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Optimal location for continuous catheter analgesia among the femoral triangle, proximal, or distal adductor canal after total knee arthroplasty: a randomized double-blind controlled trial

Authors
 Bora Lee  ;  Sang Jun Park  ;  Kwan Kyu Park  ;  Hee Jung Kim  ;  Yong Suk Lee  ;  Yong Seon Choi 
Citation
 REGIONAL ANESTHESIA AND PAIN MEDICINE, Vol.47(6) : 353-358, 2022-06 
Journal Title
REGIONAL ANESTHESIA AND PAIN MEDICINE
ISSN
 1098-7339 
Issue Date
2022-06
MeSH
Analgesia* / methods ; Analgesics, Opioid ; Anesthetics, Local ; Arthroplasty, Replacement, Knee* / adverse effects ; Arthroplasty, Replacement, Knee* / methods ; Catheters ; Femoral Nerve / diagnostic imaging ; Humans ; Nerve Block* / adverse effects ; Nerve Block* / methods ; Pain Management / methods ; Pain, Postoperative / diagnosis ; Pain, Postoperative / etiology ; Pain, Postoperative / prevention & control
Keywords
analgesia ; lower extremity ; nerve block ; pain ; postoperative
Abstract
Background: Pain management after total knee arthroplasty is essential to improve early mobilization, rehabilitation, and recovery. Continuous adductor canal (AC) block provides postoperative analgesia while preserving quadriceps strength. However, there have been inconsistencies regarding the optimal location for continuous catheter block. We compared continuous femoral triangle, proximal AC, and distal AC blocks for postoperative analgesia after total knee arthroplasty.

Methods: Patients undergoing unilateral total knee arthroplasty were randomly assigned to three groups: femoral triangle, proximal AC, or distal AC. The surgeon performed periarticular local anesthetic infiltration. After surgery, an ultrasound-guided perineural catheter insertion procedure was performed. The primary endpoint was pain scores at rest in the morning on the first postoperative day. Secondary endpoints included pain scores at rest and during activity at other time points, quadriceps strength, and opioid consumption.

Results: Ninety-five patients, 32 in the femoral triangle group, 31 in the proximal AC group, and 32 in the distal AC group, completed the study. Analysis of the primary outcome showed no significant difference in pain scores among groups. Secondary outcomes showed significantly lower pain scores at rest and during activity in the distal AC group than in the femoral triangle and proximal AC groups in the morning of the second postoperative day. Quadriceps strength and opioid consumption did not differ among groups.

Conclusions: Continuous femoral triangle, proximal AC, and distal AC blocks in the setting of periarticular local anesthetic infiltration provide comparable postoperative analgesia after total knee arthroplasty.
Full Text
https://rapm.bmj.com/content/47/6/353.long
DOI
10.1136/rapm-2021-103284
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hee-Jung(김희정) ORCID logo https://orcid.org/0000-0002-2143-3943
Park, Kwan Kyu(박관규) ORCID logo https://orcid.org/0000-0003-0514-3257
Park, Sang Jun(박상준) ORCID logo https://orcid.org/0000-0002-2496-7764
Lee, Bo Ra(이보라) ORCID logo https://orcid.org/0000-0002-7699-967X
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188835
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