Combined Femoral Triangle Block and Proximal Adductor Canal Block versus Proximal Adductor Canal Block Alone in Unilateral Total Knee Arthroplasty: a Prospective Randomized Controlled Trial

บทคัดย่อ

Background: Total knee arthroplasty (TKA) frequently results in moderate to severe pain, particularly within the first 24 h following surgery. This pain is associated with delayed rehabilitation and recovery, complications, and prolonged hospitalization. Femoral triangle block (FTB) and proximal adductor canal block (PACB) are multimodal analgesic techniques known to alleviate knee pain. However, their comparative efficacy remains contentious. Methods: In this randomized controlled trial, 60 patients who underwent TKA under spinal anesthesia were randomly divided into two groups. One group received a combination of FTB and PACB, whereas the other group received PACB alone. The primary outcome measure was postoperative pain assessed via the numerical rating scale (NRS). The secondary outcomes included morphine consumption, the timing of intravenous analgesia requests, the length of hospital stay, and complications. Results: Postoperative NRS scores for resting and movement pain at 24 h, the timing of intravenous analgesic requests, the length of hospital stays, and complication rates did not significantly differ between the two groups. However, morphine consumption at 0, 4, 8, 12, 18, and 24 h postoperatively in group CB was significantly lower than in group AB. Conclusion: A combination of FTB and PACB provided broader sensory coverage and significantly reduced 24-h cumulative morphine consumption compared with PACB alone after unilateral TKA, without increasing complications. Although the clinical benefit was modest, this approach may be valuable as part of multimodal or ERAS-based analgesia.