Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement
Journal of Advances in Medicine and Medical Research,
Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA.
Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021.
Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II.
Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.
Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day.
Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.
- Total knee arthroplasty
- femoral nerve block
- adductor canal block and epidural group.
How to Cite
Adams HA, Saatweber P, Schmitz CS, Hecker H. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia. European Journal of Anaesthesiology. 2002;19:658–65.
Burton D, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Continuing Education in Anaesthesia, Critical Care & Pain. 2004;4:144 7.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesthesia & Analgesia. 2003;97:534-40.
Tong D, Chung F, Wong D. Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients. Anaesthesiology. 1997; 87:856–64.
Wang L, Guyatt GH, Kennedy SA, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. Canadian Medical Association Journal. 2016;188:352–361
Richman JM, Wu CL. Epidural analgesia for postoperative pain. Anaesthesiology. 2005;23:125-40.
Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anaesthesiology. 2010;113:1144–1162.
Manickam, B. et al. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Regional Anaesthesia and Pain Medicine. 2009;34:578–580.
Ip HY, Abrishami A, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657-77.
Society KK. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee surgery & related research. 2012;24(4):201-207.
Mai K. Abdallah, Mohamad G, Sohair MS, Ahmed A. Comparative Study between Adductor Canal Block and Femoral Nerve Block for Postoperative Analgesia in Knee Arthroscopy. The Medical Journal of Cairo University. 2018;86:667-73.
Liu SS, Ngeow J, John RS. Evidence basis for ultrasound-guided block characteristics: onset, quality, and duration. Regional anesthesia and pain medicine. 2010;35(2 Suppl):S26-35. Epub 2010/03/23.
Jæger P, Nielsen ZJ, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013; 118(2):409-15.
EF-Feky, UI AK, AM I. Comparative Study between Ultra-Sound Guided Femoral Nerve Block and Adductor Canal Block in Postoperative Analgesia after Knee Arthroscopy. The Egyptian Journal of Hospital Medicine. 2018;72(3):4179-84.
Hanson NA, Allen CJ, Hostetter LS, Nagy R, Derby RE, Slee AE, Arslan A, Auyong DB. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesthesia & Analgesia. 2014; 118(6):1370-7.
Kayupov E, Okroj K, Young AC, Moric M, Luchetti TJ, Zisman G, Buvanendran A, Gerlinger TL, Della Valle CJ. Continuous adductor canal blocks provide superior ambulation and pain control compared to epidural analgesia for primary knee arthroplasty: a randomized, controlled trial. The Journal of Arthroplasty. 2018; 33(4): 1040-4
Alsheikh K, Alkhelaifi A, Alharbi M, Alhabradi F, Alzahrani F, Alsalim A, et al. Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study. Saudi Journal of Anaesthesia. 2020;14(1):38-43.
Shanthanna H, Huilgol M, Manivackam VK, Maniar A. Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement. Indian Journal of Anaesthesia. 2012;56(3):270.
Hegazy N, Sultan S. Comparison between effects of adductor canal block and femoral nerve block on early postoperative course in total knee arthroplasty: A prospective double-blind, randomized controlled study. Ain-Shams Journal of Anesthesiology. 2015;8(1):124-8.
Memtsoudis SG, Yoo D, Stundner O, Danninger T, Ma Y, Poultsides L, et al. Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. International Orthopaedics. 2015;39(4):673-80.
Armanious SH, Botros JM, El Ganzoury IM, Abdelhameed GA. Adductor canal block versus femoral nerve block in unicompartmental knee arthroplasty: a randomized, double blind, prospective, comparative study. Ain-Shams Journal of Anesthesiology. 2020;12(1):28.
Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J, Oldfield S, Oh J, Brull R. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology. 2016;124(5):1053-64.
Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta anaesthesiologica Scandinavica. 2011;55(1):14-9. Epub 2010/11/03.
Koh IJ, Choi YJ, Kim MS, Koh HJ, Kang MS, In Y. Femoral nerve block versus adductor canal block for analgesia after total knee arthroplasty. Knee surgery & related research. 2017;29(2):87-95.
Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine. 2018;97(48):133-91.
Kozian A. Epidural analgesia compared with femoral nerve block for post operative pain therapy after total knee arthroplasty–a matched pair analysis. Journal of Anaesthesia and Surgry. 2019;20(12):150-60.
Park S-J, Shim SY, Park SG. A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement. Anesthesia Pain Medicine. 2017;12(2):176-82.
Dauri M, Polzoni M, Servetti S, Coniglione F, Mariani P, Sabato AF. Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction. Acta Anaesthesiologica Scandinavica. 2003;47(1):20-25.
Vishwanatha S, Kalappa S. Continuous femoral nerve blockade versus epidural analgesia for postoperative pain relief in knee surgeries: A randomized controlled study. Anesthesia, Essays Researches. 2017;11(3):599.
Arjun BK, Prijith RS, Sreeraghu GM, Narendrababu MC. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian Journal of Anaesthesia. 2019;63(8):635-639.
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