Comparison of local infiltration anesthesia, adductor canal block, and combination of both in postoperative pain management for total knee arthroplasty

BACKGROUND: The primary objective of this research was to conduct a comprehensive investigation and analysis of the factors contributing to variations in Visual Analog Scale (VAS) scores among post-total knee arthroplasty (TKA) patients who have received different pain management approaches.METHODS: This study encompassed the entire population of post-total knee arthroplasty patients at Wahidin Sudirohusodo Central General Hospital, Makassar (Indonesia), from July 2021 to July 2022. Eligible patients were categorized into two groups: one receiving local infiltration anesthesia (LIA) and another receiving adductor canal block (ACB). Daily data collection included VAS scores, postoperative opioid usage, and the duration of hospital stays. Data analysis was conducted using SPSS version 25 (SPSS Inc., Chicago, IL, USA). The analytical process involved descriptive statistics for data characterization, frequency distributions for visualizing data distribution, and the Kruskal-Wallis Test.RESULTS: The analysis revealed significant differences in mean VAS 1 (24 hours postoperation) and VAS 2 (48 hours postoperation) scores among the treatment groups (P<0.01). Specifically, the ACB group exhibited significantly lower scores than the control group (P<0.01). In contrast, no significant differences were observed between the LIA and ACB+LIA groups (P>0.05) for both VAS 1 and VAS 2. At the 72-hour postoperation mark (VAS 3), no significant differences were detected among the treatment groups (P>0.05). While the ACB group had the lowest mean VAS 3 score (0.17) and the control group had the highest (0.44), all groups achieved similar pain control levels at this stage.CONCLUSIONS: ACB effectively mitigated early postoperative pain, as evidenced by significantly lower VAS 1 and VAS 2 scores than the control group. However, pain control became comparable across all treatment groups at the 72-hour postoperation assessment. These findings hold important implications for optimizing pain management strategies in clinical practice.