Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial

Abstract

Background Local infiltration analgesia (LIA) and adductor canal block (ACB) provide postoperative analgesia for total knee arthroplasty (TKA). ACB blocks the saphenous nerve and has smaller impacts on quadriceps muscle weakness. ACB theoretically does not have enough analgesic effects on posterior sensory nerves. LIA may increase its analgesic effects on the posterolateral knee. The purpose of this study was to evaluate whether ACB combined with a LIA cocktail of ropivacaine, morphine, and betamethasone has superior analgesic effect than LIA for TKA. Methods A total of 86 patients were assessed for eligibility from February 2019 to May 2019. 26 of those were excluded, and 60 patients were divided into 2 groups by computer-generated random number. Group A (LIA group) received LIA cocktail of ropivacaine, morphine and betamethasone. Group B (LIA+ ACB group) received ultrasound-guided ACB and LIA cocktail of ropivacaine, morphine and betamethasone. Postoperative visual analogue scale (VAS) resting or active pain scores, opioid consumption, range of motion (ROM), functional tests, complications and satisfaction rates were measured. The longest follow-up was 2 years. Results Two groups have no differences in terms of characteristics, preoperative pain or function (P > 0.05). ACB combined with LIA had significantly lower resting and active VAS pain scores, better ROM, better sleeping quality and higher satisfaction rates than LIA alone within 72 h postoperatively (P < 0.05). Complications, or adverse events and HSS score, SF-12 score were observed no significant differences within 2 years postoperatively. Conclusions Adductor canal block combined with Local infiltration analgesia provide better early pain control. Although the small statistical benefit may not result in minimal clinically important difference, Adductor canal block combined with Local infiltration analgesia also reduce opioid requirements, improve sleeping quality, and do not increase the complication rate. Therefore, Adductor canal block combined with Local infiltration analgesia still have good application prospects as an effective pain management for total knee arthroplasty. Trial registration Chinese Clinical Trial Registry, ChiCTR1900021385, 18/02/2019.

Analgesic Effectiveness of Motor-sparing Nerve Blocks for Total Knee Arthroplasty: A Network Meta-analysis

“…The full reference list of all excluded citations can be viewed in Appendix B (https://links.lww.com/ALN/D182). Thus, a total of 27 studies 3,4,30–54 satisfied the inclusion criteria and were included in this review. The full flow diagram for study inclusion can be viewed in figure 1.…”

“…Across all studies, 3,4,30–54 a total of 2,317 patients were assessed, of which 5 regional anesthetic strategies were investigated: 613 patients received LIA alone, 30–34,37,41,42,44,45,48,49,51–53,56 939 received LIA with single-injection ACB, 3,31,33,35,36,38–42,44–46,48,49,51–55 585 received LIA with continuous ACB, 3,4,30,32,34–38,40,43,46,51,55 58 received LIA with single-injection ACB and single-injection iPACK, 39,47 and 122 received LIA with continuous ACB and single-injection iPACK. 4,43,54 The primary anesthetic was general anesthesia in 6 studies, 35,39,49,50,53,55 spinal in 20 studies, 4,30–34,36–38,40–48,52,54 and general or spinal in 1 study. 3 Regarding outcome assessment, 25 studies 3,4,30–35,37–41,43–54 assessed early postoperative pain (within 24 h), and 23 studies 3,4,30–35,37–40,42,44,45,47–54 assessed late postoperative pain (after 24 h).…”

“…4,43,54 The primary anesthetic was general anesthesia in 6 studies, 35,39,49,50,53,55 spinal in 20 studies, 4,30–34,36–38,40–48,52,54 and general or spinal in 1 study. 3 Regarding outcome assessment, 25 studies 3,4,30–35,37–41,43–54 assessed early postoperative pain (within 24 h), and 23 studies 3,4,30–35,37–40,42,44,45,47–54 assessed late postoperative pain (after 24 h). Similarly, for opioid consumption, 23 studies 3,4,30–35,37–39,41,43–52,54 assessed early postoperative analgesic consumption (within 24 h), and 22 studies 3,4,30–40,42,45,47–51,53,54 assessed late analgesic consumption (after 24 h).…”

“…3 Regarding outcome assessment, 25 studies 3,4,30–35,37–41,43–54 assessed early postoperative pain (within 24 h), and 23 studies 3,4,30–35,37–40,42,44,45,47–54 assessed late postoperative pain (after 24 h). Similarly, for opioid consumption, 23 studies 3,4,30–35,37–39,41,43–52,54 assessed early postoperative analgesic consumption (within 24 h), and 22 studies 3,4,30–40,42,45,47–51,53,54 assessed late analgesic consumption (after 24 h). Finally, postoperative function at 24 h and beyond was assessed by 23 studies.…”

A Case-Control Study of the Effects of Implementing the Registered Nurses’ Association of Ontario Guidelines for the Assessment and Management of Postoperative Pain and the Use of Relaxation Therapy in 312 Patients with Bone and Soft-Tissue Malignancy

“…In the clinical care of patients with bone and soft-tissue malignancy, postoperative pain control is one of the important indicators used to evaluate the quality of nursing care. However, pain control for patients in China is still less than satisfactory, warranting a more standardized and effective pain care management strategy [ 1 , 2 ]. The third edition of the Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline on the Assessment and Management of Pain (RNAO pain guideline), published in 2013, is designed to apply to all domains of nursing practice, including clinical, administration, and education, to assist nurses in becoming more comfortable, confident, and competent when assessing and managing people with the presence, or risk of, any type of pain.…”