Ultrasound Guided Sciatic Nerve Block Combined with Adductor Canal Block Virsus Local Analgesic Infiltration to Control the Pain after Total Knee Arthroplasty

Background: A combined adductor canal block (ACB) and sciatic nerve block (SNB) is a novel method for achieving effective postoperative analgesia following complete knee replacement (TKR) while avoiding quadriceps femoris muscle weakness. Within the first 24 hours after TKR, we compared anesthesiologist-performed ultrasound-guided combined adductor canal and sciatic nerve blocks to surgeon-applied local anaesthetic infiltration for analgesic efficacy. This randomised controlled trial compared the efficacy and protection of combined adductor canal and sciatic nerve blocks to local analgesic infiltration alone for pain relief following complete knee replacement.

Patients and Procedures: Forty patients (ASA II and III) undergoing unilateral complete knee replacement were divided into two groups, each with 20 patients: block group (ACB+SNB): The patient received an adductor canal block with sciatic nerve block directed by ultrasound, local community (LAI): The patient received a local analgesic injection (LAI) to the entire knee joint. Postoperative visual analogue scale (VAS) at rest and with activity, first order for analgesics, and 24-hour gross morphine intake were the primary outcomes. Sedation score and morphine-related side effects including nausea and vomiting were used as secondary outcome indicators.

The local community had significantly lower postoperative morphine intake, VAS, nausea and vomiting, and sedation at 12 hours. The ACB and SNB blocks did not cause any complications.

Conclusion: As compared to local analgesic penetration alone after TKA, combined adductor canal and sciatic nerve blocks could substantially reduce VAS ratings, morphine intake, and the first request for analgesia. In addition, the combined blocks category has a lower risk of sedation, nausea, and vomiting.

Author (s) Details

Magdy H. Eldegwy
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Mohamed A. Negm
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

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