Adductor Canal Nerve Block Versus Local Infiltration Analgesia For Postoperative Analgesia In Total Knee Arthroplasty:A Prospective Randomized Clinical Trial

Objective To compare the analgesic effect of adductor canal nerve block and local infiltration analgesia after total knee arthroplasty.Methods 60 patients undergoing unilateral knee total knee arthroplasty were selected at the Affiliated Hospital of Qingdao University from August 2016 to October 2017.Sixty patients were randomly divided into two groups,30 patients in ACB group and 30 in LIA group.Immediately after the operation,the ACB group underwent ultrasound-guided injection of ropivacaine 30 ml in the medial thigh of the anterior superior iliac spine and the patella.In the LIA group,100 ml of mixed analgesic drugs were infiltrated into the posterior joint capsule,the medial and lateral collateral ligaments,the meniscus stump,the periprosthetic periosteum,the quadriceps tendon,and the subcutaneous tissue before and after the placement of prosthesis.Surgery and analgesic injections are performed by the same experienced surgeon.Observe and evaluate the rest pain VAS at 2h,5h,8h,12 h,24h and 48 h after operation,motion pain VAS,ROM on the first postoperative day,ROM on the secend postoperative day,operation time,PCA supplementation,drainage,hemoglobin reduction,analgesic satisfaction,number of cases of nausea and vomiting.There was a statistically significant difference in postoperative drainage between the two analgesic methods.The LIA group had less drainage than the ACB group.There was a statistically significant difference in the amount of haemoglobin changes between the two analgesic methods.The decrease in hemoglobin in the LIA group was less than that in the ACB group.Result There was no significant difference in VAS scores of rest pain at 2h,5h,8h,12 h,24h and 48 h after operation in ACB group and LIA group.There was no significant difference in VAS scores of active pain at 2h,5h,8h,12 h,24h,and 48 h after operation in both groups.There was no significant difference in ROM between the two groups on the first and second day after operation.There was no significant difference in the amount of postoperative PCA between the two groups.There was no significant difference in the degree of patient analgesic satisfaction between the two analgesic methods.There was no significant difference in the incidence of postoperative nausea and vomiting complications between the two analgesic methods under multimodal analgesia.There was no statistically significant difference in operative time between the two groups.There was a statistically significant difference in postoperative drainage between the two analgesic methods.The LIA group had less drainage than the ACB group.There was a statisticallysignificant difference in the amount of hemoglobin change between the two analgesic methods.The reduction in hemoglobin in the LIA group was less than that in the ACB group.Conclusion Local infiltration analgesia and adductor canal nerve block can achieve good analgesia after total knee arthroplasty.Local infiltration analgesia have advantages in reducing bleeding.It is recommended that local infiltration analgesia and adductor canal nerve block be used as an analgesic method after total knee arthroplasty.