DOI: 10.1213/01.ane.0000492878.11489.ff

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Issn Print: 0003-2999

Publication Date: 2016/09/01


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Abstract PR493: A Comparison of Adductor Canal Block with Or Without Local Infiltration Analgesia On Postoperative Pain And Functional Outcomes After Total Knee Arthroplasty

W. Kampitak; C. Amarase; R. Apihansakorn; P. Varapalux; S. Ngarmukos; A. Tanavalee

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Author Information: Anesthesiology,

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Background & Objectives: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Effectiveness of analgesia without motor weakness may enhance early mobilization during the recovery period. We hypothesized that the combination of a single-injection adductor canal block (ACB) with single- dose local infiltration analgesia (LIA) may improve postoperative pain and accelerate functional recovery, compared with single injection ACB alone.
Materials & Methods: In this double-blind study, 62 patients presenting for TKA were randomized to receive either a LIA with a mixture containing levobupivacaine, morphine and epinephrine (Group L+C) or sham injection (group C) during the operation. All patients received a intrathecal morphine 0.05 mg combined with spinal anesthesia and postoperative single-injection ultrasound-guided ACB (0.5%Levobupivacaine 20 ml). The primary outcome was Time-Up and Go (TUG) test on postoperative day 2. Early (postoperative day 1-3) and late (postoperative 2, 6 weeks and 3 months) functional capacity (TUG test, Quadriceps strength, degree of knee movement), postoperative pain, total dosage of rescue analgesia, time to first rescue analgesia, postoperative nausea and vomiting, length of hospital stay and patient satisfaction were measured. Clinical trial TCTR20150720006, http://www.clinicaltrial.in.th
Results: We found no difference in TUG test on postoperative day 2 between treatment and control groups. However, the median time to first postoperative rescue analgesia was significantly longer in the L+C group compared to that in the L group (490.50 mins VS 142.50 mins, P= 0.04). The number of patients requiring rescue analgesia during postoperative 180 minutes in the L+C group was remarkably less than that in the L group (5/25 VS 13/17, P= 0.024). Other parameters of pain or functional capacity, side effects, length of stay and patient satisfaction were not significantly different between the 2 groups.
Conclusion: Addition of single-dose local infiltration analgesia with single-injection adductor canal block may prolong the time to first request for rescue analgesia and reduce the number of patients requiring rescue analgesia during postoperative 180 minutes than single-injection adductor canal block alone after Total knee arthroplasty.
References:
1. Perlas A, Kirkham AR. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med 2013; 38(4):334-9.
2. Anderson HL, Gyrn J. Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. Reg Anesth Pain Med. 2013; 38(2):106-11.
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