Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery - A Randomized Controlled Trial

Abstract

Context: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. Aim: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. Settings and Design: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h postoperative period. The primary outcome measures were first 24 h morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. Statistical Analysis: Statistical analysis was performed using the Student s t-test, Mann–Whitney test, and Chi-square test. Results: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. Conclusion: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.