Purpose: A continuous adductor canal block (cACB) for pain control in total knee arthroplasty (TKA) is always performed by an anesthesiologist. A surgeon-performed cACB during surgery is somewhat questionable in terms of feasibility, reproducibility, and efficacy.
Methods: This study was divided into 2 phases. In Phase I, an experimental dissection of 16 cadaveric knees to expose the Saphenous nerve and related muscles around the adductor canal was conducted. The extent of dye after injection via a catheter inserted into the adductor canal at the time of TKA was evaluated. In phase II, an RCT study comparing clinical outcomes between surgeon-performed (Group 1) and anesthesiologist-performed cACB (Group 2) during TKA in 63 patients was evaluated. The visual analog scale (VAS) at rest and during movement at several time points and functional outcomes during hospitalization were compared.
Results: The phase I study demonstrated surgeon-performed cACB during surgery feasible and reproducible with consistent dye extension into the adductor canal after injection via a catheter. In the phase II study, 29 patients of Group 1 and 30 patients of Group 2 completed the evaluation with no differences in baseline parameters. The VAS during movement at 24 and 36 hours, quadriceps strength, time up and go test, and knee motion at different time points, and total morphine consumption showed no differences between both groups. There were no procedure-related complications.
Conclusion: The surgeon-performed cACB during surgery was feasible and reproducible with similar VAS scores and functional outcomes during hospitalization to anesthesiologist cACB.
Level of evidence Level I, prospective randomized trial.
Keywords: adductor canal block, peripheral nerve block, total knee arthroplasty, surgeon-performed ACB
Purpose: This report describes the case of 59-year-old woman with right medial compartment knee osteoarthritis (OA) who experienced an unusual adverse reaction to intra-articular sodium hyaluronate injection.
Methods: The patient received an intra-articular sodium hyaluronate injection for treatment of knee OA. Ten days after injection, she experienced severe pain in her right knee wherein laboratory test results showed inflammatory profiles that could not rule out septic arthritis. Joint lavage was performed, after which the patient was monitored for any changes in her symptoms or laboratory test results.
Results: The patient experienced severe pain in her right knee after intra-articular sodium hyaluronate injection. Additionally, laboratory test results showed inflammatory profiles that could not rule out septic arthritis. One month after joint lavage, the patient's symptoms resolved, and her laboratory test results returned to normal range.
Conclusions: An inflammatory flare could occur as an adverse effect of intra-articular sodium hyaluronate injection, mimicking septic arthritis. Importantly, both physicians and patients should be aware of this potential reaction, particularly, patients should report any unusual symptoms to their healthcare provider.
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