Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial

Abstract

BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated with periarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAIL group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAIL group than in the ACB-L group (P < 0.05).

Pain management after total knee arthroplasty

“…A total of eight RCTs compared ACB with LIA 54,169–175 (six of them included in a recent meta-analysis 142 ). In four RCTs, ACB had greater analgesic efficacy than LIA, particularly regarding dynamic pain, whereas in others, ACB was not inferior to LIA 169,172,174,175 . Postoperative opioid consumption was similar between ACB and LIA in four RCTs, whereas in others opioid-sparing was greater but without reduction of opioid-related adverse effects.…”

“…A total of eight RCTs compared ACB with LIA 54,[169][170][171][172][173][174][175] (six of them included in a recent meta-analysis 142 ). In four RCTs, ACB had greater analgesic efficacy than LIA, particularly regarding dynamic pain, whereas in others, ACB was not inferior to LIA.…”

Strategies for the management of postoperative pain in total knee arthroplasty: integrative review

“…The addition of percutaneous periarticular injection of multiple drugs the day after TKA may provide better relief of POP, but more studies are needed to confirm the safety of percutaneous injection 49,50 . ACB-L was superior to PAI-L in the treatment of pain after TKA; however, PAI-L was superior to ACB-L with respect to postoperative ROM and walking capacity 51 . As for surgical approach techniques, the configuration of the catheter orifice did not influence the efficacy of CFNB in this setting: the quality of analgesia was similar, with no reduction in local anesthetic or morphine consumption and equivalent postoperative quadriceps weakness 52 .…”

Multimodal Analgesia for Accelerated Rehabilitation after Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on the Effect of the Co-Application of Local Infiltration Analgesia and Femoral Nerve Block Combined with Dexmedetomidine

“…Diiorio [ 39 ] observed that the incidence rate of PONV was 39–70% in orthopedics. Although we now pay more attention to postoperative analgesia, recent studies [ 40 , 41 ] indicated that 13–60% of patients still suffered from moderate to severe postoperative pain. To reduce PONV as well as to increase postoperative pain control, we added periarticular LIA to FNB for patients undergoing TKA.…”