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Original Article

Korean J Pain 2019; 32(1): 30-38

Published online January 28, 2019 https://doi.org/10.3344/kjp.2019.32.1.30

Copyright © The Korean Pain Society.

The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial

Min Kyoung Kim1, Hyoung Yong Moon1, Choon Gun Ryu1, Hyun Kang1, Han Jun Lee2, and Hwa Yong Shin1*

1Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.

2Department of Orthopedic Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.

Correspondence to: Hwa Yong Shin. Depa rtment o f Anesthesiology a nd P ain Medicine, C hung-Ang University Hospita l, 1 02 H eukseok-ro, D ongja k-gu, Seoul 06973, Korea. Tel: +82-2-6299-3164, Fax: +82-2-6299-2585, pain@cau.ac.kr

Received: October 15, 2018; Revised: December 7, 2018; Accepted: December 7, 2018

Abstract

Background

The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group.

Methods

Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured.

Results

Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were 0.14 ± 0.37, 4.57 ± 2.37, 6.00 ± 1.63, and 4.28 ± 1.49, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB.

Conclusions

In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB.

Keywords: Analgesia, Fentanyl, Knee replacement arthroplasty, Local anesthetics, Nausea, Opioid, Pain management, Patient controlled analgesia, Postoperative pain, Ropivacaine, Vomiting