JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

eISSN: 2717-7505
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Original Article
Accelerated recovery protocol in total knee replacement patients: reducing pain and opioid consumption with adductor canal block
Abstract
Aims: This study aims to evaluate the effects of ultrasound-guided adductor canal block (ACB) on postoperative pain control, opioid consumption, and discharge time in total knee arthroplasty (TKA) operations performed in accordance with enhanced recovery after surgery (ERAS) protocols.
Methods: This prospective randomized controlled trial was conducted at Pamukkale University Hospital after obtaining ethical approval. A total of 60 patients who underwent TKA under spinal anesthesia were randomly assigned into two groups. Group I received only local infiltration analgesia (LIA), while group II received both LIA and an ACB. The groups were compared in terms of postoperative Visual Analog Scale (VAS) score at rest and during first ambulation, comparison of tramadol use, dosage, and side effects, time to first ambulation, ambulation distance, quadriceps muscle strength scores, and patient satisfaction and hospital discharge times.
Results: Group II showed consistently lower VAS scores compared with group I at all time points, including rest, walking, and sleep (p<0.05). Opioid consumption was significantly higher in group I (p=0.027), and readiness for discharge was delayed in group I compared with group II (p<0.05).
Conclusion: In patients undergoing TKA, the combination of LIA and ACB appears to be an effective option in multimodal analgesia practices during the postoperative period and may provide potential benefits in accelerating recovery and reducing opioid-related side effects.

Keywords : Adductor canal block, functional recovery, knee arthroplasty, opioid consumption, postoperative pain, regional anesthesia

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1. ERAS Türkiye Derneği. ERAS Türkiye Derneği. http://eras.org.tr/page.php?id=9. Accessed October 15, 2020.
2. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS) society recommendations. Acta Orthop. 2020;91(1):3-19. doi:10.1080/17453674. 2019.1683790
3. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect. 2012;61:389-395.
4. Fraser TW, Doty JF. Peripheral nerve blocks in foot and ankle surgery. Orthop Clin North Am. 2017;48(4):507-515. doi:10.1016/j.ocl.2017.06.008
5. Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep. 2017;21(5):23. doi:10.1007/s11916-017-0623-y
6. Li J, Lam D, King H, et al. Novel regional anesthesia for outpatient surgery. Curr Pain Headache Rep. 2019;23(10):69. doi:10.1007/s11916-019-0809-6
7. Kastelik J, Fuchs M, Krämer M, et al. Local infiltration anesthesia versus sciatic nerve and adductor canal block for fast-track knee arthroplasty: a randomized controlled clinical trial. Eur J Anaesthesiol. 2019;36(4):255-263. doi:10.1097/EJA.0000000000000929
8. Deiter J, Ponzio D, Grau L, et al. Efficacy of adductor canal block protocol implementation in a multimodal pain management protocol for total knee arthroplasty. J Clin Orthop Trauma. 2020;11(1):118-121. doi:10.1016/j.jcot.2019.05.012
9. Agarwala S, Bhadiyadra R, Menon A. Analgesic effectiveness of local infiltrative analgesia alone versus combined single-dose adductor canal block with local infiltrative analgesia: a single center case-control study. J Clin Orthop Trauma. 2020;11(Suppl 5):S717-S721. doi:10.1016/j.jcot. 2020.05.044
10. Çardaközü T, Aksu C. Abdominal cerrahide anestezi. KOU Sag Bil Derg. 2019;5(1):47-53. doi:10.30934/kusbed.456408
11. Frassanito L, Vergari A, Nestorini R, et al. Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg. 2020;104(1): 87-92. doi:10.1007/s12306-019-00603-4
12. Goytizolo EA, Lin Y, Kim DH, et al. Addition of adductor canal block to periarticular injection for total knee replacement: a randomized trial. J Bone Joint Surg Am. 2019;101(9):812-820. doi:10.2106/JBJS.18.00195
13. Sawhney M, Mehdian H, Kashin B, et al. Pain after unilateral total knee arthroplasty: a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg. 2016;122(6): 2040-2046. doi:10.1213/ANE.0000000000001210
14. Henshaw DS, Jaffe JD, Reynolds JW, et al. An evaluation of ultrasound-guided adductor canal blockade for postoperative analgesia after medial unicondylar knee arthroplasty. Anesth Analg. 2016;122(4):1192-1201. doi:10.1213/ANE.0000000000001162
15. Lee HH, Kwon H, Lee WS, et al. Effectiveness of ERAS (enhanced recovery after surgery) protocol via peripheral nerve block for total knee arthroplasty. J Clin Med. 2022;11(12):3354. doi:10.3390/jcm11123354
16. Mingdeng X, Yuzhang A, Xiaoxiao X, et al. Combined application of adductor canal block and local infiltration anesthesia in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2022;142(6):913-926. doi:10.1007/s00402-020-03706-x
17. Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systematic review and meta-analysis of randomized trials. Reg Anesth Pain Med. 2022;48(1):49-60. doi:10.1136/rapm-2022-103756
18. Gudmundsdottir S, Franklin JL. Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative days 1 and 2 compared with LIA alone. Acta Orthop. 2017;88(5):537-542. doi:10.1080/17453674.2017.1342184
19. Laoruengthana A, Rattanaprichavej P, Kositanurit I, et al. Adductor canal block combined with interspace between the popliteal artery and capsule of the knee (iPACK) versus periarticular injection for total knee arthroplasty. Clin Orthop Surg. 2022;14(4):514-521. doi:10.4055/cios21108
20. Ahmed RKA, Mohamed AS, Nassef JN, et al. Adductor canal block as an adjuvant in a multimodal analgesia protocol vs. multimodal analgesia alone for total knee arthroplasty. Anaesth Pain Intensive Care. 2023; 27(1):31-36. doi:10.35975/apic.v27i1.1941
21. Muñoz-Leyva F, Jack JM, Bhatia A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology. 2022;137(4):459-470. doi:10.1097/ALN. 0000000000004326
22. Xing Q, Dai W, Zhao D, et al. Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(38):e8103. doi:10.1097/MD.0000000000008103
23. Hanson NA, Derby RE, Auyong DB, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-masked trial. Can J Anaesth. 2013;60(9):874-880. doi:10.1007/s12630-013-9992-9
24. Zhou M, Ding H, Ke J, et al. Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA. Ir J Med Sci. 2018;187(2):465-471. doi:10.1007/s11845-017-1647-3
25. Li Y, Li A, Zhang Y, et al. The efficacy of combined adductor canal block with local infiltration analgesia for pain control after total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2018;97(49):e13326. doi:10.1097/MD.0000000000013326
26. Choi J, Lahori A, Merlo JA, et al. Adductor canal blocks with bupivacaine and magnesium after same-day discharge total knee arthroplasty improve postoperative pain relief and decrease opioid consumption. Clin J Pain. 2022;38(5):388-395. doi:10.1097/AJP.0000000000001036
27. Ahmad MR, Datu MD, Hardiyanti R, et al. Adductor canal block (ACB) provides adequate postoperative analgesia in patients undergoing total knee arthroplasty (TKA): case report. Open Pain J. 2022;15(1). doi:10. 2174/18763863-v15-e2206100
28. Ma J, Gao F, Sun W, et al. Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty. Medicine (Baltimore). 2016;95(52):e5701. doi:10.1097/MD.0000000000005701
29. Biswas A, Perlas A, Ghosh M, et al. Relative contributions of adductor canal block and intrathecal morphine to analgesia and functional recovery after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2018;43(2):154-160. doi:10.1097/AAP. 0000000000000724
30. Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334-339. doi:10.1097/AAP.0b013e318296b6a0
31. Abdo HMA, Abd elaziz M, Eldin Abd Elhamid AE, et al. Effect of adding infiltration between the popliteal artery and capsule of the knee block (IPACK) to continuous adductor canal block after total knee arthroplasty. Egypt J Anaesth. 2023;39(3):680-686. doi:10.1080/11101849. 2023.2246732
32. Domagalska M, Reysner T, Kowalski G, et al. Pain management, functional recovery, and stress response expressed by NLR and PLR after the iPACK block combined with adductor canal block for total knee arthroplasty: a prospective, randomised, double-blinded clinical trial. J Clin Med. 2023;12(22):7088. doi:10.3390/jcm12227088
33. Kampitak W, Tanavalee A, Ngarmukos S, et al. Does adductor canal block have a synergistic effect on local infiltration analgesia for enhancing ambulation and improving analgesia after total knee arthroplasty? Knee Surg Relat Res. 2018;30(2):133-141. doi:10.5792/ksrr.17.088
34. Grevstad U, Mathiesen O, Valentiner LS, et al. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, masked study. Reg Anesth Pain Med. 2015;40(1):3-10. doi:10.1097/AAP.0000000000000169
1. ERAS Türkiye Derneği. ERAS Türkiye Derneği. http://eras.org.tr/page.php?id=9. Accessed October 15, 2020.
2. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS) society recommendations. Acta Orthop. 2020;91(1):3-19. doi:10.1080/17453674. 2019.1683790
3. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect. 2012;61:389-395.
4. Fraser TW, Doty JF. Peripheral nerve blocks in foot and ankle surgery. Orthop Clin North Am. 2017;48(4):507-515. doi:10.1016/j.ocl.2017.06.008
5. Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep. 2017;21(5):23. doi:10.1007/s11916-017-0623-y
6. Li J, Lam D, King H, et al. Novel regional anesthesia for outpatient surgery. Curr Pain Headache Rep. 2019;23(10):69. doi:10.1007/s11916-019-0809-6
7. Kastelik J, Fuchs M, Krämer M, et al. Local infiltration anesthesia versus sciatic nerve and adductor canal block for fast-track knee arthroplasty: a randomized controlled clinical trial. Eur J Anaesthesiol. 2019;36(4):255-263. doi:10.1097/EJA.0000000000000929
8. Deiter J, Ponzio D, Grau L, et al. Efficacy of adductor canal block protocol implementation in a multimodal pain management protocol for total knee arthroplasty. J Clin Orthop Trauma. 2020;11(1):118-121. doi:10.1016/j.jcot.2019.05.012
9. Agarwala S, Bhadiyadra R, Menon A. Analgesic effectiveness of local infiltrative analgesia alone versus combined single-dose adductor canal block with local infiltrative analgesia: a single center case-control study. J Clin Orthop Trauma. 2020;11(Suppl 5):S717-S721. doi:10.1016/j.jcot. 2020.05.044
10. Çardaközü T, Aksu C. Abdominal cerrahide anestezi. KOU Sag Bil Derg. 2019;5(1):47-53. doi:10.30934/kusbed.456408
11. Frassanito L, Vergari A, Nestorini R, et al. Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg. 2020;104(1): 87-92. doi:10.1007/s12306-019-00603-4
12. Goytizolo EA, Lin Y, Kim DH, et al. Addition of adductor canal block to periarticular injection for total knee replacement: a randomized trial. J Bone Joint Surg Am. 2019;101(9):812-820. doi:10.2106/JBJS.18.00195
13. Sawhney M, Mehdian H, Kashin B, et al. Pain after unilateral total knee arthroplasty: a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg. 2016;122(6): 2040-2046. doi:10.1213/ANE.0000000000001210
14. Henshaw DS, Jaffe JD, Reynolds JW, et al. An evaluation of ultrasound-guided adductor canal blockade for postoperative analgesia after medial unicondylar knee arthroplasty. Anesth Analg. 2016;122(4):1192-1201. doi:10.1213/ANE.0000000000001162
15. Lee HH, Kwon H, Lee WS, et al. Effectiveness of ERAS (enhanced recovery after surgery) protocol via peripheral nerve block for total knee arthroplasty. J Clin Med. 2022;11(12):3354. doi:10.3390/jcm11123354
16. Mingdeng X, Yuzhang A, Xiaoxiao X, et al. Combined application of adductor canal block and local infiltration anesthesia in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2022;142(6):913-926. doi:10.1007/s00402-020-03706-x
17. Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systematic review and meta-analysis of randomized trials. Reg Anesth Pain Med. 2022;48(1):49-60. doi:10.1136/rapm-2022-103756
18. Gudmundsdottir S, Franklin JL. Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative days 1 and 2 compared with LIA alone. Acta Orthop. 2017;88(5):537-542. doi:10.1080/17453674.2017.1342184
19. Laoruengthana A, Rattanaprichavej P, Kositanurit I, et al. Adductor canal block combined with interspace between the popliteal artery and capsule of the knee (iPACK) versus periarticular injection for total knee arthroplasty. Clin Orthop Surg. 2022;14(4):514-521. doi:10.4055/cios21108
20. Ahmed RKA, Mohamed AS, Nassef JN, et al. Adductor canal block as an adjuvant in a multimodal analgesia protocol vs. multimodal analgesia alone for total knee arthroplasty. Anaesth Pain Intensive Care. 2023; 27(1):31-36. doi:10.35975/apic.v27i1.1941
21. Muñoz-Leyva F, Jack JM, Bhatia A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology. 2022;137(4):459-470. doi:10.1097/ALN. 0000000000004326
22. Xing Q, Dai W, Zhao D, et al. Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(38):e8103. doi:10.1097/MD.0000000000008103
23. Hanson NA, Derby RE, Auyong DB, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-masked trial. Can J Anaesth. 2013;60(9):874-880. doi:10.1007/s12630-013-9992-9
24. Zhou M, Ding H, Ke J, et al. Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA. Ir J Med Sci. 2018;187(2):465-471. doi:10.1007/s11845-017-1647-3
25. Li Y, Li A, Zhang Y, et al. The efficacy of combined adductor canal block with local infiltration analgesia for pain control after total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2018;97(49):e13326. doi:10.1097/MD.0000000000013326
26. Choi J, Lahori A, Merlo JA, et al. Adductor canal blocks with bupivacaine and magnesium after same-day discharge total knee arthroplasty improve postoperative pain relief and decrease opioid consumption. Clin J Pain. 2022;38(5):388-395. doi:10.1097/AJP.0000000000001036
27. Ahmad MR, Datu MD, Hardiyanti R, et al. Adductor canal block (ACB) provides adequate postoperative analgesia in patients undergoing total knee arthroplasty (TKA): case report. Open Pain J. 2022;15(1). doi:10. 2174/18763863-v15-e2206100
28. Ma J, Gao F, Sun W, et al. Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty. Medicine (Baltimore). 2016;95(52):e5701. doi:10.1097/MD.0000000000005701
29. Biswas A, Perlas A, Ghosh M, et al. Relative contributions of adductor canal block and intrathecal morphine to analgesia and functional recovery after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2018;43(2):154-160. doi:10.1097/AAP. 0000000000000724
30. Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334-339. doi:10.1097/AAP.0b013e318296b6a0
31. Abdo HMA, Abd elaziz M, Eldin Abd Elhamid AE, et al. Effect of adding infiltration between the popliteal artery and capsule of the knee block (IPACK) to continuous adductor canal block after total knee arthroplasty. Egypt J Anaesth. 2023;39(3):680-686. doi:10.1080/11101849. 2023.2246732
32. Domagalska M, Reysner T, Kowalski G, et al. Pain management, functional recovery, and stress response expressed by NLR and PLR after the iPACK block combined with adductor canal block for total knee arthroplasty: a prospective, randomised, double-blinded clinical trial. J Clin Med. 2023;12(22):7088. doi:10.3390/jcm12227088
33. Kampitak W, Tanavalee A, Ngarmukos S, et al. Does adductor canal block have a synergistic effect on local infiltration analgesia for enhancing ambulation and improving analgesia after total knee arthroplasty? Knee Surg Relat Res. 2018;30(2):133-141. doi:10.5792/ksrr.17.088
34. Grevstad U, Mathiesen O, Valentiner LS, et al. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, masked study. Reg Anesth Pain Med. 2015;40(1):3-10. doi:10.1097/AAP.0000000000000169
1. ERAS Türkiye Derneği. ERAS Türkiye Derneği. http://eras.org.tr/page.php?id=9. Accessed October 15, 2020.
2. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS) society recommendations. Acta Orthop. 2020;91(1):3-19. doi:10.1080/17453674. 2019.1683790
3. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect. 2012;61:389-395.
4. Fraser TW, Doty JF. Peripheral nerve blocks in foot and ankle surgery. Orthop Clin North Am. 2017;48(4):507-515. doi:10.1016/j.ocl.2017.06.008
5. Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep. 2017;21(5):23. doi:10.1007/s11916-017-0623-y
6. Li J, Lam D, King H, et al. Novel regional anesthesia for outpatient surgery. Curr Pain Headache Rep. 2019;23(10):69. doi:10.1007/s11916-019-0809-6
7. Kastelik J, Fuchs M, Krämer M, et al. Local infiltration anesthesia versus sciatic nerve and adductor canal block for fast-track knee arthroplasty: a randomized controlled clinical trial. Eur J Anaesthesiol. 2019;36(4):255-263. doi:10.1097/EJA.0000000000000929
8. Deiter J, Ponzio D, Grau L, et al. Efficacy of adductor canal block protocol implementation in a multimodal pain management protocol for total knee arthroplasty. J Clin Orthop Trauma. 2020;11(1):118-121. doi:10.1016/j.jcot.2019.05.012
9. Agarwala S, Bhadiyadra R, Menon A. Analgesic effectiveness of local infiltrative analgesia alone versus combined single-dose adductor canal block with local infiltrative analgesia: a single center case-control study. J Clin Orthop Trauma. 2020;11(Suppl 5):S717-S721. doi:10.1016/j.jcot. 2020.05.044
10. Çardaközü T, Aksu C. Abdominal cerrahide anestezi. KOU Sag Bil Derg. 2019;5(1):47-53. doi:10.30934/kusbed.456408
11. Frassanito L, Vergari A, Nestorini R, et al. Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg. 2020;104(1): 87-92. doi:10.1007/s12306-019-00603-4
12. Goytizolo EA, Lin Y, Kim DH, et al. Addition of adductor canal block to periarticular injection for total knee replacement: a randomized trial. J Bone Joint Surg Am. 2019;101(9):812-820. doi:10.2106/JBJS.18.00195
13. Sawhney M, Mehdian H, Kashin B, et al. Pain after unilateral total knee arthroplasty: a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg. 2016;122(6): 2040-2046. doi:10.1213/ANE.0000000000001210
14. Henshaw DS, Jaffe JD, Reynolds JW, et al. An evaluation of ultrasound-guided adductor canal blockade for postoperative analgesia after medial unicondylar knee arthroplasty. Anesth Analg. 2016;122(4):1192-1201. doi:10.1213/ANE.0000000000001162
15. Lee HH, Kwon H, Lee WS, et al. Effectiveness of ERAS (enhanced recovery after surgery) protocol via peripheral nerve block for total knee arthroplasty. J Clin Med. 2022;11(12):3354. doi:10.3390/jcm11123354
16. Mingdeng X, Yuzhang A, Xiaoxiao X, et al. Combined application of adductor canal block and local infiltration anesthesia in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2022;142(6):913-926. doi:10.1007/s00402-020-03706-x
17. Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systematic review and meta-analysis of randomized trials. Reg Anesth Pain Med. 2022;48(1):49-60. doi:10.1136/rapm-2022-103756
18. Gudmundsdottir S, Franklin JL. Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative days 1 and 2 compared with LIA alone. Acta Orthop. 2017;88(5):537-542. doi:10.1080/17453674.2017.1342184
19. Laoruengthana A, Rattanaprichavej P, Kositanurit I, et al. Adductor canal block combined with interspace between the popliteal artery and capsule of the knee (iPACK) versus periarticular injection for total knee arthroplasty. Clin Orthop Surg. 2022;14(4):514-521. doi:10.4055/cios21108
20. Ahmed RKA, Mohamed AS, Nassef JN, et al. Adductor canal block as an adjuvant in a multimodal analgesia protocol vs. multimodal analgesia alone for total knee arthroplasty. Anaesth Pain Intensive Care. 2023; 27(1):31-36. doi:10.35975/apic.v27i1.1941
21. Muñoz-Leyva F, Jack JM, Bhatia A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology. 2022;137(4):459-470. doi:10.1097/ALN. 0000000000004326
22. Xing Q, Dai W, Zhao D, et al. Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(38):e8103. doi:10.1097/MD.0000000000008103
23. Hanson NA, Derby RE, Auyong DB, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-masked trial. Can J Anaesth. 2013;60(9):874-880. doi:10.1007/s12630-013-9992-9
24. Zhou M, Ding H, Ke J, et al. Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA. Ir J Med Sci. 2018;187(2):465-471. doi:10.1007/s11845-017-1647-3
25. Li Y, Li A, Zhang Y, et al. The efficacy of combined adductor canal block with local infiltration analgesia for pain control after total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2018;97(49):e13326. doi:10.1097/MD.0000000000013326
26. Choi J, Lahori A, Merlo JA, et al. Adductor canal blocks with bupivacaine and magnesium after same-day discharge total knee arthroplasty improve postoperative pain relief and decrease opioid consumption. Clin J Pain. 2022;38(5):388-395. doi:10.1097/AJP.0000000000001036
27. Ahmad MR, Datu MD, Hardiyanti R, et al. Adductor canal block (ACB) provides adequate postoperative analgesia in patients undergoing total knee arthroplasty (TKA): case report. Open Pain J. 2022;15(1). doi:10. 2174/18763863-v15-e2206100
28. Ma J, Gao F, Sun W, et al. Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty. Medicine (Baltimore). 2016;95(52):e5701. doi:10.1097/MD.0000000000005701
29. Biswas A, Perlas A, Ghosh M, et al. Relative contributions of adductor canal block and intrathecal morphine to analgesia and functional recovery after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2018;43(2):154-160. doi:10.1097/AAP. 0000000000000724
30. Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334-339. doi:10.1097/AAP.0b013e318296b6a0
31. Abdo HMA, Abd elaziz M, Eldin Abd Elhamid AE, et al. Effect of adding infiltration between the popliteal artery and capsule of the knee block (IPACK) to continuous adductor canal block after total knee arthroplasty. Egypt J Anaesth. 2023;39(3):680-686. doi:10.1080/11101849. 2023.2246732
32. Domagalska M, Reysner T, Kowalski G, et al. Pain management, functional recovery, and stress response expressed by NLR and PLR after the iPACK block combined with adductor canal block for total knee arthroplasty: a prospective, randomised, double-blinded clinical trial. J Clin Med. 2023;12(22):7088. doi:10.3390/jcm12227088
33. Kampitak W, Tanavalee A, Ngarmukos S, et al. Does adductor canal block have a synergistic effect on local infiltration analgesia for enhancing ambulation and improving analgesia after total knee arthroplasty? Knee Surg Relat Res. 2018;30(2):133-141. doi:10.5792/ksrr.17.088
34. Grevstad U, Mathiesen O, Valentiner LS, et al. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, masked study. Reg Anesth Pain Med. 2015;40(1):3-10. doi:10.1097/AAP.0000000000000169
Article available in :
Volume 6, Issue 3, 2025
Page : 252-257
https://doi.org/10.47582/jompac.1655139
Article Information
Received : 10 Mar 2025
Accepted : 27 May 2025
Published : 18 Haz 2025
Corresponding Author :

Turan Evran: Department of Anesthesia and Reanimation, Faculty of Medicine, Pamukkale University, Denizli, Turkiye

[email protected]
Citation : Evran AT, Evran T, Erbay RH. Accelerated recovery protocol in total knee replacement patients: reducing pain and opioid consumption with adductor canal block. J Med Palliat Care. 2025;6(3):252-257. doi:10.47582/jompac.1655139

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