ULTRASOUND GUIDED FEMORAL VS ADDUCTOR CANAL BLOCK FOR POST OPERATIVE ANALGESIA AND EARLY AMBULATION AFTER KNEE SURGERY

Abstract

Background: In recent times, Adductor Canal Block is considered a valiant replacement to Femoral Nerve Block after knee surgeries, owing to the fact that there is no Motor Sparing in Adductor Canal Block and the analgesic effects post operatively are at par with that of the femoral nerve block. In this study, we put these 2 widely used blocks to test by giving a standard dose of local anaesthetics to patients undergoing all knee surgeries, dividing them randomly into 2 groups and giving one block per group and observing the motor function of quadriceps, and post operative analgesia in both the groups.

Materials and methods: This randomized controlled trial was conducted on 40 patients at tertiary care center for 18 months. They were divided into 2 groups consisting of 20 patients each.

Group 1 received ultrasound guided Femoral nerve block with 20 ml of 0.25% of Bupivacaine with 8 mg Dexamethasone. Group 2 received ultrasound guided Adductor Canal block with 20 ml of 0.25% of Bupivacaine with 8 mg Dexamethasone. All vitals and The Numerical Rating Scale for pain along with Pressure Biofeedback of Bilateral quadriceps muscle for strength (in mmHg) were recorded at rest and at every 2hrs for first 12 postoperative hours and every 4hrs for next 12 hours.

Results: Mean post-operative quadriceps pressure rate in adductor canal block receiving patient was higher than femoral block receiving patient 30 min afterwards and difference between them was statistically significant (p < 0.05). Mean post-operative pain score in adductor canal block receiving patient was lower than femoral block receiving patient, 8 hours onwards after surgery and difference between them was statistically significant (p < 0.05).

Conclusion: Adductor Canal Block provided a better postoperative analgesia comparable to Femoral Nerve Block. Adductor canal block is superior in providing early ambulation and early return of quadriceps motor function as compared with femoral nerve block. Thus, the ACB should speed mobilisation and aid rehabilitation, minimising immobilization-related problems such deep vein thrombosis and pulmonary emboli, decreasing hospital stays, and reducing falls during ambulation along with significant decrease in rate of Fall during ambulation.