Post-operative analgesia using intermittent vs. continuous adductor canal block technique: a randomized controlled trial.
OBJECTIVE
Intermittent boluses for neural blockade provide better post-operative analgesia when compared to continuous infusion. However, these techniques of administration have not yet been compared while performing adductor canal block (ACB). We compared intermittent vs. continuous ACB for managing post-operative pain following anterior cruciate ligament (ACL) reconstruction. The primary endpoint was total morphine consumption for 24 h post-operatively in both the groups. Secondary outcomes included evaluation of pain scores and opioid-related side effects.


METHODS
After ethics board approval, subjects presenting for ACL reconstruction were randomized to receive either continuous ACB (n = 25) with 0.5% ropivacaine infusing at 2.5 ml/h or intermittent boluses (n = 25) of 15 ml of 0.5% ropivacaine every 6 h. Total morphine consumption 24 h following surgery was recorded in each group.


RESULTS
Fifty subjects completed this study. The mean 24-h total morphine consumption in the intermittent group, [11.36 (6.82) mg], was significantly reduced compared with the continuous group, [23.40 (10.45) mg] (P < 0.001). The mean visual analogue scale (VAS) pain score at rest and on knee flexion was significantly reduced in the intermittent group at 4, 6, 8, and 12 h compared with the continuous group.


CONCLUSIONS
Intermittent ACB allowed significantly reduced consumption of morphine for 24 h in the post-operative period compared with continuous ACB when identical doses of ropivacaine were used in each group.
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. dpkthapa@gmail.com.
D
D
Thapa
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
V
V
Ahuja
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
P
P
Verma
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
S
S
Gombar
Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
R
R
Gupta
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
D
D
Dhiman
D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*
D009020:Morphine