Ultrasound-Guided Single Injection Adductor Canal Block with Intrathecal Morphine for Analgesia after Total Knee Arthroplasty

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Sophit Lhoawcha


Background: Total knee arthroplasty (TKA) is an operation associated with moderate to severe postoperative pain. Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing TKA when combined with multimodal analgesia. Objectives: To compare the outcomes of the ACB with no block (NB) in patients who have received intrathecal morphine as multimodal analgesia. Methods: We performed a double-blind, randomized, controlled study of eighty patients scheduled for TKA with spinal anesthesia and 0.2 mg of intrathecal morphine. After the operation, the patients were randomized to either the ACB group (ACB with 20 ml of bupivacaine 0.5% with 1: 200,000 epinephrine) or the NB group (no block). The primary outcome was the comparative postoperative pain score at rest and during movement in 6, 12, and 24 hours postoperatively. Secondary comparative outcomes included quadriceps and adductor muscle strength, opioid-related side effects, hospital length of stay, and patient satisfaction. Results: The pain scores at rest and during movement in 6, 12, and 24 hours were no significant difference. However, there was a tendency of numbers of patients with no pain (NRS=0) in the ACB group than the NB group, especially during knee motion. When controlling the factor of preoperative quadriceps strength, operation time, and periarticular block by a surgeon, the results showed that there were significant differences in the pain on movement between both groups (Odds ratio 0.35; 95%CI 0.13-0.89, p=0.028). Conclusions: ACB is a peripheral nerve blockade technique that provides good pain control, particularly pain during movement in patients undergoing TKA when combined with intrathecal morphine as multimodal analgesia.

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