Comparative study between continuous adductor canal block and intravenous morphine for postoperative analgesia in total
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Ain-Shams Journal of Anesthesiology
(2020) 12:62
ORIGINAL ARTICLE
Open Access
Comparative study between continuous adductor canal block and intravenous morphine for postoperative analgesia in total knee arthroplasty Hithem Mohammed Gamil Mohammed Ali* , Bassel Mohammed Essam Nour Eldin, Heba Abd Elazim Labib Ahmed, Ramy Mounir Wahba Gobran and Diaa Eldin Mahmoud Heiba
Abstract Background: Postoperative pain after total knee arthroplasty (TKA) is known to range from moderate (30% of patients) to severe (60% of patients). Inadequate management for postoperative pain may induce various immobility-related complications, muscle weakness, and chronic pain. Therefore, post-TKA analgesia is crucial, not only for patients’ satisfaction, but for improving surgical outcomes and reducing complications. The present study aims to compare the effect of ultrasound-guided adductor canal block ACB (saphenous nerve block) versus incremental dose of intravenous morphine after total knee arthroplasty surgery. Results: The results of this study revealed no difference between group A and group B as regards postoperative quadriceps muscle strength; maximal knee flexion, total distance ambulated, and postoperative vital data (heart rate per minute and respiratory rate per minute). However, group A showed better postoperative pain control, lower doses of intravenous morphine consumption and lower incidence of nausea and vomiting. Conclusion: Continuous adductor canal block (saphenous nerve block) is superior to intravenous morphine in decreasing postoperative pain and decreasing total morphine consumption and adverse effects as nausea and vomiting, but both are equivalent in preserving quadriceps muscle power. Keywords: US-guided continuous ACB, Total knee arthroplasty, IV morphine consumption
Background Total knee arthroplasty (TKA) is a successful intervention for patients with painful degenerative diseases affecting the knee joint. The management of pain after TKA has always been a key focus in the clinical treatment of patients undergoing this procedure (Hanson et al. 2014). Postoperative pain leads to decreased ability to mobilize the knee, prolonged hospitalization, and increased complications. Despite comprehensive multimodal analgesic * Correspondence: [email protected] Department of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams University, Abbassia, Cairo 11591, Egypt
regimens, this problem has not been successfully addressed (Charous et al. 2011). For post-TKA pain, continuous adductor canal block (ACB) compared with intravenous patient-controlled analgesia alone, addition of ACB to an analgesic regimen provides superior pain control, reduces the incidence of postoperative complications, and shortens the time to functional recovery (Kapoor et al. 2012). Peripheral nerve blocks are increasingly preferred to relieve postoperative pain and to reduce opioid consumption and opioid-related adverse effects in patients undergoing total knee arthroplasty (Bauer et al. 2012). Continuous adduct
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