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A Comparative Study: USG guided Adductor Canal Block Versus Femoral Nerve Block for Postoperative

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Why is it important?

In today’s era, multimodal analgesia is the main strategy used for providing postoperative analgesia in patients undergoing knee surgeries yet 25-40% patients experience severe postoperative pain [1]. Intravenous opioids, epidural analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesics but have many systemic side-effects [2]. Peripheral nerve blocks have minimal systemic sideeffects and ultrasonography guided peripheral nerve block isa preferred method for providing pain relief. The femoral nerve block (FNB) was widely used for knee surgeries but it had the disadvantage of prolonged quadriceps muscle weakness which can be minimized by Adductor canal block (ACB). Therefore ACB has been introduced recently for knee surgeries. Thus, we decided to compare the efficacy of USG guided femoral nerve block and adductor canal block for postoperative analgesia in knee surgeries. Our study included adult patients undergoing knee surgeries. Fifty patients were randomly divided in two groups – group A: (n=25) received adductor canal block; group F: (n=25) received femoral nerve block, postoperatively. Both blocks were performed under USG guidance after complete wearing off of central neuraxial blockade. The average duration of sensory blockade for group F was 6.53 hours ± 4.64 while for group A was 5.77 hours ± 1.30 which was statistically not significant (p value >0.05). However, we found statistically significant difference in motor blockade in group A as compared to group F (p value <0.05). Thus we conclude that USG guided Adductor canal block effectively provides comparable postoperative analgesia to femoral nerve block while preserving the quadriceps muscle strength.

Perspectives

In today’s era, multimodal analgesia is the main strategy used for providing postoperative analgesia in patients undergoing knee surgeries yet 25-40% patients experience severe postoperative pain [1]. Intravenous opioids, epidural analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used analgesics but have many systemic side-effects [2]. Peripheral nerve blocks have minimal systemic sideeffects and ultrasonography guided peripheral nerve block isa preferred method for providing pain relief. The femoral nerve block (FNB) was widely used for knee surgeries but it had the disadvantage of prolonged quadriceps muscle weakness which can be minimized by Adductor canal block (ACB). Therefore ACB has been introduced recently for knee surgeries. Thus, we decided to compare the efficacy of USG guided femoral nerve block and adductor canal block for postoperative analgesia in knee surgeries. Our study included adult patients undergoing knee surgeries. Fifty patients were randomly divided in two groups – group A: (n=25) received adductor canal block; group F: (n=25) received femoral nerve block, postoperatively. Both blocks were performed under USG guidance after complete wearing off of central neuraxial blockade. The average duration of sensory blockade for group F was 6.53 hours ± 4.64 while for group A was 5.77 hours ± 1.30 which was statistically not significant (p value >0.05). However, we found statistically significant difference in motor blockade in group A as compared to group F (p value <0.05). Thus we conclude that USG guided Adductor canal block effectively provides comparable postoperative analgesia to femoral nerve block while preserving the quadriceps muscle strength.

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This page is a summary of: A Comparative Study: USG guided Adductor Canal Block Versus Femoral Nerve Block for Postoperative Analgesia for Knee Surgeries, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6319.44.
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