ESRA Academy. Bhakta P. Sep 8, 2016; 138439; 0289 Topic: Peripheral Nerve Blocks
Disclosure(s): I have no conflict of interest and I have not received any fund for conduction of audit or writing of this poster from any organisation. Neither I represent any organisation, company nor I have any share of financial benefit in any organisation.
Dr. Pradipta Bhakta
Dr. Pradipta Bhakta

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Background and Aims:

Background: Total knee replacement (TKR) is associated with intense postoperative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilisation without residual weakness are of paramount importance in recovery of these patients. Adductor canal block (ACB) using lower concentration of local anaesthetic serves this purpose.

Aims: To determine difference in postoperative pain scores and opioids consumption at rest and on flexion in first 24 hours. 


Six month retrospective audit at our hospital was conducted. All patient who had TKR during this period were included. Patients were evaluated postoperatively for opioid consumption and pain scores at rest and with 45°flexion during first 24 hours. We also assessed postoperative nausea and vomiting and the antiemetics requirement. ACB was instituted using ultrasound guidance and 20 mL of ropivacaine 0.475% was injected under vision. Patients in control group received local anaesthetic infiltration with same volume and percentage of ropivacaine performed by surgeons. Total number patients in this study were 40. They were equally divided to receive either ACB or infiltration analgesia. Postoperative analgesia was instituted by PRN oxynorm, regular oral paracetamol and diclofenac.


Those who received ultrasound guided adductor-canal-block had significantly reduced opioid consumption, lower pain scores and lesser dynamic pain on 45° knee flexion compared to patients who didn’t receive ACB. Incidentally we noted that 10% of patients with ACB had less incidence of chronic pain. 


Ultrasound guided ACB provided better pain relief with lesser opioid consumption and helped in next day physiotherapy and even helped to reduce occurrence of chronic pain.

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