Abstract

Femoral Nerve Block (FNB) and Adductor canal blocks are peripheral nerve blocks for postoperative pain management of TKR. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. Objective: The current study aims to compare post operative management of pain and risk of falls in patients who underwent TKR using femoral nerve block and adductor canal block. Methodology: A comparative study was done in 124 patients posted for TKR during February 2022 to December 2022 in a tertiary care teaching hospital. Patients were assigned to either of two groups by sealed envelope method. Group “FNB”- bolus of 20 mL of 0.2% ropivacaine was given through femoral catheter. Then infusion of 5ml of 0.2% ropivacaine per hour. Group “ACB” - bolus of 20 mL of 0.2% ropivacaine was given through adductor canal catheter. Then infusion of 5ml of 0.2% ropivacaine per hour. Outcomes measured were tinetti score for gait and balance, MMT (manual muscle testing), and pain scores (Visual analogue scale- VAS) before and after physical therapy (PT) sessions. Results: VAS score in POD2 (48 hrs), POD 7 and POD 14 was slightly low in Group ACB which was significant. Risk of fall was significantly more in patients of group FNB when compared to group ACB at 48 (50%/30.6%) and 72 hours (33.9%/ 16.1%). Mean grade of MMT was significantly more in group ACB when compared to group FNB on POD 1, (2.7/1.7) POD2 (3.2/1.9) and POD3(4.41/4.11). Conclusion: Continuous ACB provides better ambulation with equivalent analgesia to continuous FNB for TKR patients.

Description