ARTHROPLASTY
The Effect of Postoperative Single-Injection Adductor Canal Block in Total Knee Arthroplasty Under Spinal Anesthesia With Intraoperative Dexmedetomidine Infusion.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(22):1 Arthroplast Today . 2024 Apr 17:27:101366.What this means for my practice?
SACB improves postoperative pain control within the first 12 hours following total knee arthroplasty, enhances patient satisfaction, and preserves motor strength, making it a valuable addition to multimodal pain management. However, the analgesic effects diminish by 24 hours. The study's limitation includes a lack of long-term follow-up to assess sustained benefits.
Study Summary
Seventy-eight patients undergoing total knee arthroplasty were randomized to receive either a single-injection adductor canal block with 0.5% ropivacaine (n=39) or a placebo with saline (n=39). The primary outcome was pain score on the numerical rating scale (NRS) at rest and during movement at 2, 6, 12, and 24 hours postoperatively. Secondary outcomes included morphine-equivalent consumption, nausea/vomiting scores, quadriceps strength, and patient satisfaction. Outcomes were assessed up to 48 hours post-block. Overall, the study revealed that the SACB group experienced significantly lower pain scores at 6 and 12 hours but not at 24 hours. Patient satisfaction and quadriceps strength were higher in the SACB group. These findings suggest SACB improves early postoperative pain management and satisfaction without compromising motor function.
Why was this study needed now?
Total knee arthroplasty (TKA) is associated with significant postoperative pain, which can delay recovery and lead to chronic pain if inadequately managed. Single-injection adductor canal block (SACB) provides sensory nerve blockade while sparing motor nerves, potentially enabling early ambulation. However, the analgesic effects of SACB, especially when combined with the residual effects of spinal anesthesia prolonged by dexmedetomidine, have not been well studied. This study addresses these gaps by evaluating SACB in a multimodal analgesia context under spinal anesthesia with dexmedetomidine.
What was the principal research question?
In patients undergoing total knee arthroplasty under spinal anesthesia with intraoperative dexmedetomidine infusion, does a single-injection adductor canal block, compared to placebo, reduce postoperative pain within the first 24 hours?
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