Anesthesia & Analgesia: January 14, 2016
AUTHORS: Henshaw, Daryl S. MD et al
BACKGROUND: Unicondylar knee arthroplasty (UKA) is a commonly performed procedure with significant expected postoperative pain. Peripheral nerve blocks are 1 analgesic option, but some approaches may decrease quadriceps motor strength and interfere with early ambulation. In this study, we compared the analgesia provided by an adductor canal block (ACB) and a psoas compartment block (PCB) after UKA. We hypothesized that the ACB would provide equivalent analgesia, defined as a difference of <2 points on the pain scale (0-10 numeric rating scale [NRS]), at rest and with movement 6 hours after block placement.
METHODS: One hundred fifty patients undergoing medial UKA were randomly assigned to receive either an ACB or a PCB with 0.25% bupivacaine, 5 [mu]g/mL epinephrine, and 1.67 [mu]g/mL clonidine. All patients received multimodal analgesics, sham blockade at the alternate site, and a posterior capsule injection during surgery. Patients and observers were blinded to treatment groups. The primary end points were NRS pain scores with rest and movement at 6 hours. Secondary end points included quadriceps muscle strength at 6 hours (0-5 [5 being full strength]; Medical Research Council scale) as well as NRS pain scores, opioid consumption, and opioid-related side effects over 24 hours.
RESULTS: One hundred forty-seven patients were analyzed. Pain scores were equivalent at 6 hours with rest (ACB 1.0 +/- 2 vs PCB 1.1 +/- 2.2 [mean NRS +/- SD]; 95% confidence interval of mean difference, -0.8 to 0.6; P < 0.0001) and with movement (ACB 1.6 +/- 2.6 vs PCB 1.5 +/- 2.8; 95% confidence interval of mean difference, -0.8 to 0.9; P < 0.0001). In addition, pain scores at rest and with movement at 12, 18, and 24 hours were equivalent. Quadriceps motor strength was significantly increased in the ACB group (Medical Research Council scale score, 4.0 +/- 1.1 vs 2.5 +/- 1.3 [mean +/- SD]; P < 0.0001). No significant differences were found between groups for time to first analgesic or for cumulative opioid consumption at 6, 12, 18, or 24 hours. Other than an increase in the incidence of pruritus in the ACB group at 6 hours, there were no differences in opioid-related side effects.
CONCLUSIONS: An ACB provides equivalent analgesia after medial UKA when compared with a PCB. In addition, the ACB caused significantly less motor weakness. An ACB should be considered for postoperative analgesia after medial UKA.