022 23805673
Abstract
Total knee arthroplasty is associated with intense, early post-operative pain. Femoral nerve block is known to provide optimal pain relief but reduces the strength of the quadriceps muscle and associated with the risk of falling. Adductor canal block is almost pure sensory blockade with minimal effect on quadriceps muscle strength. We prospectively randomized 100 patients in two groups’ continuous adductor and femoral block group. Ambulation ability (Timed up go, 10-m walk, 30 s chair test), time to active SLR, quadsticks, staircase competency, ambulation distance was significantly better (P value b 0.001) in adductor canal group whereas pain scores, opioid consumption showed no significant difference. Adductor canal block provided better ambulation and early functional recovery but without superior analgesia than femoral nerve block post TKA. Level of evidence: Level III, therapeutic study.
Total knee arthroplasty (TKA) is associated with intense, early post-operative pain and effective analgesia post TKA is of paramount importance. Moreover, nowadays fast track patient management is gaining popularity. Nevertheless, the ideal analgesia modality should facilitate early rehabilitation, prevent knee stiffness, improve patient satisfaction, reduce the length of hospital stay [1] and promote good functional outcomes [2,3].
Peripheral nerve blockade have been reported to deliver optimal postoperative pain relief. Moreover, they are increasingly preferred in patients undergoing orthopedic procedures [4,5].Furthermore, multiple studies endorsed the efficacy of peripheral nerve block to shorten the time of functional recovery and provide a quality of analgesia and surgical outcomes comparable to intravenous patient-controlled analgesia (PCA) or epidural analgesia without the associated side-effects [5,6]. Femoral nerve block is known to provide optimal pain relief after TKA [7–9]. However, previous studies have found that femoral nerve block (FNB) reduces the strength of the quadriceps muscle [10–12]. In addition, several studies reported that peripheral nerve blocks involving the femoral nerve may be associated with the risk of falling [13–16]. Consequently, regional anesthesia and analgesia techniques with preserved muscle function are more justifiable.