Comparison of adductor canal block, peri–articular injection or infiltration between popliteal artery and posterior knee capsule with adductor canal block in total knee arthroplasty

Abstract

Background: Moderate to severe postoperative pain is experienced by patients after total knee arthroplasty (TKA), which has an impact on postoperative rehabilitation, patient satisfaction, and overall results. Aim: Patients receiving total knee arthroplasty under general anesthesia were evaluated to see how well the combined adductor canal block and infiltration of the interspace between popliteal artery and the capsule of posterior knee block (IPACK) reduced post-operative discomfort. These treatments were compared to adductor canal block (ACB) and peri-articular injections alone (PAIs). Patients and methods: 60 patients were randomly allocated into three groups (20 in each). All that Group I patients got was an adductor block. Patients in Group II only received the periarticular injection. The IPACK (interspace between popliteal artery and posterior knee capsule) block and adductor block procedures were performed on patients in Group III. The Numeric Rating Scale (NRS) was used to measure post-operative pain as the primary endpoint both during physical therapy and when the patient was at rest. Mobilization was assisted by the Timed Up-and-Go (TUG) and MRC tests, and the second objective was postoperative analgesia, which was assessed by the total number of analgesics used and the time it took until the first rescue analgesic was delivered. Results: The total amount of morphine consumed in IQR amongst the three study groups was statistically different (p-value 0.005). Total postoperative morphine consumption in groups II and III was statistically significantly lower than in groups I (p-value 0.005), and there was also a significant difference between groups II and III (p-value 0.005), indicating that group II had significantly less total morphine consumption than the other two groups. Conclusion: In contrast to combination IPACK-ACB and ACB alone, we came to the conclusion that adding PAIs to the pain management regimen for patients having TKA enhances analgesia quality and reduces opioid intake. Even though the combined IPACK-ACB block was less successful than PAIs, it nevertheless showed superior pain scores at rest and during physiotherapy and required less opioid consumption than ACB alone, making it a viable option to PAIs in situations where this technique is not practical.