesia; however, the optimal location of adductor canal block placement is still controversial. We aimed to assess the opioid consumption and pain intensity in patients undergoing proximal, mid, and distal adductor canal block after knee arthroscopy. A total of 90 patients who had undergone an arthroscopic knee surgery and proximal, mid, or distal adductor canal block for postoperative analgesia were examined. All groups received 20 mL of bupivacaine (0.375%) to the adductor canal. Post-operative pain scores, tramadol consumption, Bromage scores, additional analgesic need, and other complications were recorded. Our results demonstrated that proximal adductor canal block group significantly reduced opioid consumption compared to the midadductor canal block group (P < .001), and mid-adductor canal block group provided significantly decreased opioid consumption than the distal adductor canal block group (P = .004). The visual analog scale values were significantly lower in the proximal adductor canal block group compared to the mid-adductor canal block group at 0, 2, 4, 8, 12, and 24 hours, except in resting visual analog scale values at 24 hours. When the proximal and distal groups were compared, visual analog scale values were significantly lower in the proximal adductor canal block group. The Bromage score was 0 in all groups at each follow-up point. Post-operative nausea was observed in only 3 (3.3%) patients, all of these patients were in the distal adductor canal block group. Ultrasound-guided adductor canal block can be applied reliably at proximal, mid, and distal locations. The proximal adductor canal block approach provides significantly lower tramadol consumption and post-operative visual analog scale values than the mid- and distal adductor canal block groups.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

Comparison of the effect of adding dexamethasone magnesium sulphate dexmedetomidine to bupivacaine in ultrasound guided adductor canal block for post-operative analgesia following anterior cruciate ligament repair

A Combination of Ultrasound-guided Popliteal Sciatic Nerve Block and Adductor Canal Block as a Sole Anaesthetic Technique for below Knee Amputation in High-risk Patients: A Case Series

Below-knee amputation in high-risk patients is associated with significant mortality and morbidity. Spinal anaesthesia is linked to an increased incidence of hypotension and bradycardia, and it is relatively contraindicated in patients with coagulation abnormalities. General anaesthesia is used as an alternative when spinal anaesthesia is contraindicated, but it is associated with a considerable increase in perioperative morbidity and the need for postoperative ventilatory support and Intensive Care Unit (ICU) care. A combination of sciatic nerve block and femoral block has been employed for below-knee surgeries as it provides complete anaesthesia below the knee. Adductor canal block, compared to femoral nerve block, is motor-sparing and, when combined with popliteal sciatic nerve block, offers complete anaesthesia below the knee. Below-knee amputation requires complete motor and sensory blockage, making regional block for below-knee amputation more challenging for the anaesthesiologist. Present case series is of five cases of below-knee amputation performed under a combination of ultrasound-guided popliteal sciatic nerve block and adductor canal block. Ultrasound-guided popliteal sciatic nerve block was administered with a combination of 10 mL of bupivacaine 0.5% and 5 mL of lignocaine 2% with adrenaline (1:200,000) diluted with 5 mL of distilled water to a total volume of 20 mL. Ultrasound-guided adductor canal block was performed with 8 mL of bupivacaine 0.5% and 4 mL of lignocaine 2% with adrenaline (1:200,000), diluted with 4 mL of distilled water to a total volume of 16 mL. All patients achieved adequate surgical anaesthesia, and none experienced any anaesthesia-related complications.

Comparative study between the analgesic efficacy of adductor canal block alone and adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block for knee surgeries

ABSTRACT Background Knee surgeries are needed in a wide range of patients, from young athletes with anterior cruciate ligament injuries up to old patients with comorbidities presenting for arthroscopy up to total knee replacement procedures. The trend is fast track knee surgery with early ambulation and hospital discharge, so analgesic options of neuraxial blocks and main nerve blocks are less attractive due to the unavoidable muscle weakness. In this study, the benefit of pure sensory nerve block could be reached. Aim of the study To compare the postoperative range of motion and the analgesic efficacy of adductor canal block (ACB) alone against adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block in knee surgeries. Patients and methods The study is a randomized, prospective, comparative study where 50 patients subjected to knee surgeries were randomized into two groups: Group (A): patients in this group received ultrasound-guided ACB only; Group (AB): under ultrasound guide, patients in this group received a combined ACB and IPACK block at the start of surgery. Results Regarding pain control over the first 24hours following surgery, range of motion and walking distance; there were statistical differences between both groups. When demographic information such age, sex, BMI, and ASA scores were examined between the two groups, there was no statistically significant difference between them (p-value > 0.05). Additionally, there was no statistically significant difference between groups in terms of opioid needs or consumption. Conclusion Regardless of the good analgesic effect of ACB, patients who received a combination of ACB and IPACK blocks have experienced a better pain control, a wider range of motion and a longer walking distance following surgery when compared to patients who received ACB alone.

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.

Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.

Adductor canal block vs. femoral nerve block in patients undergoing arthroscopic anterior cruciate ligament reconstruction using levobupivacaine: a comparative randomized controlled double-blind study

BackgroundThe aim of this study was to compare the efficacy of ultrasound-guided adductor canal block versus femoral nerve block in postoperative analgesia, as well as their effect on quadriceps muscle strength.ResultsThe study included 66 patients who were underwent arthroscopic anterior cruciate ligament reconstruction under general anesthesia. They were randomly divided into 2 groups; A and F, of 33 patients in each. Patients in group A received an adductor canal block, while patients in group F received a femoral nerve block. The primary outcome was the total morphine requirements in the first 24 h after the procedure. Secondary outcomes included time to first analgesic request and the patients’ ability to perform straight leg raise in the post-anesthesia care unit and 2 h later. The straight leg raise was impaired in group F compared with group A both in the post-anesthesia care unit (p value = 0.017) and 2 h postoperatively (p value = 0.020). While there was no differences between both groups regarding time to first analgesic request, and total morphine requirements.ConclusionsCompared with femoral nerve block, the adductor canal block may be an effective analgesic alternative with the advantage of sparing the quadriceps muscle strength in anterior cruciate ligament reconstruction surgeries.

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.

Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.

Poster 245: Periarticular Local Infiltrative Anesthesia after Anterior Cruciate Ligament Reconstruction: A Comparison to Regional Adductor Canal Block with Matched Sub-Analysis

Objectives:There is a paucity of literature that directly compares postoperative pain control and hospital recovery after using periarticular local infiltrative anesthesia (LIA) or regional anesthesia with an adductor canal block (ACB) for ambulatory anterior cruciate ligament reconstruction (ACLR) surgery. Additional studies are needed to investigate the analgesic efficacy of both ACB and LIA in patients undergoing ACLR surgery with concomitant procedures. The purpose of this study is to compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA).Methods:Study Design: Retrospective comparison studyA retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups matched for age, sex, BMI, graft type, and meniscal treatment. A p-value < 0.05 indicated statistical significance.Results:There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 ± 1.5 vs. ACB 2.4 ± 1.4, p=0.334) and total MMEs were similar (LIA 17.6 ± 7.6 vs. ACB 18.5 ± 6.7 (MME), p=0.134). Total time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 ± 1.4 vs ACB: 2.7 ± 1.5, p=0.122) or total MMEs (LIA 18.6 ± 6.7 vs. ACB 17.9 ± 7.1, p=0.532).Conclusions:The use of ACB or LIA resulted in similar pain levels and opioid consumption during early recovery after ACLR surgery.

Ultrasound-Guided Adductor Canal Block Versus Intraoperative Transarticular Saphenous Nerve Block: A Retrospective Analysis.

The ultrasound-guided adductor canal block (High-ACB) is an effective option for pain control in total knee arthroplasty (TKA), but its use can add substantial cost and preparatory time to a TKA procedure. An intraoperative adductor canal block (Low-ACB) performed by the operative surgeon has been described as an alternative. The hypothesis of this study is that the Low-ACB would achieve noninferior pain control and opioid utilization postoperatively when compared to the High-ACB. This is a retrospective study of a prospectively maintained database comparing the High-ACB vs the Low-ACB. The primary outcome measure was morphine milligram equivalents consumed. Secondary outcome measures included Visual Analog Scale pain scores, postoperative outcomes (Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, knee range of motion), length of stay, postoperative speed of mobilization, and complications related to the type of block. There were 139 patients in the study. There was lower opioid use in the first 24hours in the Low-ACB compared to the High-ACB group respectively (26.3 vs 30, P= .29) but this did not reach statistical significance. There was a statistically significant difference in Visual Analog Scale score on postoperative day 1 in the Low-ACB vs High-ACB groups respectively (4.6 vs 3.7, P= .02) but this did not reach the level of clinical significance. There was no statistical difference in the Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, or postoperative range of motion. There were no block-related complications in either group. The Low-ACB is a safe, effective, and cost-saving alternative to the traditional High-ACB for pain control in TKA.

Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial

BackgroundLocal infiltration analgesia (LIA) and adductor canal block (ACB) provide postoperative analgesia for total knee arthroplasty (TKA). ACB blocks the saphenous nerve and has smaller impacts on quadriceps muscle weakness. ACB theoretically does not have enough analgesic effects on posterior sensory nerves. LIA may increase its analgesic effects on the posterolateral knee. The purpose of this study was to evaluate whether ACB combined with a LIA cocktail of ropivacaine, morphine, and betamethasone has superior analgesic effect than LIA for TKA.MethodsA total of 86 patients were assessed for eligibility from February 2019 to May 2019. 26 of those were excluded, and 60 patients were divided into 2 groups by computer-generated random number. Group A (LIA group) received LIA cocktail of ropivacaine, morphine and betamethasone. Group B (LIA+ ACB group) received ultrasound-guided ACB and LIA cocktail of ropivacaine, morphine and betamethasone. Postoperative visual analogue scale (VAS) resting or active pain scores, opioid consumption, range of motion (ROM), functional tests, complications and satisfaction rates were measured. The longest follow-up was 2 years.ResultsTwo groups have no differences in terms of characteristics, preoperative pain or function (P > 0.05). ACB combined with LIA had significantly lower resting and active VAS pain scores, better ROM, better sleeping quality and higher satisfaction rates than LIA alone within 72 h postoperatively (P < 0.05). Complications, or adverse events and HSS score, SF-12 score were observed no significant differences within 2 years postoperatively.ConclusionsAdductor canal block combined with Local infiltration analgesia provide better early pain control. Although the small statistical benefit may not result in minimal clinically important difference, Adductor canal block combined with Local infiltration analgesia also reduce opioid requirements, improve sleeping quality, and do not increase the complication rate. Therefore, Adductor canal block combined with Local infiltration analgesia still have good application prospects as an effective pain management for total knee arthroplasty.Trial registrationChinese Clinical Trial Registry, ChiCTR1900021385, 18/02/2019.