Korean J Pain.  2019 Jan;32(1):30-38. 10.3344/kjp.2019.32.1.30.

The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea. pain@cau.ac.kr
  • 2Department of Orthopedic Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.

Abstract

BACKGROUND
The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group.
METHODS
Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured.
RESULTS
Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were 0.14 ± 0.37, 4.57 ± 2.37, 6.00 ± 1.63, and 4.28 ± 1.49, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB.
CONCLUSIONS
In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB.

Keyword

Analgesia; Fentanyl; Knee replacement arthroplasty; Local anesthetics; Nausea; Opioid; Pain management; Patient controlled analgesia; Postoperative pain; Ropivacaine; Vomiting

MeSH Terms

Analgesia
Analgesia, Patient-Controlled
Analgesics
Analgesics, Opioid
Anesthetics, Local
Antiemetics
Arthroplasty, Replacement, Knee*
Catheters
Fentanyl*
Humans
Nausea
Pain Management
Pain, Postoperative
Postoperative Period
Quadriceps Muscle
Skin
Ultrasonography
Vomiting
Analgesics
Analgesics, Opioid
Anesthetics, Local
Antiemetics
Fentanyl
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