Comparison of local infiltration versus adductor block versus combined use of these two after knee arthroplasty

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Created On: 06/07/2020

Comparison of local infiltration versus adductor block versus combined use of these two after knee arthroplasty

In this comparative study, the efficacy and outcomes of analgesic treatments- ACB and LIA when used alone or in combination has been studied for TKA.

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Key take away

Adductor canal block (ACB) and local infiltration analgesia (LIA) are analgesic therapies helpful for post-operative analgesia following total knee arthroplasty (TKA). As found in this study, comparison of 3 analgesic modalities: LIA, ACB and their combination resulted in good postoperative pain relief, functional outcome and patient satisfaction although the combination proved to be better than the other two.

Background

In this comparative study, the efficacy and outcomes of analgesic treatments- ACB and LIA when used alone or in combination has been studied for TKA.

Method

On the whole, 120 patients undergoing unilateral TKA were randomized into 3 groups, namely: LIA (Group I), ACB (Group II) and combination of both i.e. LIA + ACB (Group III). The outcome was expressed as the post-operative analgesia attained by the 3 techniques (calculated by the NPRS) and quantity of fentanyl utilized after the operation. Secondary outcome was examined as per the postoperative functional outcomes concerning ability to stand, distance covered, range of motion (ROM) of knee on the 1st post-operative day, associated-problems and WOMAC (Western Ontario & McMaster Universities Osteoarthritis Index) scores.

Result

At 24 hours, NPRS for pain revealed significant differences between Group I and Group II, with a p value = 0.018 (Group I was better) and between Group III and Group II, with p values =0.023 and 0.004 (Group III was better). For the same time period, no significant differences were found between Group I and Group III. Use of total fentanyl consumption was significantly less in Group III as compared to Group I and Group II (p value=0.042 and 0.005, respectively), as found Group III was better and consumed less fentanyl (Refer to the graph below).

At baseline, 2 and 6 weeks, no significant differences were found in WOMAC scores between the 3 groups postoperatively.

Conclusion

In patients undertaking TKA, analgesic effect of combination of ACB and LIA was superior, as specified by decreased opioid consumption. No differences in functional outcomes and complications were observed than the distinct use of the two methods.