A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on kne
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ORIGINAL ARTICLE
A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial A. V. Gurava Reddy1,5 · M. Manohar1,5 · A. Shetty1,5 · S. R. Sankineani1,5 · P. S. Ashok Kumar2,5 · V. C. Bose2,5 · S. Pichai2,5 · S. Patil3,5 · R. Mukartihal3,5 · P. Dhanasekhara Raja4,5 · N. Rajkumar4,5 · S. Rajasekharan4,5 Received: 14 January 2019 / Accepted: 20 June 2019 © Istituto Ortopedico Rizzoli 2019
Abstract Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another. Keywords Total knee arthroplasty · Adductor canal block · Intraarticular catheter · Local infiltration analgesia
Introduction Total knee arthroplasty (TKA) is a surgical procedure which relieves pain and restores function caused by severe arthritis. However, TKA can be associated with moderate-to-severe * S. R. Sankineani [email protected] 1
Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad 500003, India
2
Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai 600026, India
3
Department of Orthopaedics, Sparsh Hospital, Bangalore 560022, India
4
Department of Orthopaedics, Ganga Hospital, Coimbatore 641043, India
5
South India Arthroplasty Academy (SIAA), Secunderabad, India
postoperative pain [1]. Acute postsurgical pain after TKA is ubiquitous with approximately 58% of patients experiencing moderate-to-severe acute postsurgical pain [2]. Inappropriately managed acute pain can become chronic in nature and lead to significant dissatisfaction rates among patients
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