Adductor canal block compared with periarticular bupivacaine injection for total knee arthroplasty - A prospective randomized trial

Abstract

Background: In the recent years, the methods for pain control after total knee arthroplasty (TKA) have been extensively studied. Improvements in pain control, rapid functional recovery, decrease in period of the hospital stay following total knee arthroplasty is because of the widespread use of regional anesthesia in practice. Aim of the study: To compare the efficacy of adductor canal blocks (ACB) and periarticular anesthetic injections (PAI) with bupivacaine in total knee arthroplasty. Methods and Materials: Ninenty patients undergoing primary total knee arthroplasty under spinal anesthesia were randomized to 1 of 3 groups: ACB alone (15 mL of 0.5% bupivacaine), PAI alone (50 mL of 0.25% bupivacaine with epinephrine) and ACB + PAI. The primary outcome in this study was the visual analog scale (VAS) pain score in the immediate postoperative period. Secondary outcomes included postoperative opioid use, activity level during physiotheraphy, length of hospital stay and range of motion. Results: The mean VAS pain score was significantly higher after use of ACB alone, compared with the score after use of ACB1PAI, on postoperative day 1 and POD3. Total opioid consumption through POD3 was significantly higher when ACB alone had been used compared with PAI alone and ACB + PAI. Opioid consumption in the ACB-alone group was significantly higher than that in the ACB + PAI group on POD2 and POD 3 and significantly higher than that in the PAI alone group on POD2. There was no significant difference in opioid consumption between the patients treated with PAI alone and those who received ACB + PAI. The activity level during physiotherapy on POD 0 was significantly lower after use of ACB alone than after use of PAI alone or ACB + PAI. Conclusion: There is significantly higher pain scores after total knee arthroplasty done with an ACB and without PAI, suggesting that ACB alone is inferior for perioperative pain control. There were no significant differences between ACB alone, PAI alone and ACB + PAI with regard to other parameters measured.