A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery

  • Islam Mostafa Ibrahim Salem
  • Galal Adel Mohamed Elkadi
  • Sherif George Anis Said
  • Mona Ahmed Abdelmotaleb Ammar
  • Mohamed Mohsen Rashed
DOI: https://doi.org/10.35975/apic.v26i2.1834
Keywords: Total knee replacement, Nerve block; Nerve Block / methods, Pain Management / methods, Pain, Postoperative / complications, Pain, Postoperative / drug therapy, Four in one block, Femoral nerve block, Adductor canal block

Abstract

Background & Objective: Ultrasound-guided 4-in-1 block has been suggested as a good alternative to various other nerve blocks to control pain after total knee replacement (TKR) surgery. We compared the three regional techniques; 4-in-1 block, femoral nerve block (FNB) and adductor canal block (ACB) following TKR regarding pain scores, opioid consumption, quadriceps muscle strength and early ambulation.

Methodology: We enrolled 93 patients and divided them into three equal groups of 31 each. Patients received either 4-in-1 block (Group A), FNB (Group B) or ACB (Group C) under ultrasound guidance. Outcome measures included assessment of VAS scores at 2, 4, 8, 12, 16, and 24 h). Nalbuphine consumption was calculated in the first 24 h. We also evaluated quadriceps muscle strength and early ambulation using straight leg raising (SLR) test at 12 and 24 h, and timed up-and-go (TUG) test at 24 h postoperatively.

Results: Patients received 4-in-1 block showed lower pain scores and lower nalbuphine consumption compared to FNB or ACB. Also, the SLR test values at 12h were higher (p-value<0.001), and TUG test values were lower (p-value0.005) in 4-in-1 block and ACB groups compared to FNB group.

Conclusion: The results of our study conclude that 4-in-1 block was found to be superior in pain control after TKR surgeries compared to FNB or ACB alone. It also facilitates early ambulation as it preserves quadriceps muscle strength.

Trial Registration: PACTR202110830502351.

Abbreviations: ACB - Adductor canal block; TKR - Total knee replacement; SLR - Straight leg raising test; FNB - Femoral nerve block; TUG test - Timed up-and-go test

Key words: Total knee replacement; Nerve block; Nerve Block / methods; Pain Management / methods; Pain, Postoperative / complications; Pain, Postoperative / drug therapy;  Four in one block; Femoral nerve block; Adductor canal block

Citation: Salem IMI, Elkadi GAM, Said SGA, Ammar MAA, Rashed MM. A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery. Anaesth. pain intensive care 2022;26(2):191–198; DOI: 10.35975/apic.v26i2.1834

Received: December 25, 2021, Reviewed: January 19, 2022, Accepted: January 28, 2022

Author Biographies

Islam Mostafa Ibrahim Salem

Islam Mostafa Ibrahim Salem, MSc, Assistant lecturer of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo – Egypt

Galal Adel Mohamed Elkadi

Galal Adel Mohamed El-Kadi, Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo – Egypt

Sherif George Anis Said

Sherif George Anis Said, Assistant Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo – Egypt

Mona Ahmed Abdelmotaleb Ammar

Mona Ahmed Abdelmotaleb Ammar, Assistant Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo – Egypt

Mohamed Mohsen Rashed

Mohamed Mohsen Rashed, MD, Lecturer of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo – Egypt

Published
04-15-2022
How to Cite
Ibrahim Salem, I., Mohamed Elkadi, G., Anis Said, S., Ammar, M. A., & Rashed, M. (2022). A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery. Anaesthesia, Pain & Intensive Care, 26(2), 191-198. https://doi.org/10.35975/apic.v26i2.1834
Issue
Vol 26 No 2 (2022): April 2022
Section
ORIGINAL RESEARCH