Comparative efficacy of Periarticular Infiltration versus Femoral Nerve Block versus Adductor Canal Block for Postoperative Pain control in Patients undergoing Total Knee Arthroplasty in Sawanpracharak Hospital : A Randomized controlled study

Aunthika  Mantay; Chirarphron  Puksuetrong; Busara   Pudee

Authors

Aunthika Mantay โรงพยาบาลสวรรค์ประชารักษ์
Chirarphron Puksuetrong โรงพยาบาลสวรรค์ประชารักษ์
Busara Pudee โรงพยาบาลสวรรค์ประชารักษ์

Keywords:

Periarticular infiltration, Femoral nerve block, Adductor canal block, Total knee arthroplasty, Local anesthetic drug

Abstract

Objective : This study aimed to compare the effect of periarticular infiltration (PAI), femoral nerve block (FNB), and adductor canal block (ACB) with spinal anesthesia on postoperative pain, consumption of tramadol, length of stay and expense in patients who are undergoing total knee arthroplasty (TKA).

Method : The study design was a prospective randomized controlled study in patients undergoing primary unilateral TKA in Sawanpracharak Hospital. Patients with elective total knee arthroplasty under spinal anesthesia with 0.2 mg of morphine were randomized into three groups to receive three postoperative pain control. In group 1, the patients received PAI (20 ml of 0.5% bupivacaine plus 30 mg of ketorolac plus 1 mg of adrenalin in 28 ml of normal saline). In group 2, the patients received FNB (20 ml of 0.5% levobupivacaine). In group 3, the patients received ACB (20 ml of 0.5% levobupivacaine). Recorded data were demographic data, postoperative numeric rating pain score, amount of tramadol consumption for breakthrough pain in 24 hrs., first time of rehabilitation, length of stay, and expense for TKA. Categorical data were analyzed by Chi-square test, and numeric rating pain scores were analyzed by One –way ANOVA, Post Hoc Test (Bonferroni). The results were presented as mean ± SD, and a p-value of <0.05 was considered statistically significant.

Result : One hundred fifteen patients were enrolled, Thirty-eight patients received PAI, thirty-nine patients received FNB and thirty-eight patients received ACB. However, no difference in demographic data. The mean of the numeric rating pain score at 72 hrs post-operative was significantly lower in PAI (3.21) than in the FNB (3.72) and ACB (3.82) group (p-value=0.002) and significant difference between PAI with FNB, ACB group (p-value=0.015, p-value=0.003) but no significant difference between FNB with ACB group (p-value=1.000). Moreover, the hospital expanse of PAI group was significantly lower than the other two groups (FNB=90,894. 10, ACB=90,038.29, PAI= 87,856.95; p-value=0.000). There were no significant difference in tramadol consumption or length of stay between the three groups.

Conclusion : Periarticular infiltration can provide better pain relief at 72 hrs. post-operative and lower in expanse than Femoral nerve block and Adductor canal block.

Keywords : Periarticular infiltration, Femoral nerve block, Adductor canal block, Total knee arthroplasty, Local anesthetic drug

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