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In this comparative study, the efficacy and outcomes of analgesic treatments- ACB and LIA when used alone or in combination has been studied for TKA.
Adductor canal block (ACB) and local
infiltration analgesia (LIA) are analgesic therapies helpful for post-operative
analgesia following total knee arthroplasty (TKA). As found in this study,
comparison of 3 analgesic modalities: LIA, ACB
and their combination resulted in good postoperative pain relief, functional
outcome and patient satisfaction although the combination proved to be better
than the other two.
In this comparative study, the efficacy and outcomes of
analgesic treatments- ACB and LIA when used alone
or in combination has been studied for TKA.
On the whole,
120 patients undergoing unilateral TKA were randomized into 3 groups, namely:
LIA (Group I), ACB (Group II) and combination of both i.e. LIA + ACB
(Group III). The outcome was expressed as the post-operative analgesia attained
by the 3 techniques (calculated by the NPRS) and quantity of fentanyl utilized
after the operation. Secondary outcome was examined as per the postoperative
functional outcomes concerning ability to stand, distance covered, range of
motion (ROM) of knee on the 1st post-operative day, associated-problems
and WOMAC (Western Ontario & McMaster Universities Osteoarthritis Index)
scores.
At 24 hours, NPRS for pain revealed significant differences between Group I and Group II, with a p value = 0.018 (Group I was better) and between Group III and Group II, with p values =0.023 and 0.004 (Group III was better). For the same time period, no significant differences were found between Group I and Group III. Use of total fentanyl consumption was significantly less in Group III as compared to Group I and Group II (p value=0.042 and 0.005, respectively), as found Group III was better and consumed less fentanyl (Refer to the graph below).
At baseline, 2 and 6 weeks, no significant
differences were found in WOMAC scores between the 3 groups postoperatively.
In patients undertaking
TKA, analgesic effect of combination of ACB and LIA was superior, as specified
by decreased opioid consumption. No differences in functional outcomes and
complications were observed than the distinct use of the two methods.
Arthroplasty
A prospective comparative study of local infiltration versus adductor block versus combined use of the two techniques following knee arthroplasty
S.K.S. Marya
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