Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA

Adductor canal block (ACB) and local infiltration anesthesia (LIA) are both widely accepted techniques for postoperative pain control without quadriceps weakness after total knee arthroplasty (TKA). However, the above techniques are insufficient in efficacy or duration.

The aim of our study was to address whether ACB plus posterior capsular infiltration (PCI) result in improved analgesia compared with ACB or LIA in patients underwent TKA during 48 h after operation.

Sixty patients were included: ACB group (group A, ACB with 0.375% ropivacaine 30 ml, n = 20), ACB + PCI group (group B, ACB same as group A, PCI with 0.2% ropivacaine 50 ml, n = 20), LIA group (group C, local infiltration with 0.2% ropivacaine 100 ml, n = 20). VAS pain scores, rescue analgesic tramadol consumption, nausea and vomiting occurrence, and patient satisfaction were recorded at 4, 8, 24, and 48 h post-operation.

Group B, versus group A, had lower pain scores (at rest and during mobilization) at 4 to 8 h post-operation (P < 0.017). As compared with group C, only at 24 h post-operation, group B had statistically decreased rest and active pain scores (p = 0.016 and 0.014, respectively). There were no statistical differences in total tramadol consumption and nausea and vomiting occurrence among the three groups. However, there was improved patient satisfaction in group B.

Overall, as compared with ACB or LIA, ACB plus PCI appeared to provide more ideal analgesia and patient satisfaction in the first 24 h after operation.