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Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

ACB is given as single injection or as continuous block or combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) to reduce postoperative knee pain after total knee arthroplasty. The aim of this study is to evaluate the technique of ACB that is superior in controlling postoperative pain, decrease opioid consumption and facilitate ambulation in the immediate postoperative period.

Methods

A total of 171 patients were analyzed from a group of 180 patients who were randomized into three groups: (1) ACB alone, (2) continuous ACB infusion via catheter (CACB) and (3) ACB combined with IPACK. The primary outcome was pain at rest and after ambulation measured by VAS scale every 8 h till 48 h after surgery. The secondary outcome measures were opioid consumption in morphine equivalents, ambulation distance measured in feet on postoperative day 2, timed up and go test, 30 s chair stand test, sitting active extension lag test and maximal knee flexion at discharge.

Results

VAS score at rest and after ambulation, opioid consumption was significantly lower (p < 0.05%) in CACB group compared to other study groups. Similarly, patients in CACB showed significantly (p < 0.05%) better results in the secondary outcome measures. There were no significant differences in the outcomes between ACB and ACB combined with IPACK.

Conclusion

CACB allows better pain control and less opioid consumption in the immediate postoperative period after TKA compared to ACB alone or ACB with IPACK resulting in better ambulation and rehabilitation.

Clinical Trial Registration Number CTRI/2019/03/018239 registered on March 25, 2019.

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Authors and Affiliations

  1. Department of Orthopaedics and Joint Replacement, Sunshine Hospital, Penderghast Road, Secunderabad, Telangana, 500003, India

    R. Tak, A. V. Gurava Reddy, K. Karumuri & S. R. Sankineani

  2. Department of Anesthesia and Perioperative Care, Sunshine Hospital, Penderghast Road, Secunderabad, Telangana, 500003, India

    K. Jhakotia

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  1. R. Tak
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Tak, R., Gurava Reddy, A.V., Jhakotia, K. et al. Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial. Musculoskelet Surg 106, 155–162 (2022). https://doi.org/10.1007/s12306-020-00682-8

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