The Effect Of Continuous Adductor Canal Block On Fast-track Rehabilitation In Primary Total Knee Arthroplasty

Objective: Decrease hospital length of stay,reduce peri-operative morbidity may improve the patients' satisfaction,attenuate costs associated with total knee arthroplasty.The purpose of this study was to modify an existing fast-track rehabilitation to include adductor canal nerve block(ACNB),explore the influence of an continuous adductor canal block strategy on fast-track rehabilitation in primary total knee arthroplasty(TKA).Methods: This single-centered study was carried out by the the Central Hospital of Loudi Affiliated to University of South China,from January 2017 to December 2017,ninety received primary unilateral TKA were enrolled in this study.The patients were randomly divided into the traditional ERAS group and the updated ERAS group.All patients were involved in the mode of fast-track rehabilitation,All the patients were given celecoxib two days preoperative.The updated ERAS group wasgiven adductor canal block after the surgery,those patients in the updated ERAS group received physical therapy on the day of surgery.The traditional ERAS group was given femoral nerve block after the surgery,in the traditional ERAS group mobility was not scheduled nor actively encouraged until POD1.Both of the two groups were given local infiltration analgesia before click into the prosthesis.After surgery,all the patients were given celecoxib until discharged.The resting and motion numeric rating scales(NRS)scores,the hospital stay,the knee joint range of motion,HSS score,the muscle strength of quadriceps femoris,total opioid consumption and complications were observed and compared between two groups.Results: 1.There were no significant differences in gender,age,body mass index,AKS score,American society of anesthesiologists class or operation time between two groups(P>0.05).2.In updated ERAS group,the mean discharge time was(11.9±2.59)d,significantly shorter compared with(13.2±2.98)d in traditional ERAS group(P<0.05).3.There were no significant differences in the resting and motion NRS scores between the two groups(P>0.05),The range of motion(1,2,3,7 days after surgery),HSS score,and muscular strength of quadriceps femofis in the updated ERAS group was better than in the traditional ERAS group(P<0.05).4.In addition,the updated ERAS group had lower rate of nausea(P<0.05).there were no significant differences in opioid consumption,falls during hospitalization,deep vein thrombosis,blood transfusion rate between the two groups(P>0.05).Conclusion: Using an updated enhanced recovery after surgery in total knee arthroplasty can shorten the length of hospital stay,not increase postoperative complication,under fast-track rehabilitation,the adductor canal block had similar early analgesia effects with the femoral nerve block when TKA was performed.However,the CACB was more beneficial to patients regarding the early postoperative rehabilitation to patient,continuous adductor block strategy can provided superior quadriceps strength,a faster time to discharge,which may have benefit to the implement of fast-track rehabilitation in TKA.