Femoral triangle and adductor canal blocks versus femoral nerve block for total knee arthroplasty: postoperative pain management and functional recovery

Abstract

Background and Goal of Study: Adequate postoperative pain control after knee joint replacement surgery helps to improve patient satisfaction, promote earlier mobilization and functional recovery and reduce the risk of postoperative complications. The aim of the study is to compare femoral triangle and adductor canal blocks with femoral nerve block in order to evaluate postoperative pain management and functional recovery in patients following elective knee arthroplasty. Materials and Methods: the prospective, double-blinded, randomized study was approved by the local Ethics Committee. 77 patients undergoing elective knee arthroplasty under the spinal anaesthesia were included. Preoperatively all patients were randomized into one of two groups: femoral triangle and distal adductor canal blocks (FT + AC blocks) group and femoral nerve block (FN block) group. All blocks were performed by one anaesthesiologist under the guidance of a linear ultrasound transducer probe. The FT and AC blocks were performed by injecting 10 ml of 0.125% bupivacaine for each block separately and FN block was performed with injection of 20 ml of 0.125% bupivacaine by a single injection. Patients in both groups postoperatively received standard doses of analgesic medications such as paracetamol and dexketoprofen. At 3, 6, 24 and 48 hours after the surgery pain control efficacy (using visual analogue scale (VAS)) when the operated leg was at rest, during active and passive operated knee flexion, requirement of additional opioid analgesics and their adverse effects, extent of motor blockade (using Bromage scale) were assessed. Statistical significance was determined as p < 0.05. Results and Discussion: at first 6 postoperative hours unrestricted operated leg movements were significantly more frequent in FT + AC blocks group (95 %) than in FN block group (67.6 %), p < 0.05. Moreover, patients in both groups rated [...].