The Efficacy of Combining Selective Tibial Nerve Block with Adductor Canal Block on Postoperative Pain Control After Total Knee Replacement: A Prospective Randomized Controlled Trial

Naruemon  Vattanasiriporn; Aumjit Wittayapairoj; Jedniphat  Intrapongpan; Chat  Sumananont; Kriangkrai Wittayapairoj; Pattamaporn  Chokkatiwat; Ruttiyaporn  Chumsri

doi:10.33192/smj.v78i7.281148

Authors

Naruemon Vattanasiriporn Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Aumjit Wittayapairoj Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Jedniphat Intrapongpan Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Chat Sumananont Department of Orthopedic, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Kriangkrai Wittayapairoj Department of Orthopedic, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Pattamaporn Chokkatiwat Nurse Anesthesia Unit, Division of Nursing, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Ruttiyaporn Chumsri Nurse Anesthesia Unit, Division of Nursing, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

DOI:

https://doi.org/10.33192/smj.v78i7.281148

Keywords:

Adductor canal block, motor-sparing block, postoperative pain, tibial nerve block, total knee replacement

Abstract

Objective: Pain control after total knee replacement (TKR) is crucial for early recovery but remains challenging. This study aimed to assess the analgesic efficacy of the combination of tibial nerve block (TNB) and adductor canal block (ACB), the motor-sparing block for TKR.

Material and Methods: This randomized controlled trial was performed from June 2022 to March 2024. Sixty patients undergoing unilateral TKR were recruited and randomly allocated to one of three groups. Group A received the ACB, group AT-10 received ACB and TNB using 10 ml of local anesthetic (LA), and group AT-15 received ACB and TNB using 15 ml of LA. The primary outcome was 24-hour total postoperative morphine consumption. Secondary outcomes included Numeric Rating Scale (NRS) pain scores, sensorimotor function, and adverse events.

Results: The 24-hour postoperative accumulated morphine consumption in groups A, AT-10, and AT-15 was 18.35 ± 14.08 mg, 11.2 ± 7.7 mg, and 11.95 ± 7.4 mg, respectively. There was no statistically significant difference in morphine consumption or NRS pain scores at any time point. Motor function of the common peroneal nerve (CPN) was significantly impaired in group AT-15 compared with group A (P = 0.020), with no significant differences
observed between group AT-10 and group A or in group AT-10 and group AT-15. No serious adverse event was observed in any group.

Conclusion: The addition of TNB to ACB does not improve analgesic efficacy following TKR, and 15 ml of TNB is also associated with CPN motor impairment that may delay ambulation.

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