การทดลองแบบสุ่มมีกลุ่มควบคุมเทียบผลการระงับปวดหลังผ่าตัดเปลี่ยนข้อเข่าเทียมระหว่างการระงับเส้นประสาทในช่องแอดดักเตอร์ส่วนต้นเทียบกับการระงับเส้นประสาทสองจุดที่ช่องแอดดักเตอร์ส่วนต้นกับส่วนปลาย

Tatcha  Tratornpisuttikul

Authors

Tatcha Tratornpisuttikul Sawanpracharak Hospital

Keywords:

postoperative pain control, adductor canal block, total knee arthroplasty

Abstract

Objective: To compare the analgesic efficacy of a single-injection proximal adductor canal block (Proximal ACB) versus a dual-injection technique at both proximal and distal sites of the adductor canal (Two-point ACB) in patients undergoing total knee arthroplasty (TKA).

Materials and Methods: This double-blind randomized controlled trial included 98 patients scheduled for elective TKA. Participants were randomly allocated into two groups using computer-generated randomization. Group A received a single injection of 0.33% bupivacaine 30 mL combined with dexamethasone 5 mg at the proximal adductor canal. Group D received injections at both the proximal and distal adductor canal, using the same total volume and concentration of local anesthetic. The total 30 mL of 0.33% bupivacaine was equally divided (15 mL per site), and each site received 2.5 mg of dexamethasone. All nerve blocks were performed under ultrasound guidance by an experienced anesthesiologist. The primary outcome was postoperative pain scores, assessed by the visual analog scale (VAS) at rest and during movement at 6, 12, and 24 hours. Secondary outcomes included time to first morphine requirement (minutes), cumulative morphine consumption within 24 hours (mg),quadriceps muscle strength at 6 and 24 hours, and the incidence of peripheral nerve block-related complications.

Results: There were no statistically significant differences in VAS at any time point between groups (p-value > 0.05). However, Group D demonstrated a delayed onset of morphine use (median 290 vs. 145 minutes, p-value = 0.05) and significantly lower total morphine consumption within 24 hours (3 mg vs. 6 mg, p-value < 0.01). Morphine administration in the post-anesthesia care unit (PACU) was more frequent in Group A (8.16% vs. 0%, p-value = 0.04). No significant differences were observed in quadriceps strength or complication rates.

Conclusion: Two-point adductor canal block did not result in significantly different pain scores compared to single-point block but was associated with reduced morphine consumption during the first 24 hours postoperatively without increasing complications.

Keywords: postoperative pain control, adductor canal block, total knee arthroplasty

References

Farooq H, Oetojo W, Bajwa S, Brown NM. Patellar resurfacing in contemporary total knee arthroplasty: Frequency of complications in a matched cohort. J Orthop. 2024;60:25–8. Doi:10.1016/j.jor.2024.09.006

Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, et al. Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients. Anesthesiology. 2013;118(5):1046–58. Doi:10.1097/ALN.0b013e318286061d

Lavand’homme PM, Kehlet H, Rawal N, Joshi GP. Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J Anaesthesiol. 2022;39(9):743–57. Doi:10.1097/EJA.0000000000001691

Wang D, Yang Y, Li Q, Tang SL, Zeng WN, Xu J, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Sci Rep. 2017;7(1):40721. Doi:10.1038/srep40721

Runge C, Moriggl B, Børglum J, Bendtsen TF. The Spread of Ultrasound-Guided Injectate From the Adductor Canal to the Genicular Branch of the Posterior Obturator Nerve and the Popliteal Plexus: A Cadaveric Study. Reg Anesth Pain Med. 2017;42(6):725–30. Doi:10.1097/AAP.0000000000000675

Sonawane K, Dixit H, Mistry T, Balavenkatasubramanian J. Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial. Cureus. 2021;13(12):e20488. Doi:10.7759/cureus.20488

Sonawane K, Saxena S, Mistry T, Balavenkatasubramanian J, Rajan S, Shanmuganathan R. Pursuing an Optimal Regional Analgesia Strategy for Total Knee Arthroplasty: A Double-Blind Randomized Controlled Study of Femoral Triangle, Adductor Canal, and Dual Subsartorial Blocks (FAD Trial). Cureus. 2025;17(8):e91147. Doi:10.7759/cureus.91147

de Arzuaga CIS, Miguel M, Biarnés A, García M, Naya J, Khoudeir A, et al. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial. Arch Orthop Trauma Surg. 2023;143(11):6763–71. Doi:10.1007/s00402-023-04960-5

Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med. 2015;40(1):3–10. Doi:10.1097/AAP.0000000000000169

Yee EJ, Gapinski ZA, Ziemba-Davis M, Nielson M, Meneghini RM. Quadriceps Weakness After Single-Shot Adductor Canal Block: A Multivariate Analysis of 1,083 Primary Total Knee Arthroplasties. J Bone Joint Surg Am. 2021;103(1):30–6. Doi:10.2106/JBJS.19.01425