Comparison of the Clinical Outcomes of a Single Injection Adductor Canal Block with the Concomitant Use of Transdermal Buprenorphine and Continuous Adductor Canal Block after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.

Analgestic efficacy of intermittent boluses for adductor canal block after total knee arthroplasty / 临床麻醉学杂志

Objective To compare two different regimens of ultrasound-guided Continuous ad-ductor canal block (CACB)for postoperative analgesia and early ambulation after total knee arthro-plasty (TKA).Methods Sixty-seven patients scheduled for unilateral TKA undergoing spinal anes-thesia,13 males and 54 females,aged 18-85 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ, were randomly divided into the continuous infusion group A (n=34)and the intermittent boluses group B (n=33).After the operations,ultrasound-guided CACB were administered and 20 ml of 0.2% ropivacaine was given as the loading dose.From then on,patients in both groups used electronic analgesic pumps containing 240 ml of 0.2% ropivacaine for postoperative analgesia.5 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the group A.5 ml of 0.2% ropivacaine was automated injected every 60 minutes in the group B.All infusion pumps were setted at a bolus dose of 5 ml,with a lock time of 30 minutes.The total consumptions of analgestic pum solution and dezoine, quadriceps muscle strength, active range of knee flexion, ambulation distance and occurrences of adverse reactions such as nausea and vomiting,dizziness,drowsiness,extravasating and errhysis were recorded at different time points postoperatively.Results The total consumptions of analgestic pum solution at 12,24 h postoperatively of group B were significantly reduced than that of group A (P<0.05).The 48 h total dezoine consumption of group B was significantly reduced than group A (P<0.05).Active range of knee flexion at 24,48 h and ambulation distance at 48,72 h of group B were significantly higher than group A (P<0.05).There was no statistical difference in quadriceps muscle strength between group A and group B.The incidence of nausea and vomiting in group A was significantly higher than that in group B,and there were no statistical difference in other adverse reactions between group A and group B.Conclusion Compared with the continuous infusion group,the intermittent bolus group for CACB after TKA can provide better analgesic effect and de-crease opioid use postoperatively,with little effect on motor nerve,promoting early ambulation.