Analgesic effect of continuous adductor canal block versus continuous femoral nerve block for knee arthroscopic surgery: a randomized trial
Efeito analgésico do bloqueio contínuo do canal adutor versus bloqueio contínuo do nervo femoral para cirurgia artroscópica do joelho: um estudo randomizado
Chandni Sinha, Akhilesh Kumar Singh, Amarjeet Kumar, Ajeet Kumar, Sudeep Kumar, Poonam Kumari
Abstract
Background and objectives
Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR.
Method
In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion).
Results
The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p < 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p < 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p < 0.001).
Conclusion
The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.
Keywords
Resumo
Justificativa e objetivos: A reconstrução do ligamento cruzado anterior (RLCA) é um dos procedimentos ortopédicos mais realizados. A capacidade de realizar RLCA ambulatorialmente depende em grande parte de um regime analgésico eficaz. O objetivo do estudo foi comparar o efeito analgésico entre o bloqueio contínuo do canal adutor (cACB) e o bloqueio do nervo femoral (cFNB) durante o RLCA guiado por artroscopia. Método: Neste ensaio clínico prospectivo, randomizado e controlado, foram recrutados 60 pacientes ASA I/II para RLCA artroscópico. Os pacientes do Grupo I receberam cACB e os do Grupo II cFNB. Uma dose em bolus de 20 cc de levobupivacaína 0,5% seguida de 0,125% 5 ml/h-1 foi iniciada por 24 horas. Analgesia de resgate na forma de paracetamol 1 g por via intravenosa (IV) foi administrada. Parâmetros avaliados como tempo da primeira analgesia de resgate, necessidade total de analgésico em 24 horas e amplitude de movimento indolor do joelho (15 graus de flexão para flexão posterior indolor). Resultados: O tempo até a primeira solicitação de analgésico pós-operatório (horas) foi mais precoce no Grupo II (14,40 ± 4,32) do que no Grupo I (16,90 ± 3,37) e essa diferença foi estatisticamente significativa (p < 0,05). O consumo cumulativo de analgésico em 24 horas (paracetamol em g) foi de 0,70 ± 0,47 no Grupo I e 1,70 ± 0,65 no Grupo II (p < 0,001). A amplitude de movimento indolor (grau) foi de 55,67 ± 10,40 no Grupo I e 40,00 ± 11,37 no Grupo II (p < 0,001). Conclusão: Os achados deste estudo sugerem que o bloqueio contínuo do canal adutor proporciona analgesia superior em pacientes submetidos ao RLCA artroscópico quando comparado ao bloqueio contínuo do nervo femoral.
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References
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