Comparative Evaluation of Ultrasound-guided Adductor Canal Block with Intra-articular Infiltration versus Intra-articular Analgesia alone in Postoperative Pain Management and Early Ambulation after Total Knee Replacement.

BACKGROUND

Effective postoperative pain management and early ambulation are critical in patients undergoing total knee replacement (TKR). This study aimed to compare the efficacy of ultrasound-guided single-shot Adductor Canal Block (ACB) with intra-articular infiltration versus intra-articular infiltration alone in controlling postoperative pain and promoting early mobilization.

METHODS

This prospective, randomized, interventional study included 60 patients undergoing unilateral primary TKR, divided into two groups: Group A (ACB + intra-articular infiltration) and Group B (intra-articular infiltration only). All patients received spinal anesthesia. Postoperative pain scores were assessed using the Visual Analogue Scale (VAS) at rest and during physiotherapy at 4, 8, 12, and 24 hours. Quadriceps strength was evaluated on a 0-5 scale at similar intervals. Rescue analgesic requirements and adverse effects were also recorded.

RESULTS

Group A demonstrated significantly lower VAS scores at 8, 12, and 24 hours postoperatively, including during physiotherapy sessions (P<0.005). Quadriceps strength recovered earlier and more significantly in Group A, with notable improvement as early as 4 hours postoperatively (P<0.005), compared to 12 hours in Group B. Rescue analgesia was required more frequently in Group B (66.67%) compared to Group A (26.67%), which was statistically significant (P=0.0009). Adverse effects were more common in Group B, but this difference was not statistically significant.

CONCLUSION

Ultrasound-guided ACB combined with intra-articular infiltration provides superior pain control, preserves quadriceps strength, reduces analgesic requirements, and promotes earlier ambulation compared to intra-articular infiltration alone in TKR patients.