Top

MUSCULOSKELETAL SURGERY

Published in:

01-08-2018 | Original Article

Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study

Authors: S. R. Sankineani, A. R. C. Reddy, K. S. Ajith Kumar, K. K. Eachempati, A. V. G. Reddy

Published in: MUSCULOSKELETAL SURGERY | Issue 2/2018

Abstract

Purpose

Pain management after total knee arthroplasty has seen many recent advances such as peripheral nerve blocks in order to improve the functional outcome and reduce morbidity after surgery. Adductor canal block (ACB) and multimodal periarticular infiltration (MPI) are two techniques that have been proven to be efficacious individually. We hypothesized that the combination of ACB with MPI would reduce pain and improve knee range of movement (ROM) compared to ACB alone.

Methods

A prospective non-randomized study was conducted from July 2015 to December 2015 in our institution in a total of 200 consecutive patients undergoing unilateral total knee arthroplasty who were either given ACB alone (Group 1, n = 100 patients) or ACB + MPI (Group 2, n = 100 patients). All the patients were assessed for severity of pain by Visual Analogue Scale (VAS) at 8, 24, 48 h postoperatively and knee ROM after 48 h.

Results

Patients in ACB + MPI group had significantly better VAS scores at 8 h postoperatively but showed no significant difference at 24 and 48 h compared to ACB group. Patients in ACB + MPI group showed significantly better knee ROM after 48 h.

Conclusions

Our study concludes that patients receiving ACB + MPI have demonstrated better VAS scores in the immediate postoperative period but have no significant difference at the time of discharge.

Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C (2011) Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 82(4):441–447. https://doi.org/10.3109/17453674.2011.581264 CrossRefPubMedPubMedCentral

Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A (2010) Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop 81(3):354–360. https://doi.org/10.3109/17453674.2010.487241 CrossRefPubMedPubMedCentral

Wang H, Boctor B, Verner J (2002) The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement. Reg Anesth Pain Med 27:139–144PubMed

De Ruyter ML, Brueilly KE, Harrison BA et al (2006) A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes. J Arthroplasty 21(8):1111–1117CrossRefPubMed

Hebl JR, Kopp SL, Ali MH et al (2005) A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 87(Suppl 2):63–70PubMed

Chaumeron A, Audy D, Drolet P, Lavigne M, Vendittoli PA (2013) Periarticular injection in knee arthroplasty improves quadriceps function knee. Clin Orthop Relat Res 471:2284–2295. https://doi.org/10.1007/s11999-013-2928-4 CrossRefPubMedPubMedCentral

Uesugi K, Kitano N, Kikuchi T, Sekiguchi M, Konno SI (2014) Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized controlled study. Knee 21(4):848–852. https://doi.org/10.1016/j.knee.2014.04.008.77 CrossRefPubMed

Allen HW, Liu SS, Ware PD et al (1998) Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 87(1):93–97PubMed

Milani P, Castelli P, Sola M et al (2015) Multimodal analgesia in total knee arthroplasty: a randomized, double-blind, controlled trial on additional efficacy of periarticular anesthesia. J Arthroplasty 30(11):2038–2042. https://doi.org/10.1016/j.arth.2015.05.035 CrossRefPubMed

10.

Nakai T, Tamaki M, Nakamura T et al (2013) Controlling pain after total knee arthroplasty using a multimodal protocol with local periarticular injections. J Orthop 10(2):92–94. https://doi.org/10.1016/j.jor.2013.02.001 CrossRefPubMedPubMedCentral

11.

Schwarzkopf R, Drexler M, Ma MW et al (2016) Is there a benefit for liposomal bupivacaine compared to a traditional periarticular injection in total knee arthroplasty patients with a history of chronic opioid use? J Arthroplasty 31(8):1702–1705. https://doi.org/10.1016/j.arth.2016.01.037 CrossRefPubMed

12.

Vora MU, Nicholas TA, Kassel CA, Grant SA (2016) Adductor canal block for knee surgical procedures: review article. J Clin Anesth 35:295–303CrossRefPubMed

13.

Kwofie MK, Shastri UD, Gadsden JC et al (2013) The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 38(4):321CrossRefPubMed

14.

Jenstrup MT, Jaeger P, Lund J et al (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56:357CrossRefPubMed

15.

Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 22:33–38CrossRefPubMed

16.

Gwam CU, Mistry JB, Khlopas A, Chughtai M, Thomas M, Mont MA, Delanois RE (2017) Does addition of multimodal periarticular analgesia to adductor canal block improve lengths of stay, pain, discharge status, and opioid use after total knee arthroplasty? J Arthroplasty 32(5):1470–1473CrossRefPubMed

17.

Perlas A, Kirkham KR, Billing R et al (2013) The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med 38(4):334–339. https://doi.org/10.1097/AAP.0b013e318296b6a0 CrossRefPubMed

18.

Ma J, Gao F, Sun W, Guo W, Li Z, Wang W (2016) Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty. Medicine (Baltimore) 95(52):e5701CrossRef

19.

Mörwald EE, Zubizarreta N, Cozowicz C, Poeran J, Memtsoudis SG (2017) Incidence of local anesthetic systemic toxicity in orthopedic patients receiving peripheral nerve blocks. Reg Anesth Pain Med. https://doi.org/10.1097/AAP.0000000000000544 PubMedCrossRef

20.

Weinberg G, Barron G (2016) Local anesthetic systemic toxicity (LAST): not gone, hopefully not forgotten. Reg Anesth Pain Med 41(1):1–2CrossRefPubMed

Title: Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study
Authors: S. R. Sankineani
A. R. C. Reddy
K. S. Ajith Kumar
K. K. Eachempati
A. V. G. Reddy
Publication date: 01-08-2018
Publisher: Springer Milan
Published in: MUSCULOSKELETAL SURGERY / Issue 2/2018
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-017-0519-3

At a glance: The STEP trials

Springer Medicine

Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

A review of the management of tibial plateau fractures

Correlation between MRI and hip arthroscopy in children with Legg–Calve–Perthes disease

Biphasic bioresorbable scaffold (TruFit®) in knee osteochondral defects: 3-T MRI evaluation of osteointegration in patients with a 5-year minimum follow-up

The utility of botulinum toxin A in the repair of distal biceps tendon ruptures

Biochemical stress evaluation after medial parapatellar and subvastus approach in total knee replacement

Baropodometry on patients after total knee arthroplasty