Adductor canal block versus intravenous patient controlled analgesia for postoperative pain control for primary total knee arthroplasty

Abstract

hen a noxious stimulus produces tissue injury, chemical mediators are released and activate nociceptors which in turn generate nerve impulses. Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response. Surgeries of the knee are associated with moderate to severe postoperative pain, so these procedures are better to be done under regional anesthetic techniques which reduce neuroendocrinal stress responses, central sensitization of the nervous system and muscle spasms which occur in response to painful stimuli. Recently, among these regional anesthetic techniques adductor canal block is gaining popularity because they reduce the possibility of complications and side effects associated with the central blocks. Adductor canal block provides effective analgesia and anesthesia with potentially fewer complications and side effects than epidural blocks. The purpose of this study was to compare between Adductor canal block and PCA in adult patients undergoing total knee replacement including comparison of analgesic efficacy, side-effects, and complications.