{"id":45222,"date":"2022-09-29T10:52:33","date_gmt":"2022-09-29T10:52:33","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=45222"},"modified":"2022-10-01T04:21:24","modified_gmt":"2022-10-01T04:21:24","slug":"comparison-of-femoral-nerve-block-with-dexmedetomidine-and-adductor-canal-block-with-dexmedetomidine-for-postoperative-analgesia-for-total-knee-arthroplasty","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol15no3\/comparison-of-femoral-nerve-block-with-dexmedetomidine-and-adductor-canal-block-with-dexmedetomidine-for-postoperative-analgesia-for-total-knee-arthroplasty\/","title":{"rendered":"Comparison of Femoral Nerve Block with Dexmedetomidine and Adductor Canal Block with Dexmedetomidine for Postoperative Analgesia for Total Knee Arthroplasty"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

The very severe pain after Total Knee Arthroplasty (TKA) required adequate postoperative analgesia which proved crucial for early rehabilitation(1,2)<\/sup>. Due to this established fact, Peripheral Nerve Block ( PNB ) were preferred as other modes of pain management such as Epidural analgesia and patient controlled analgesia were seen to be associated with side effects(3-6)<\/sup>. PNBs were implemented to facilitate early ambulation, rehabilitation, reduced hospital stay, cost of treatment and patient satisfaction(3).<\/sup>\u00a0 Femoral nerve block ( FNB ) is the widely used standard peripheral nerve block to provide postop analgesia but has the major downside of weakening the quadriceps weakness and hence\u00a0 delaying rehabilitation.(7- 9)<\/sup> Adductor canal block (ACB), an alternative nerve block, has gained popularity as it provides optimal pain relief while maintaining the motor function in the postoperative period(10-25)<\/sup>. Pain relief offered by femoral nerve block was seen to compromise the preservation of muscle strength concluding that the ideal nerve block for TKA should provide effective analgesia while preserving the muscle power to expedite the recovery \u00a0Dexmedetomidine, an alpha 2 agonist is being used as an additive at a of 1 mcg\/kg\u00a0 for blocks as it is known to prolong the duration of the block. Dexmedetomidine acts by inhibition of hyperpolarisation-activated cation current. Other mechanism are centrally mediated pain relief in peripheral nerve blockades, alpha 2B adrenoceptor- mediatedvasoconstrictory effects,weakening of the inflammatory response and direct action on peripheral nerve.Dexmedetomidine enhances activity dependent hyperpolarisation by inhibiting hyperpolarisation activated cation current which plays a key role in cell excitation, especially its firing frequency in both the central and peripheral nervous systems. (26-28)<\/sup> Hence by conducting the study we compared\u00a0 the postoperative analgesic efficacy of FNB and\u00a0 ACB with dexmedetomidine, along\u00a0 with\u00a0 their effect on\u00a0 patient hemodynamics, time for rescue analgesia and success of postoperative ambulation.<\/p>\n

Materials and methods<\/strong><\/p>\n

This study was designed to be a comparative, observational study which was conducted at\u00a0 Kasturba Medical College Hospitals, Mangalore. The duration of the study was from\u00a0 September\u00a0 2019 to June\u00a0 2021 with study subjects included throughout the duration.<\/p>\n

All patients between 18-70 years with BMI < 35 kg\/m2 who were ASA I, II posted for elective TKA were chosen. Those who refused to participate, with h\/o Local anaesthetic\u00a0 allergy, Coagulopathy or Bleeding diathesis, H\/o peripheral neuropathy, Local skin\u00a0 infection, Significant psychiatric or mental disorders and Neurological deficits involving lower limbs were excluded. Institutional Ethics Committee approval was obtained. (IEC KMC MLR 08-19\/347).<\/p>\n

Written and informed consent was taken from all the patients participating in this observational study.<\/p>\n

Pre-anaesthetic checkup was conducted thoroughly and patients were explained the procedure, benefits and risks associated with it.<\/p>\n

The study was conducted on 140 patients who were designated into two groups: Group\u00a0 ACB (Those who received Adductor Canal Block)\u00a0 and Group FNB (Those who received\u00a0 Femoral Nerve Block) with 70 participants each .\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 The sample size was calculated using the formula \u2013<\/p>\n

Where Z1-\u03b1<\/sub> = 1.96 (at 5% level of significance with 95 % confidence interval)<\/p>\n

Z1-\u03b2<\/sub> = 0.84 (with 80% power)<\/p>\n

\u03c3\u00a0 = 1.96 ( standard deviation )<\/p>\n

d\u00a0 = 0.9 ( clinically significant difference )(23)<\/sup><\/p>\n

n=70 in each group<\/p>\n

Monitors were connected are Electrocardiogram, Pulse oximetry and noninvasive Blood pressure in the preoperative area. An appropriate sized intravenous cannula were secured for drug and fluid administration. Spinal Anaesthesia was administered with 0.5% heavy Bupivucaine using 25\/23 G QBS needle. Adequate blockade was achieved.<\/p>\n

The study participants were sub-divided into two :<\/p>\n

Group ACB \u2013 Subjects received ACB with 20 ml of 0.25% bupivacaine and 50 microgram of dexmedetomidine under ultrasound guidance .<\/p>\n

GROUP FNB \u2013 Subjects\u00a0 received FNB with 20 ml of 0.25% bupivacaine and 50 microgram of dexmedetomidine under ultrasound guidance .<\/p>\n

A\u00a0 VAS score was recorded before and immediately after the block at 5 and 10 minutes. Immediate post operative pain was measured at 2, 6,10, 12 and 24 hours using VAS score. If the VAS score was >4, rescue analgesia; injection paracetamol 10mg\/kg iv infusion was given over 10 to 15 minutes w. Post-operative time of first analgesic request and the total dose were recorded\u00a0<\/strong>. The time required by the subject to ambulate were also recorded.<\/p>\n

Data Analysis<\/strong><\/p>\n

To analyze the data, SPSS version 25 (IBM) was used . Unpaired t-t\u00east & ch\u00ec-square test were used to compare between 2 groups. Pa\u00ecred-t test used to compare analgesic efficacy of ACB and FNB. Repeated measures AN0VA was performed to compare the data across various time periods, also post-h\u00f2c analys\u00eds was done by Bonferron\u00ef test. Statistical significance of p-value less than 0.05 were considered significant .<\/p>\n

Results<\/strong>\u00a0<\/strong>\u00a0<\/strong><\/p>\n

One hundred and forty patients were included in this study with seventy\u00a0 participants allotted to each group .\u00a0<\/strong><\/p>\n

The mean age in the study was 65.9 \u00b1 6.27 years in the ACB group while it was 67.54 \u00b1 5.01 years.\u00a0 (Table 1).<\/p>\n

Table 1: Patient demographics \u2013 Age ( mean ).<\/strong><\/p>\n\n\n\n\n\n
<\/td>\nN*<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
Age (yrs )<\/td>\nACB<\/td>\n70<\/td>\n65.90<\/td>\n6.27<\/td>\n0.089<\/td>\nNS**<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n67.54<\/td>\n5.01<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

* N- Number<\/p>\n

** NS \u2013 Not Significant<\/p>\n

It was noted that the majority of the study population belonged to the age group of 61-70 years in both the groups followed by the those above 70 years old. ( Figure 1).<\/p>\n\n\n\n
\"Vol15No3_Com_Neh_fig1\"<\/a><\/td>\nFigure 1: Patient Demographics – Age distribution.<\/strong><\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Among all the participants, females accounted for the majority at 55.7% in the ACB group and 62.9% in FNB group. (Figure 2).<\/p>\n\n\n\n
\"Vol15No3_Com_Neh_fig2\"<\/a><\/td>\nFigure 2: Gender distribution between the 2 groups.<\/strong><\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The Mean intraoperative and postoperative HR (Heart rate) among the 2 group showed statistical significance\u00a0 at 2, 4 and 6 hours postoperatively ( p = 0.000; 0.001 and 0.04 respectively ) (Table 2 ).<\/p>\n

Table 2 : Mean intraoperative and postoperative Heart rate ( HR )\u00a0 between the 2 groups <\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Parameter<\/strong><\/p>\n<\/td>\n

N<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
HR<\/td>\nbaseline<\/td>\nACB<\/td>\n70<\/td>\n91.87<\/td>\n11.79<\/td>\n89.06<\/td>\n94.68<\/td>\n0.675<\/td>\n\n

NS<\/p>\n<\/td>\n<\/tr>\n

FNB<\/td>\n70<\/td>\n92.74<\/td>\n12.74<\/td>\n89.70<\/td>\n95.78<\/td>\n<\/tr>\n
5 min<\/td>\nACB<\/td>\n70<\/td>\n87.66<\/td>\n9.86<\/td>\n85.31<\/td>\n90.01<\/td>\n0.382<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n89.13<\/td>\n9.99<\/td>\n86.75<\/td>\n91.51<\/td>\n<\/tr>\n
10 min<\/td>\nACB<\/td>\n70<\/td>\n81.70<\/td>\n9.03<\/td>\n79.55<\/td>\n83.85<\/td>\n0.381<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n83.04<\/td>\n9.04<\/td>\n80.89<\/td>\n85.20<\/td>\n<\/tr>\n
2\u00a0 hr<\/td>\nACB<\/td>\n70<\/td>\n79.16<\/td>\n10.03<\/td>\n76.76<\/td>\n81.55<\/td>\n0.000<\/td>\nHS*<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n86.27<\/td>\n10.06<\/td>\n83.87<\/td>\n88.67<\/td>\n<\/tr>\n
4 hr<\/td>\nACB<\/td>\n70<\/td>\n77.30<\/td>\n6.32<\/td>\n75.79<\/td>\n78.81<\/td>\n0.001<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n82.39<\/td>\n11.38<\/td>\n79.67<\/td>\n85.10<\/td>\n<\/tr>\n
6hr<\/td>\nACB<\/td>\n70<\/td>\n81.09<\/td>\n6.83<\/td>\n79.46<\/td>\n82.71<\/td>\n0.041<\/td>\nSig<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n84.06<\/td>\n9.94<\/td>\n81.69<\/td>\n86.43<\/td>\n<\/tr>\n
8hr<\/td>\nACB<\/td>\n70<\/td>\n78.93<\/td>\n7.68<\/td>\n77.10<\/td>\n80.76<\/td>\n0.075<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n81.87<\/td>\n11.40<\/td>\n79.15<\/td>\n84.59<\/td>\n<\/tr>\n
10 hr<\/td>\nACB<\/td>\n70<\/td>\n78.96<\/td>\n7.70<\/td>\n77.12<\/td>\n80.79<\/td>\n0.059<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n76.66<\/td>\n6.53<\/td>\n75.10<\/td>\n78.21<\/td>\n<\/tr>\n
12 hr<\/td>\nACB<\/td>\n70<\/td>\n76.01<\/td>\n8.68<\/td>\n73.95<\/td>\n78.08<\/td>\n0.006<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n80.07<\/td>\n8.62<\/td>\n78.02<\/td>\n82.13<\/td>\n<\/tr>\n
24 hr<\/td>\nACB<\/td>\n70<\/td>\n80.33<\/td>\n6.12<\/td>\n78.87<\/td>\n81.79<\/td>\n0.402<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n78.67<\/td>\n15.32<\/td>\n75.02<\/td>\n82.32<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*HS \u2013 Highly Significant<\/p>\n

The Mean MAP (Mean Arterial Pressure) among the 2 groups both before and after the respective blocks were statistically significant at the time of block , 5 minutes, 10 minutes, 4 hour , 6 hour and 8 hours. (Table 3).<\/p>\n

Table 3: Mean and standard deviation of Mean Arterial Pressure ( MAP )\u00a0 of the 2 groups.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Parameter<\/strong><\/p>\n<\/td>\n

N<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
\n

MAP<\/p>\n<\/td>\n

baseline<\/td>\nACB<\/td>\n70<\/td>\n85.09<\/td>\n7.48<\/td>\n83.30<\/td>\n86.87<\/td>\n0.002<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n89.31<\/td>\n8.00<\/td>\n87.41<\/td>\n91.22<\/td>\n<\/tr>\n
5 min<\/td>\nACB<\/td>\n70<\/td>\n80.89<\/td>\n9.16<\/td>\n78.70<\/td>\n83.07<\/td>\n0.002<\/td>\n\n

HS<\/p>\n<\/td>\n<\/tr>\n

FNB<\/td>\n70<\/td>\n86.07<\/td>\n10.52<\/td>\n83.56<\/td>\n88.58<\/td>\n<\/tr>\n
10 min<\/td>\nACB<\/td>\n70<\/td>\n81.16<\/td>\n6.65<\/td>\n79.57<\/td>\n82.74<\/td>\n0.000<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n90.49<\/td>\n6.45<\/td>\n88.95<\/td>\n92.02<\/td>\n<\/tr>\n
2\u00a0 hr<\/td>\nACB<\/td>\n70<\/td>\n78.63<\/td>\n6.92<\/td>\n76.98<\/td>\n80.28<\/td>\n0.731<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n79.17<\/td>\n11.19<\/td>\n76.50<\/td>\n81.84<\/td>\n<\/tr>\n
4 hr<\/td>\nACB<\/td>\n70<\/td>\n76.66<\/td>\n6.27<\/td>\n75.16<\/td>\n78.15<\/td>\n0.000<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n81.90<\/td>\n9.90<\/td>\n79.54<\/td>\n84.26<\/td>\n<\/tr>\n
6hr<\/td>\nACB<\/td>\n70<\/td>\n79.51<\/td>\n6.44<\/td>\n77.98<\/td>\n81.05<\/td>\n0.004<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n76.16<\/td>\n7.01<\/td>\n74.49<\/td>\n77.83<\/td>\n<\/tr>\n
8hr<\/td>\nACB<\/td>\n70<\/td>\n78.59<\/td>\n5.51<\/td>\n77.27<\/td>\n79.90<\/td>\n0.014<\/td>\nSig*<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n81.81<\/td>\n9.29<\/td>\n79.60<\/td>\n84.03<\/td>\n<\/tr>\n
10 hr<\/td>\nACB<\/td>\n70<\/td>\n78.36<\/td>\n5.96<\/td>\n76.94<\/td>\n79.78<\/td>\n0.862<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n78.53<\/td>\n5.68<\/td>\n77.17<\/td>\n79.88<\/td>\n<\/tr>\n
12 hr<\/td>\nACB<\/td>\n70<\/td>\n79.73<\/td>\n6.11<\/td>\n78.27<\/td>\n81.18<\/td>\n0.818<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n79.49<\/td>\n6.33<\/td>\n77.98<\/td>\n80.99<\/td>\n<\/tr>\n
24 hr<\/td>\nACB<\/td>\n70<\/td>\n81.39<\/td>\n5.43<\/td>\n80.09<\/td>\n82.68<\/td>\n0.000<\/td>\nHS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n86.97<\/td>\n7.25<\/td>\n85.24<\/td>\n88.70<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Sig \u2013 Significant<\/p>\n

The VAS scores between the 2 groups were comparable both before and after administration of the respective blocks (\u2018t\u2019 test p values > 0.05 (Table 4 ).<\/p>\n

Table 4: VAS scores at various time intervals post administration of the block.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Parameter<\/strong><\/p>\n<\/td>\n

N<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
VAS<\/td>\nbaseline<\/td>\nACB<\/td>\n70<\/td>\n8.54<\/td>\n0.56<\/td>\n8.41<\/td>\n8.68<\/td>\n0.900<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n8.56<\/td>\n0.77<\/td>\n8.37<\/td>\n8.74<\/td>\n<\/tr>\n
5 min<\/td>\nACB<\/td>\n70<\/td>\n7.04<\/td>\n0.86<\/td>\n6.84<\/td>\n7.25<\/td>\n0.603<\/td>\n\n

NS<\/p>\n<\/td>\n<\/tr>\n

FNB<\/td>\n70<\/td>\n7.13<\/td>\n1.08<\/td>\n6.87<\/td>\n7.39<\/td>\n<\/tr>\n
10 min<\/td>\nACB<\/td>\n70<\/td>\n5.99<\/td>\n0.63<\/td>\n5.84<\/td>\n6.13<\/td>\n0.270<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n5.84<\/td>\n0.88<\/td>\n5.63<\/td>\n6.05<\/td>\n<\/tr>\n
15 min<\/td>\nACB<\/td>\n70<\/td>\n4.41<\/td>\n0.73<\/td>\n4.24<\/td>\n4.59<\/td>\n0.754<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n4.46<\/td>\n0.88<\/td>\n4.25<\/td>\n4.67<\/td>\n<\/tr>\n
2\u00a0 hr<\/td>\nACB<\/td>\n70<\/td>\n1.04<\/td>\n0.75<\/td>\n0.86<\/td>\n1.22<\/td>\n0.261<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n1.19<\/td>\n0.75<\/td>\n1.01<\/td>\n1.36<\/td>\n<\/tr>\n
4 hr<\/td>\nACB<\/td>\n70<\/td>\n3.06<\/td>\n0.98<\/td>\n2.82<\/td>\n3.29<\/td>\n0.587<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n2.97<\/td>\n0.88<\/td>\n2.76<\/td>\n3.18<\/td>\n<\/tr>\n
6hr<\/td>\nACB<\/td>\n70<\/td>\n3.36<\/td>\n0.90<\/td>\n3.14<\/td>\n3.57<\/td>\n0.658<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n3.43<\/td>\n1.00<\/td>\n3.19<\/td>\n3.67<\/td>\n<\/tr>\n
8hr<\/td>\nACB<\/td>\n70<\/td>\n4.53<\/td>\n0.93<\/td>\n4.31<\/td>\n4.75<\/td>\n0.927<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n4.51<\/td>\n0.91<\/td>\n4.30<\/td>\n4.73<\/td>\n<\/tr>\n
10 hr<\/td>\nACB<\/td>\n70<\/td>\n5.23<\/td>\n0.78<\/td>\n5.04<\/td>\n5.42<\/td>\n0.769<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n5.27<\/td>\n0.93<\/td>\n5.05<\/td>\n5.49<\/td>\n<\/tr>\n
12 hr<\/td>\nACB<\/td>\n70<\/td>\n5.84<\/td>\n0.69<\/td>\n5.68<\/td>\n6.01<\/td>\n0.217<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n6.01<\/td>\n0.92<\/td>\n5.79<\/td>\n6.23<\/td>\n<\/tr>\n
24 hr<\/td>\nACB<\/td>\n70<\/td>\n6.81<\/td>\n0.64<\/td>\n6.66<\/td>\n6.97<\/td>\n0.713<\/td>\nNS<\/td>\n<\/tr>\n
FNB<\/td>\n70<\/td>\n6.86<\/td>\n0.73<\/td>\n6.68<\/td>\n7.03<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The average time taken by participants to request for analgesia were 8.14 \u00b1 0.92 (7.92-8.36) hours in the ACB group and 6.49 \u00b1 1.32 (6.18-6.81) hours in the FNB group ( Table 5).<\/p>\n

Table 5: Mean Time ( hours ) for rescue analgesia as requested by the patient.<\/strong><\/p>\n\n\n\n\n\n\n
<\/td>\nN<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
Postop Time ( hr ) for rescue analgesia<\/td>\nACB<\/td>\n70<\/td>\n8.14<\/td>\n0.92<\/td>\n7.92<\/td>\n8.36<\/td>\n0.000<\/td>\n\n

HS<\/p>\n<\/td>\n<\/tr>\n

FNB<\/td>\n70<\/td>\n6.49<\/td>\n1.32<\/td>\n6.18<\/td>\n6.81<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The Average time taken by the participants to have active movements in their operated limb in the ACB group was 4.23 \u00b1 0.90 hours (4.01-4.44 hours) while it was 7.06 \u00b1 7.04 ( 5.38-8.73) hours in the FNB group.( Table 6 ).<\/p>\n

Table 6: Mean Time ( in hours ) for postoperative ambulation between the 2 groups.<\/strong><\/p>\n\n\n\n\n\n\n
<\/td>\nN<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nt test p value<\/strong><\/td>\n<\/td>\n<\/tr>\n
\n

Lower Bound<\/strong><\/p>\n<\/td>\n

\n

Upper Bound<\/strong><\/p>\n<\/td>\n<\/tr>\n

Postoperative hours of\u00a0 ambulation<\/td>\nACB<\/td>\n70<\/td>\n4.23<\/td>\n0.90<\/td>\n4.01<\/td>\n4.44<\/td>\n0.001<\/td>\n\n

HS<\/p>\n<\/td>\n<\/tr>\n

FNB<\/td>\n70<\/td>\n7.06<\/td>\n7.04<\/td>\n5.38<\/td>\n8.73<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion<\/strong>\u00a0<\/strong><\/p>\n

Our study demonstrated that the postoperative analgesia provided by ACB was equivalent to that provided by FNB with the added advantages of prolonged duration of action and early ambulation postoperatively.<\/p>\n

A previous study comparing ACB and FNB as a part of multimodal postop analgesia following TKA concluded that at six to eight hours post-block, ACB group showed relative sparing of quadriceps strength which was not inferior to FNB in any aspect (23) <\/sup>.<\/p>\n

Our study also demonstrated similar results in terms of Postoperative analgesia; both blocks being equally efficacious, Reduced analgesic requirement in the patients who received ACB and early ambulation postoperatively.<\/p>\n

Another randomized controlled study compared the effect of ACB\u00a0 and FNB on the early postoperative course following total knee arthroplasty concluded that ACB may promote early ambulation after total knee arthroplasty without decrease in analgesia demonstrated by their ability to perform TUG test and 10 minute walk test on Postoperative day 1\u00a0 & 2 (17)<\/sup><\/p>\n

The post-operative time taken by patients with ACB were shorter in our study when compared to those who received FNB.<\/p>\n

Another recent study compared the pain control offered by ACB with that of FNB following anterior cruciate ligament reconstruction concluded that in those patients who received ACB required lesser analgesia but greater quadriceps strength (29)<\/sup>.<\/p>\n

However our study subjects were those who underwent TKA, contrary to the study mentioned those who received ACB were seen to ambulate earlier with similar analgesia when compared to those who received FNB.<\/p>\n

A previous study that evaluated the postop analgesic efficacy of ACB and FNB after TKA showed that there were no differences in VAS score at rest or ambulation, quadriceps strength, the duration of hospital stay and postoperative nausea and vomiting (30)<\/sup>.<\/p>\n

Similar to this study, the VAS scores of our study subjects post administration of the block were not statistically different . However , contrary to this study , it was noted that those who received Adductor canal block ambulated earlier and had prolonged analgesia which can be attributed to the addition of Dexmedetomidine to our local anaesthetic solution .<\/p>\n

In a previous study on volunteers those who received ACB reported early ambulation in the postoperative period and the analgesic effect was comparable to that of FNB (31)<\/sup> .<\/p>\n

This finding in our study were similar to that of previous studies\u00a0 that deduced the ACB was comparable to that of FNB with added advantage of maintaining muscle strength enabling the patients to ambulate earlier<\/p>\n

Another randomized control study conducted on 12 healthy volunteers regarding effect of ACB and FNB on quadriceps weakness concluded that FNB reduced the quadriceps strength by 49%\u00a0 as compared to the 8% reduction produced by adductor canal block demonstrating\u00a0 decreased ability to ambulate (24)<\/sup><\/p>\n

Our study also showed similar results as the ACB group ambulated earlier implying greater quadricep strength compared to the FNB group similar to other previous studies (32)<\/sup><\/p>\n

In conclusion ACB with Dexmedetomidine provides longer duration of analgesia, early postoperative ambulation and is equally efficacious as FNB with Dexmedetomidine in patients undergoing knee arthroplasty.<\/p>\n

Limitations of the study<\/strong><\/p>\n

VAS score being subjective hence could not be completely reliable. The probability of spinal anaesthesia interfering with study outcomes could not be ruled out which are the limitations of this study. Future scope would be doing the surgeries solely on peripheral nerve blocks.<\/p>\n

Acknowledgement<\/strong><\/p>\n

We are extremely thankful to Kasturba Medical College, Mangaluru & Manipal Academy of Higher Education, Manipal, Karnataka, India for their support and guidance in conducting this study.<\/p>\n

Conflicts of\u00a0Interest<\/strong><\/p>\n

No potential conflict of interest relevant to this article was reported.<\/p>\n

Funding Sources<\/strong><\/p>\n

there is no funding Source.<\/p>\n

References<\/strong><\/p>\n

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