Clinical efficacy of adductor canal blockade combined with transcutaneous electrical acupoint stimulation for total knee arthroplasty / 中国骨伤

OBJECTIVE@#To evaluate the efficacy of adductor canal block (ACB) combined with transcutaneous electrical acupoint stimulation (TEAS)for postoperative analgesia and early functional exercise after total knee arthroplasty (TKA).@*METHODS@#A total of 84 patients underwent primary unilateral TKA from January 2019 to August 2020 were selected, including 45 males and 39 females, aged 66-77 (72.8±8.9) years;body mass index (BMI) was for 19-25 (23.6±3.5) kg /m@*RESULTS@#There were no significant differences in VAS of rest pain and activity pain in postoperative 6, 12 h between two groups (@*CONCLUSION@#TEAS combined with ACB has a better postoperative analgesic efficacy than simple ACB, and can promote early functional exercise of patients. It is safe and effective for postoperative analgesia after TKA.

Comparison of adductor canal block for analgesia in arthroscopic surgery with ropivacaine alone and ropivacaine and clonidine / Comparação do bloqueio do canal adutor para analgesia em cirurgia artroscópica com ropivacaína isolada e ropivacaína + clonidina

Abstract Background and objectives: Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. Methods: A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S - control group received adductor canal block with 30 mL saline, Group R - ropivacaine group received adductor canal block with 30 mL of 0.375% ropivacaine and Group RC - clonidine group received adductor canal block with 30 mL of 0.375% ropivacaine with clonidine 1 µg.kg-1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. Results: The mean pain free periods were 20 min, 384.76 min and 558.09 min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. Conclusion: Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.

Resumo Justificativa e objetivos: O alívio inadequado da dor após a reconstrução do ligamento cruzado anterior afeta a mobilidade, leva ao desenvolvimento de aderências, inserção do ligamento enfraquecido e atrofia muscular. O bloqueio do canal adutor para analgesia pós-operatória preserva a força do quadríceps. O presente estudo foi feito para comparar o período sem dor em pacientes de reconstrução artroscópica do ligamento cruzado anterior, submetidos ao bloqueio do canal adutor guiado por ultrassom com ropivacaína isolada e ropivacaína + clonidina. Métodos: Um estudo prospectivo, randômico e duplo-cego foi conduzido com 63 pacientes adultos, estado físico ASA I-II, submetidos à reconstrução do ligamento cruzado anterior. Os pacientes foram randomizados em três grupos: Grupo S, que recebeu bloqueio do canal adutor com 30 mL de solução salina para controle; Grupo R, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375%; Grupo RC, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375% e 1 µg.kg-1 de clonidina. O desfecho primário do estudo foi comparar o período sem dor nos pacientes que receberam bloqueio do canal adutor com ropivacaína isolada ou ropivacina + clonidina. Os desfechos secundários foram escores de dor em repouso e movimento, necessidade total de analgésicos, escore de sedação, além de náusea e vômito no pós-operatório. Resultados: Os períodos médios sem dor foram 20 min, 384,76 min e 558,09 min para os grupos S, R e RC, respectivamente, e essa diferença foi estatisticamente significativa (p < 0,001). Não houve diferença significativa entre os grupos R e RC em termos de escores de dor em repouso e movimento e a necessidade total de analgésicos. Conclusão: A adição de clonidina à ropivacaína em bloqueio do canal adutor guiado por ultrassom levou a um prolongamento significativo do período sem dor, embora os escores de dor em repouso e movimento, e a necessidade de analgésico de resgate, não tenham diferido.

Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement / 대한마취과학회지

BACKGROUND: The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients. METHODS: With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation. All TKA patients received adductor canal catheters and peri-operative multimodal analgesia. The primary outcome was pain on POD 0. Other outcomes were daily pain scores, opioid consumption, ambulation distance, length of stay, and adverse events within 30 days. RESULTS: Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th–90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0–4.3] vs. 2.5 [0–7]; P = 0.003). The highest patient-reported pain scores on any POD were similar between groups with no differences in other outcomes. CONCLUSIONS: Within a multimodal analgesic protocol, addition of IPACK blocks decreased the lowest pain scores on POD 0. Although other outcomes were unchanged, there may be a role for new opioid-sparing analgesic techniques, and changing clinical practice change can occur rapidly.

Influence of Continuous Fascia Iliaca Compartment Block and Adductor Canal Block with Multimodal Analgesia on Postoperative Analgesia and Early Rehabilitation after Elderly TKA Surgery / 医用生物力学

Objective To observe the analgesia efficacy of continuous fascia iliaca compartment block (FICB) and adductor canal block (ACB) on elderly patients undergoing total knee arthroplasty (TKA) with multimodal analgesia and their early rehabilitation. Methods Sixty TKA patients (26 female and 34 male, 60-75 years old) were randomly divided into two groups and received ultrasound-guided either continuous FICB (n=30) or continuous ACB (n=30) using 0.25% ropivacaine for controlled analgesia. All the patients had no previous experiences of knee surgery. Quality of analgesia was assessed by dynamic and static visual analogue scale (VAS) based on pain intensity. In addition, rehabilitation training compliance, range of motion (ROM) and knee function were assessed at different times after rehabilitation training. Results No significant differences were found in VAS scores during resting and passive functional exercise at 6, 12, 24, 48 h after TKA surgery (P>0.05); ACB group had significant differences in rehabilitation training compliance, knee ROM and HSS scores in comparison with FICB group (P<0.05). Conclusions Ultrasound-guided continuous ACB with multimodal analgesia could promote early rehabilitation after TKA．

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.

Efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in patients undergoing knee arthroplasty / 中华麻醉学杂志

Objective@#To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.@*Methods@#Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 53-68 yr, scheduled for elective total knee arthroplasty under general anesthesia, were assigned into 2 groups (n=30 each) using a random number table method: femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A). Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5% ropivacaine 20 ml in group F and group A, respectively.Patient-controlled saphenous nerve block analgesia was used in two groups, and the analgesic pump solution contained 1% ropivacaine 400 mg diluted to 160 ml in 0.9% sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose, a 30-min lockout interval and background infusion at a rate of 5 ml/h, and analgesia lasted until 72 h after operation.When visual analog scale score > 4 and pain was not relived after 30-min pressing by patients, pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4, 8, 24, 48 and 72 h after operation.The patient′s satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication, itching, dizziness, urinary retention, nausea and vomiting) were recorded within 72 h after operation.@*Results@#Compared with group F, the muscle strength of quadriceps femoris was significantly increased at 4, 8 and 24 h after operation, the rate of postoperative rescue analgesia was decreased (P<0.05), and no significant change was found in patient′s satisfaction score or incidence of adverse reactions in group A (P>0.05).@*Conclusion@#Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.

Efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in patients undergoing knee arthroplasty / 中华麻醉学杂志

Objective To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 53-68yr,scheduled for elective total knee arthroplasty under general anesthesia,were assigned into 2 groups (n=30 each) using a random number table method:femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A).Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5％ ropivacaine 20 ml in group F and group A,respectively.Patient-controlled saphenous nerve block analgesia was used in two groups,and the analgesic pump solution contained 1％ ropivacaine 400 mg diluted to 160 ml in 0.9％ sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose,a 30-main lockout interval and background infusion at a rate of 5 ml/h,and analgesia lasted until 72 h after operation.When visual analog scale score ＞ 4 and pain was not relived after 30-min pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4,8,24,48 and 72 h after operation.The patient's satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication,itching,dizziness,urinary retention,nausea and vomiting) were recorded within 72 h after operation.Results Compared with group F,the muscle strength of quadriceps femoris was significantly increased at 4,8 and 24 h after operation,the rate of postoperative rescue analgesia was decreased (P＜0.05),and no significant change was found in patient's satisfaction score or incidence of adverse reactions in group A (P＞0.05).Conclusion Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.

Does Adductor Canal Block Have a Synergistic Effect with Local Infiltration Analgesia for Enhancing Ambulation and Improving Analgesia after Total Knee Arthroplasty?

PURPOSE: We compared a single-injection adductor canal block (ACB) with or without local infiltration analgesia (LIA) for accelerating functional recovery and reducing postoperative pain after total knee arthroplasty (TKA). MATERIALS AND METHODS: Sixty-two patients undergoing TKA with simple spinal analgesia and ACB were randomized to receive either LIA (group A+L) or placebo LIA (group A). Postoperative visual analog scale (VAS) score for pain, Timed Up and Go (TUG) test and quadriceps strength, total dosage of rescue analgesia, time to first rescue analgesia, and adverse events were serially evaluated from postoperative day 1 to 3 months. RESULTS: There were no differences between both groups in pre- and postoperative VAS, TUG test, quadriceps strength 2 days, 3 days, 2 weeks, 6 weeks, and 3 months postoperatively. There were no differences in Knee Society clinical and function scores at 6 months and 1 year. However, group A+L had a significantly longer time for postoperative rescue analgesia (491 minutes vs. 143 minutes, p=0.04) with less patients requiring rescue analgesia during 6 hours after surgery (16.7% vs. 43.3%, p=0.024). Both groups had similarly high rates of patient satisfaction with low adverse event rates. CONCLUSIONS: Combined ACB and LIA in TKA enhanced early ambulation with reduced and delayed rescue analgesia.

Effect of adductor canal block combined with local infiltration anesthesia on rehabilitation of primary total knee arthroplasty / 中国修复重建外科杂志

Objective: To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA). Methods: A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups ( P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking. Results: The operation time of the trial group was significantly shorter than that of the control group ( t=-2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups ( t=-0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups ( P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups ( P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups ( P<0.05). Conclusion: For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.

Efficacy of Dexmedetomidine mixed with Ropivacaine for adductor canal block combined with general anesthesia in patients undergoing arthroscopic knee surgery / 中国内镜杂志

Objective To observe the efficacy and safety of Dexmedetomidine mixed with Ropivacaine for adductor canal block combined with general anesthesia in patients undergoing arthroscopic knee surgery. Methods Ninety patients underwent elective unilateral arthroscopic knee surgery were randomly divided into three groups (n = 30 each): general anesthesia group (Group G), general anesthesia + Ropivacaine for adductor canal block group (Group G+R) and general anesthesia + Dexmedetomidine mixed with Ropivacaine for adductor canal block group (Group G+DR). After the end of anesthesia induction, ultrasound-guided adductor canal block was performed in G+R and G+DR groups. In G+R and G+DR groups, 20 ml of 0.375% Ropivacaine and 20 ml of 0.375% Ropivacaine mixed with 0.6 μg/kg Dexmedetomidine were injected, respectively. After the induction of general anesthesia, the i-gel laryngeal mask airway was inserted, and the patients were mechanically ventilated in the two groups. Anesthesia was maintained with Remifentanil 0.15 μg/(kg?min) and Propofol adjusted to maintain BIS between 45 and 55. The time for recovery of spontaneous breathing, emergence time, and time for removal of LMA were recorded. The VAS scores at rest, during active functional exercise (AFE) and continuous passive movement (CPM) were recorded at the following points: 1 h, 4 h, 8 h, 12 h and 24 h after surgery. And quadriceps strength was evaluated at the following points: preoperative evaluation, 1 h, 4 h, 8 h, 12 h and 24 h after surgery. The total consumption of rescue analgesics, complications associated with adductor canal block, and occurrence of adverse cardiovascular events, over-sedation and postoperative nausea and vomiting were also recorded. Results Compared with Group G and Group G+R, the time for recovery of spontaneous breathing, emergence time, and time for removal of LMA were significantly shorter (P < 0.01). Compared with Group G, the VAS scores at rest, during AFE and CPM at 1 h and 4 h after surgery and the total consumption of Flurbiprofen axetil in Group G+R, and the VAS scores at rest, during AFE and CPM at 1 h, 4 h, 8 h and 12 h after surgery and the total consumption of Flurbiprofen axetil in Group G+DR were lower (all P < 0.05). Compared with Group G+R, the VAS scores at rest, during AFE and CPM at 8 h and 12 h after surgery and the total consumption of Flurbiprofen axetil in Group G+DR were lower (P < 0.01). No significant differences were seen among three groups in the terms of quadriceps strength, Dezocine consumption and adverse reactions (P > 0.05). Conclusion 0.6 μg/kg Dexmedetomidine mixed with 0.375% Ropivacaine 20 ml can provide faster recovery from anesthesia and effectively improve postoperative analgesia without inducing obvious adverse reactions when used for adductor canal block combined with general anesthesia in patients undergoing arthroscopic knee surgery.

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.

Application of the saphenous nerve emerging site through the adductor canal in ultrasound-guided adductor canal block / 临床麻醉学杂志

Objective To study clinical data retrospectively and demonstrate the optimal injection site of adductor canal block by performing a cadaveric study.Methods Clinical part:clinical data from 19 patients,11 males and 8 females,aged 21 85 years,ASA physical status Ⅰ-Ⅲ,who received ultrasound guided adductor canal block were retrospectively collected.Among whom 9 received a mid-distance injection of 10 ml of 0.5％ ropivacaine and 10 received an injection of the same medication at the outlet of adductor canal.The primary endpoint was complete absence of cold sensation to ice cube on the medial side of calf at 30 minutes and 24 hours after injection.Cadaveric part:40 lower limbs,20 males and 20 females,were finally analyzed in the study.The distances from the anterior superior iliac spine (ASIS) to the medial tibial condyle,from ASIS to the entrance of the adductor canal,from ASIS to the exit of the canal (adductor tendinous opening),from ASIS to the site where sa phenous nerve emerges through the aponeurotic covering were measured respectively.The length of adductor canal,the relative location of adductor canal and the site where saphenous nerve pierces in the lower limbs were calculated.Results Clinical part:all 19 cases were successfully recorded with complete absence of cold sensation at 30 minutes after injection of local anesthetic and complete sensory recovery at 24 hours after injection.Cadaveric part:in all specimens,saphenous nerve enters adductor canal and coursed down until emerging at very close to the distal end of the canal with the saphenous branch of descending genicular artery.The length of the adductor canal was (10.0±2.1) cm.The entrance and the exit of adductor canal and the emerging site of the saphenous nerve located along the (54.7±3.0) ％,(76.0％±3.8) ％ and (74.1±3.2) ％ of sartorius muscle,respectively.Conclusion Performing ultrasound-guided adductor canal block at either the outlet of adductor canal or mid-distance of thigh can achieve comparable blockade of saphenous nerve.Cadaveric study implicated that the optimal injection site for adductor canal block should be the lower one-third of sartorius muscle.Ultrasound-guided injection of local anesthetics next to the descending genicular artery may possibly become a promising new method of saphenous nerve block.

Comparison of Adductor Canal Block Versus Local Infiltration Analgesia on Postoperative Pain andF unctional Outcome after Total Knee Arthroplasty: A Randomized Controlled Trial

@#Introduction:Total knee arthroplasty (TKA) is associated with intense postoperative pain for which effective analgesia is essential to facilitate early postoperative recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) have become increasingly involved in postoperative pain management after TKA. We aimed to compare their efficacy and outcomes in patients undergoing TKA. Materials and Methods: Sixty patients undergoing unilateral TKA were randomized to receive either postoperative single-injection ACB (Group A) or LIA (Group L) during the operation. All patients received spinal anaesthesia. Primary outcome was total morphine consumption over postoperative 24 hours. Visual analog pain scale, time to first and total dosage of rescue analgesia, performance-based evaluations [timed-up and go (TUG) test, quadriceps strength], side-effects, length of hospital stay and patient satisfaction were measured. Results: Fifty-seven patients were available for analysis. Median total morphine consumption over 24 and 48 postoperative hours of Group A were significantly less than Group L (6/10 mg vs 13/25 mg, p, 0.008 and 0.001, respectively). Similarly, Group A had significantly lower VAS at postoperative 6, 12 and 18 hours, VAS at ambulation on postoperative (POD) 1-3, better TUG tests on POD 2 and during POD 3 than those of Group L. However, quadriceps strength and patient satisfaction were not different between both groups. Conclusion:Patients undergoing TKA with single-injection ACB required less postoperative opioids than those with LIA. Furthermore, multimodal analgesia using ACB provided better postoperative analgesia, as well as performance-based activities, than those with LIA.

Does Combination Therapy of Popliteal Sciatic Nerve Block and Adductor Canal Block Effectively Control Early Postoperative Pain after Total Knee Arthroplasty?

PURPOSE: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. MATERIALS AND METHODS: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. RESULTS: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. CONCLUSIONS: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.

Analgesic efficacy of ultrasound?guided adductor canal blockade after minor arthroscopic knee surgery / 实用医学杂志

Objective To investigate the analgesic efficacy of ultrasound?guided adductor canal blockade (ACB)after minor arthroscopic knee surgery. Methods Sixty patients undergone minor arthroscopic knee surgery were randomly divided into group ACB(n=20)and group Control(n=20). All patients received spinal anesthesia. The patients in group ACB received ultrasound?gGuided ACB with 20 ml 0.5% ropivacaine,and patients in group Control received 20 ml saline after the surgery. In addition ,all patients have a basic analgesic regimen with etoricoxib. Visual analogue scales(VAS) during rest and passive movement ,additional analgesic dose and side effects were recorded at 4,8,12,24 h Post?operation. At 24 h post?operation,the numbers of patients who can walk for 5 meters were recorded. Results VAS during rest and movement at 4 h,8 h and 12 h post?operation in group ACB were significantly lower than those in group Control. And all patients could walk 5m at 24 h post?operation. No headache,nausea and vomiting,urinary retention and other adverse reactions were observed in group ACB. There were four patients who received additional analgesic and one patient vomitted. Conclusions Significant analgesic effect of the ACB could be detected after minor arthroscopic knee surgery ,with less reduction in requirements for supplemental opioids.

Comparision for clinical efficiency of continuous adductor canal block and femoral nerve block in total knee arthroplasty / 北京大学学报(医学版)

Objective:To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty.Methods:From April to September 2016,patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed,and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery.Numeric pain rating scales (NPRS)pain scores in rest and activity 2,6,12,24 and 48 h after surgery were collected,and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed.Opioids consumption and anesthesia related adverse effects were also recorded.Results:In the study,40 patients were enrolled,with 20 patients in each group,male ∶female =7 ∶ 33,the age:(63.8 ± 10.1) years,and the body mass index (BMI):(28.5 ± 3.5) kg/ m2.The general conditions were comparable between the two groups.Though the rest pain 2 h after surgery [ACB =0.0(0,6),FNB =3.0(0,5),P=0.004] and activity pain 12 h post operation [ACB =3.0(3,0),FNB =5.5(0,10),P =0.004] were lower in ACB group compared with FNB group,there was no statistical difference in the other pain checking points between the two groups.The quadriceps strength 24 h and 48 h after surgery were (85.3-± 27.6) N and (80.0 ± 30.1) N in ACB group,(69.0 ± 29.4) N and (64.4 ± 32.0) N in FNB group,both of them were declined by time.The exact data were higher in ACB group,however,there was no statistical difference between the two group by repeated measurements variance analysis(F =2.703,P =0.108).Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h.And among them,three patients acquired once dolantin in ACB,two in FNB,from 24 to 48 h postoperation.There were five patients who suffered nausea postoperation in ACB group,and one who reported xerostomia.Four patients in FNB had nausea with vomiting,and three experienced xerostomia.Deep vein thrombosis appeared in 2 patients in FNB group,but no one in ACB group.Conclusion:Continuous ACB is not superior in pain control after TKA compared with FNB,and the quadriceps strength could be reserved more by this method,which performed early benefits in fast rehabilitation.

Efficacy of adductor canal block combined with posterior branch of obturator nerve block for post-operative analgesia in elderly patients undergoing total knee arthroplasty / 中华麻醉学杂志

Objective To evaluate the efficacy of adductor canal block combined with posterior branch of obturator nerve block for postoperative analgesia in the elderly patients undergoing total knee ar-throplasty. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 65-75 yr, weighing 55-80 kg, scheduled for elective unilateral total knee arthroplasty, were divided into 2 groups(n=30 each)using a random number table: adductor canal block group(group A) and blockade of adductor canal and posterior branch of obturator nerve group(group AO). At the end of anesthesia induction, adductor canal block was performed under ultrasound guidance, and 0.5% ropiva-caine 20 ml was injected in A and AO groups, and in addition posterior branch of obturator nerve block was then performed under ultrasound guidance, and 0.5% ropivacaine 10 ml was injected in group AO. When postoperative visual analog scale score≥3, patient-controlled intravenous analgesia was performed with mor-phine 0.05 mg∕kg at a 10-min interval. When postoperative visual analog scale score was still≥3, mor-phine 0.025 mg∕kg was intravenously injected as rescue analgesic. The duration of first requirement for an-algesic, consumption of morphine within 24 and 48 h after operation, patient′s satisfaction with analgesia at 48 h after operation and development of nerve block-related complications and adverse reactions such as nau-sea, vomiting and itching were recorded. Results Compared with group A, the duration of first require-ment for analgesic was significantly prolonged, and the consumption of morphine within 24 h after operation was reduced in group AO(P<0.05). There was no significant difference between the two groups in the consumption of morphine within 48 h after operation, satisfaction score or incidence of nausea, vomiting and itching(P>0.05). Nerve block-related complications were not found in two groups. Conclusion Ad-ductor canal block combined with posterior branch of obturator nerve block produces better efficacy than ei-ther alone when used for postoperative analgesia in the elderly patients undergoing total knee arthroplasty.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Efficacy of adductor canal block combined with infiltration anesthesia for postoperative analgesia in patients undergoing total knee arthroplasty / 中华麻醉学杂志

Objective To evaluate the efficacy of adductor canal block combined with infiltration anesthesia for postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Sixty pa?tients of both sexes, aged 65-80 yr, weighing 40-80 kg, of American Society of Anesthesiologists physi?cal statusⅠ or Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 3 groups ( n=20 each) using a random number table: single?injection adductor canal block + infiltration anesthesia group ( group A) , single?injection femoral nerve block+infiltration anesthesia group ( group F) , and infil?tration anesthesia group ( group I) . Ultrasound?guided adductor canal block and femoral nerve block were performed with 0.5% ropivacaine 20 ml before induction of anesthesia in A and F groups, respectively. Af?ter completion of the block, all the patients were ventilated through the laryngeal mask airway under general anesthesia. After installation of the knee prosthesis, local infiltration anesthesia was conducted with 0.2%ropivacaine 50 ml around the knee joint. Acetaminophen oxycodone capsule was taken orally one pill every 6 h starting from the morning on 1st day after surgery. When visual analogue scale ( VAS) score > 5, tram?adol 100 mg was injected intramuscularly as rescue analgesic. At 4, 8, 24, 48 and 72 h after surgery, VAS scores at rest and during activity were recorded, the quadriceps strength was measured, and the re?quirement for analgesic drugs and development of adverse reactions were recorded. Results Compared with group I, VAS scores at rest and during activity were significantly decreased at 4, 8, and 24 h after surger?y, and the consumption of tramadol was significantly decreased after surgery in A and F groups ( P<0.05) . The quadriceps strength at 4 and 8 h after surgery was significantly higher in A and I groups than in group F ( P<0.05) . No patients developed serious adverse reactions in the three groups. Conclusion Adductor ca?nal block combined with infiltration anesthesia provides reliable efficacy for postoperative analgesia with little influence on the quadriceps strength in the patients undergoing total knee arthroplasty.

Application of Continuous Adductor Canal Block in Pain Control After Total Knee Arthroplasty / 中国微创外科杂志

It is very frequent that patients undergoing total knee arthroplasty ( TKA) suffer a severe pain from the bone cutting and soft tissue balance procedures postoperatively .In addition , pain control is the key point of the rehabilitation after surgery . Therefore, establishing an effective method to decrease the pain should be considered as a priority .Femoral nerve block (FNB), as a common and effective peripheral nerve block after TKA , affects the strength of quadriceps femoris and the postoperative recovery . Adductor canal block (ACB), targeting at the saphenous nerve , is proved to be as effective as FNB in pain control , and has less influence on the quadriceps strength .However , considering about the short time following up , the expansion of local anesthesia drug and few reports in China , the application of ACB in TKA needs further study .