Pain After Unilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Examining the Analgesic Effectiveness of a Combined Adductor Canal Peripheral Nerve Block with Periarticular Infiltration Versus Adductor Canal Nerve Block Alone Versus Periarticular Infiltration Alone

Abstract

Participants who received AC + PI reported significantly less pain on walking on PODs 1 and 2 compared with those who received AC only or PI only.

Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty

“…By screening the titles and reading the abstracts and the full texts, 3 studies were excluded without meeting the inclusion criteria. Ultimately, we included 3 studies [18,21,26] with 337 patients for data extraction and meta-analysis (Fig. 1), with sample sizes ranging from 40 to 198.…”

“…The publication dates of eligible studies ranged from 2013 to 2016. There were 2 RCTs [18,26] and 1 nRCT [21] in the included studies. All the researchers conducted were for unilateral primary TKA.…”

“…All trials used spinal anesthesia. Spinal anesthesia was performed using hyperbaric bupivacaine 12.5 to 15 mg administered via the L3-4 or L2-3 vertebral interspaces in 1 trial; [18] another trial [26] used 2 mL of 0.5% bupivacaine with 0.1 mg preservative-free morphine for spinal anesthesia; all patients received a standard spinal anesthetic with 15 mg of bupivacaine and 100 μg of morphine injected at the L2-3 or L3-4 levels in one trial. [21] All studies involved the use of intraoperative PI.…”

“…The variation of the contents and methods used in the PI was noted. For instance, in the study by Sawhney et al, [26] 20 mL of PI solution was injected into the posterior capsule and the medial and lateral ligaments just before implantation; after insertion of the implants, another 20 mL was infiltrated into the capsule and retinacular tissues; the remaining solution was used to infiltrate the muscle and subcutaneous tissues. In the study by Andersen et al [18] half of the PI solution was injected in the posterior joint capsule and along the meniscectomy line, and the other half was injected in the anterior joint capsule along the incision line before closure.…”

“…Total scores of the 2 RCTs [18,26] showed the quality of the 2 trials to be high (mJS scores = 6 and 7). According to the NOQAS, the remaining 1 study [21] scored 7 points (which denoted high quality) (Table 1).…”