Impact of Adductor Canal Block on Functional Recovery
Impact of Adductor Canal Block on Functional Recovery
TKA involves extensive bone resection as well as soft tissue excision and therefore is
 associated with profound postoperative pain. Adequate analgesia after TKA is therefore
 considered paramount to facilitate early hospital discharge and effective functional
 recovery.
Osteoarthritis (OA) of the knee has become a major public health issue and imposes a
 significant healthcare burden and accounts for high annual hospitalizations. Chronic OA of
 the knee may lead to reduced physical fitness, mobility disability with a resultant increased
 risk of cardio-metabolic comorbidity and early mortality. Total knee arthroplasty (TKA) is
 indicated in severe cases to improve long-term pain and function. (1) TKA involves extensive
 bone resection as well as soft tissue excision and therefore is associated with profound
 postoperative pain. (2) Inadequate perioperative pain control may prolong hospitalization,
 hinder early rehabilitation, and is also a strong predictor of persistent pain beyond 3
 months. (3) Adequate analgesia after TKA is therefore considered paramount to facilitate
 early hospital discharge and effective functional recovery. (4) The recently introduced
 adductor canal block (ACB) typically covers the anterio-medial aspect of the knee and
 preserves quadriceps function, which presumably enhances postoperative rehabilitation by
 allowing patients to actively participate in knee movement. The relative effectiveness of
 this ACB technique added to intrathecal morphine is limited to a single study (1) in which
 assessment of short-term functional recovery was done and dexamethasone was neither included
 in the LIA solution nor perineurally in the ACB. Thus, we hypothesize that adductor canal
 block as an adjunct to intrathecal morphine will have a better impact on functional recovery
 than peri-articular infiltration.
Inclusion Criteria:

 -  American Society of Anesthesiologist class ( ASA) I - III

 -  BMI 18-35 kg/m2

 -  Scheduled for primary unilateral TKR

 Exclusion Criteria:

 -  Known allergy to local anesthetics

 -  Contraindication to adductor canal block e.g. infection at the site of injection

 -  Contraindication to spinal anesthesia e.g. coagulopathy.

 -  Patients with pre-existing motor or sensory deficits in lower extremities.

 -  Patients who are morbidly obese (BMI≥35) because ultrasound-guided regional anesthesia
 could be technically difficult.

 -  Bilateral or revision total knee replacement

 -  Insulin or noninsulin-dependent diabetes mellitus.

 -  systemic corticosteroid use within 30-days of surgery