Different approaches of ultrasound-guided adductor canal block in the clinical application of total knee arthroplasty / 中国医师杂志

ABSTRACT

Objective:To investigate the clinical effects of different approaches of ultrasound-guided adductor canal block (ACB) in postoperative analgesia after total knee arthroplasty (TKA) and its impact on joint function recovery.Methods:Fifty-eight patients undergoing unilateral TKA at Nanjing First Hospital from March 2021 to March 2022 were randomly divided into two groups: group A (ultrasound-guided proximal ACB, n=29) and group B (ultrasound-guided distal ACB, n=29). Both groups received intravenous patient-controlled analgesia (PCIA) combined with ultrasound-guided ACB. The resting and exercise Visual Analog Scale (VAS) scores at various time points after surgery, the total amount of sufentanil used for PCIA, the effective compression times (P1) and actual compression times (P2) of PCIA, the analgesia satisfaction score, the number of additional tramadol analgesia cases, the quadriceps muscle strength and knee joint activity at various time points after surgery, and the complications were recorded for analysis. Results:The resting and exercise VAS scores at 4, 8, 12, 24, and 48 hours after surgery in the group B were lower than those in the group A (all P<0.05). The total amount of Sufentanil used for PCIA, P1 and P2, and the number of additional tramadol analgesia cases in the group B were less than those in the group A (all P<0.05). The analgesia satisfaction score in the group B was higher than that in the group A ( P<0.05). The quadriceps muscle strength at 24 hours after surgery and the knee joint activity at 24 and 48 hours after surgery in the group B were higher than those in the group A (all P<0.05). The incidence of nausea in the group B was lower than that in the group A ( P<0.05). Conclusions:Ultrasound-guided distal ACB is more effective in relieving postoperative pain after TKA, reducing the dosage of opioid drugs, improving quadriceps muscle strength and joint mobility, reducing the incidence of adverse reactions, and is conducive to the recovery of knee joint function.