Comparison of the Effects of an Adductor Canal Block and Periarticular Multimodal Drug Local Injection on Pain after a Medial Opening High Tibial Osteotomy

Ok-Gul Kim; Do-Hun Kim; Seung-Suk Seo; In-Seung Lee

doi:10.4055/jkoa.2019.54.2.120

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Kim, Kim, Seo, and Lee: Comparison of the Effects of an Adductor Canal Block and Periarticular Multimodal Drug Local Injection on Pain after a Medial Opening High Tibial Osteotomy

Original Article

Journal of the Korean Orthopaedic Association 2019; 54(2): 120-126.

Published online: 30 April 2019

DOI: https://doi.org/10.4055/jkoa.2019.54.2.120

Comparison of the Effects of an Adductor Canal Block and Periarticular Multimodal Drug Local Injection on Pain after a Medial Opening High Tibial Osteotomy

Ok-Gul Kim, M.D., Do-Hun Kim, M.D.

, Seung-Suk Seo, M.D.^*, In-Seung Lee, M.D.

Department of Orthopedic Surgery, Bumin Hospital Busan, Busan, Korea.

^*Department of Orthopedic Surgery, Bumin Hospital Haeundae, Busan, Korea.

Correspondence to: Do-Hun Kim, M.D. Department of Orthopedic Surgery, Bumin Hospital Busan, 59 Mandeok-daero, Buk-gu, Busan 46555, Korea. TEL: +82-51-330-3082, FAX: +82-51-330-3075, kdh7483@gmail.com

Received 1 February 2018 Revised 7 April 2018 Accepted 26 April 2018

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The efficacy of periarticular multimodal drug injection and adductor canal block after a medial opening-wedge high tibial osteotomy was compared in terms of the postoperative pain level.

Materials and Methods

From November 2016 to March 2017, 60 patients underwent a medial opening-wedge high tibial osteotomy under spinal anesthesia. Preemptive analgesic medication, intravenous patient controlled anesthesia were used for pain control in all patients. Thirty patients received a periarticular multimodal drug injection (group I), and 30 patients received an adductor canal block (group II). These two groups were compared regarding the postoperative pain level, frequency of additional tramadol injections, total amount of patient-controlled analgesia, and number of times that the patients pushed the patient-controlled analgesia button at each time interval.

Results

The visual analogue scale scores over the two-week postoperative period showed no statistical significance. The frequency of additional tramadol hydrochloride injections was similar in the two groups over time. The mean number of times that patients pushed the patient-controlled analgesia button was similar in two groups over time. The total amount of patient-controlled analgesia was similar in the two groups over time.

Conclusion

This study shows that intraoperative periarticular multimodal drug injections and adductor canal block may have a similar effect on postoperative pain control in patients who have undergone a medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee.

Keywords: knee, osteoarthritis, osteotomy, injections, nerve block

Figures and Tables

Figure 1

Photograph illustrating intraoperative periarticular injection.

Figure 2

Photograph illustrating procedure of an adductor canal block.

Figure 3

Comparison of postoperative VAS scores between groups. VAS, visual analogue scale; PMDI, periarticular multimodal drug injection; ACB, adductor canal block.

Figure 4

Comparison of frequency of additional tramadol hydrochloride injections between groups. PMDI, periarticular multimodal drug injection; ACB, adductor canal block.

Figure 5

Comparison of mean number of times that patients pushed patient controlled analgesia button between groups. PMDI, periarticular multimodal drug injection; ACB, adductor canal block.

Figure 6

Comparison of total amount of fentanyl consumption between groups. PMDI, periarticular multimodal drug injection; ACB, adductor canal block.

Table 1

Demographic and Preoperative Patient Data

Values are presented as mean±standard deviation or number only. Group I, periarticular multimodal drug injection group; Group II, adductor canal block group; KSS, knee society knee score; VAS, visual analogue scale.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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ORCID iDs: Do-Hun Kim
https://orcid.org/0000-0003-2180-9282
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