Adductor Catheter Insertion Through the Knee Arthrotomy: Can This Technique Be as Safe and Effective as Ultrasound-Guided Insertion?

Abstract

Early postoperative pain following total knee arthroplasty remains challenging. We devised a technique for inserting a continuous catheter intraoperatively in the adductor canal and aimed to compare its efficacy and safety with that of an ultrasound-guided anesthetist-administered continuous catheter. This single-center, single-surgeon, prospective, interventional, randomized controlled trial included 330 patients, who were randomized into two groups with similar preoperative status and demographics. There were 18 patients who met the exclusion criteria. Group A (n = 152) received the block from an anesthetist, while group B (n = 160) received the block from the surgeon. Patients had visual analog scale scores, range of motion, maximum ambulation distance, time to straight leg raise, length of stay, and results from a 10-meter walk test, Timed Up and Go test, and a 30-second chair test measured preoperatively and at 6, 12, and 24 hours postoperatively by a physiotherapist and pain nurse blinded to the group assignment. The visual analog scale scores at 12 hours postsurgery were significantly lower in group B (0.66) compared to group A (0.77, P = 0.04). Range of motion (supine flexion 43.2 versus 43.1, P = 0.72; sitting flexion 90.0 versus 89.9, P = 0.17), Timed Up and Go test (126.1 versus 136.9, P = 0.9), 10-meter walk test (163.5 versus 165.4, P = 0.7), 30-second chair test (3.7 versus 3.8, P = 0.7), time to active straight leg raise (4.0 versus 4.1, P = 0.3), time to ambulation with walker (4.02 versus 4.05, P = 0.3), and length of stay (1.44 versus 1.39, P = 0.49) showed no significant differences between the groups. No serious complications were reported in either group. We concluded that this technique was at least as safe and effective as the USG-guided, anesthetist-administered adductor canal catheter.