DOI: 10.1016/j.arth.2019.03.076
Total knee arthroplasty (TKA) is a common and largely successful surgical intervention for patients suffering from degenerative knee conditions. However, it is also associated with significant postoperative pain and functional limitation during the early recovery period. A new study published in The Journal of Arthroplasty offers promising evidence for an improved method of pain management that may allow patients a quicker and more comfortable recovery following TKA.
The prospective, double-blind, randomized controlled study, carried out by researchers from West China Hospital, Sichuan University, explored the efficacy of a single-shot adductor canal block (ACB) combined with posterior capsular infiltration (PCI) against standard multimodal periarticular infiltration analgesia for postoperative pain management in TKA patients.
Methodology and Patient Group
The study involved patients undergoing unilateral primary TKA from January 2018 to January 2019. In a double-blind fashion, participants were randomized into two groups. One group received ACB combined with PCI, and the other received standard periarticular infiltration analgesia, which serves as the control group.
Primary and Secondary Outcomes Measured
The primary outcomes assessed were postoperative pain using the visual analog scale (VAS) and the consumption of morphine hydrochloride. Secondary outcomes included the range of knee motion, quadriceps strength, and daily ambulation distance. Finally, tertiary outcomes focused on the duration of hospitalization and the incidence of adverse events post-surgery.
Results
Patients treated with ACB and PCI experienced lower resting VAS scores at 8 and 24 hours post-surgery and had reduced VAS scores during movement within 48 hours following the operation. The study also found that patients in the ACB and PCI group consumed less morphine compared to the control group.
Notably, there were no significant differences in functional recovery outcomes such as range of motion, quadriceps strength, daily ambulation distance, the duration of hospital stay, or the incidence of adverse events between the two groups.
Implications
The use of ACB combined with PCI appears to reduce postoperative pain more effectively and sooner after TKA without affecting the recovery of knee function. It also does not lead to an increase in complications. This pain-management method may represent a superior option for patients undergoing TKA because it allows for the preservation of muscle strength, which is crucial for an effective and rapid recovery.
References
1. Wang Qiuru, Yue Yong, Li Donghai, Yang Zhouyuan, Yeersheng Releken, Kang Pengde. “Efficacy of Single-Shot Adductor Canal Block Combined With Posterior Capsular Infiltration on Postoperative Pain and Functional Outcome After Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study.” The Journal of Arthroplasty, vol. 34, no. 8, Aug. 2019, pp. 1650-1655. DOI: 10.1016/j.arth.2019.03.076.
2. Elmallah RK, Chughtai M, Khlopas A, et al. Pain Control in Total Knee Arthroplasty. J Knee Surg. 2018;31(6):504-513. DOI: 10.1055/s-0037-1604446.
3. Hanson NA, Allen CJ, Hostetter LS, et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014;472(5):1377-1383. DOI: 10.1007/s11999-013-3345-7.
4. Jenstrup MT, Jæger P, Lund J, et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand. 2012;56(3):357-364. DOI: 10.1111/j.1399-6576.2011.02514.x.
5. Pengde, K., Qiuru, W., Donghai, L., & Yong, Y. (2019). Management of pain after total knee arthroplasty: A focus on regional anesthesia. Orthop Surg Res. 2020;15:119. DOI: 10.1186/s13018-020-01655-8.
Keywords
1. Total Knee Arthroplasty(TKA) Pain Management
2. Knee Surgery Analgesia Techniques
3. Postoperative Recovery in Knee Replacement
4. Muscle Strength Preservation after TKA
5. Adductor Canal Block (ACB) and Pain Control
The findings of this study make a compelling case for the combined use of single-shot ACB and PCI as an effective pain management strategy in TKA. It underscores the need for continued research into analgesic methods that can enhance patient outcomes, facilitate faster rehabilitation, and ultimately improve the quality of life for those undergoing knee arthroplasty. While the patient’s journey to full recovery post-TKA may still be challenging, advancements in pain management, such as those provided by the combined use of ACB and PCI, mark a positive step forward in orthopedic care.