A Comparative Evaluation of Continuous Adductor Canal and Femoral Nerve Blocks for Quadriceps Strength Preservation Using a Handheld Dynamometer after Unilateral Total Knee Arthroplasty
Manjita Sony, Divesh Arora, Niti Gulati, Nikhil DewanAbstract
Objectives:
The adductor canal block (ACB) is believed to preserve quadriceps muscle strength better than the femoral nerve block (FNB), without compromising postoperative pain relief in unilateral total knee arthroplasty (TKA). This prospective, randomized, double-blind, interventional study compared ultrasound (US)-guided continuous ACB and FNB with respect to quadriceps strength, postoperative analgesia, side effects, and patient satisfaction in patients undergoing unilateral TKA.
Materials and Methods:
Sixty-six patients scheduled for unilateral TKA were enrolled after approval by the institutional ethics committee and after obtaining informed written consent. Patients were randomized into two groups. At the end of surgery, Group I received US-guided continuous ACB, whereas Group II received US-guided continuous FNB. The primary outcome was postoperative quadriceps strength measured with a handheld dynamometer. Secondary outcomes were assessment of postoperative pain using the Visual Analog Scale, postoperative nausea and vomiting (PONV) using the Impact Scoring Scale, sedation score using the Ramsay Sedation Score, and patient satisfaction score using a 7-point Likert scale on the day of discharge.
Results:
The mean quadriceps strength at 24 h postoperatively was significantly higher in Group I (10.78 ± 2.41 kg) compared to Group II (9.33 ± 2.17 kg) (
Conclusion:
In patients undergoing unilateral TKA, continuous ACB offers superior preservation of quadriceps strength compared to FNB, while providing comparable analgesia and patient satisfaction.