Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study

BACKGROUND: Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR). MATERIALS AND METHODS: This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores. RESULTS: Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively (P < 0.05), and the total drain output was also significantly less (P < 0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale (P < 0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia. CONCLUSION: This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications.