Comparative analysis of the efficacy of intravenous tramadol plus ketorolac vs adductor canal block for postoperative pain in total knee arthroplasty

Background & objectives: postoperative pain is a significant factor for the distress and sleep disturbance for the patients undergoing surgeries, and it is equally true for the knee arthroplasty. Anesthetists have employed various means to control pain including various analgesic drugs. For the last few decades, there has been an increased tendancy to use regional blocks. This study aimed to compare the efficacy of Adductor Canal Block (ACB) with intravenous analgesia using tramadol plus ketorolac to relieve postoperative pain in knee arthroplasty. Methodology: This study was conducted in 32 patients undergoing total knee arthroplasty. Group A received intravenous analgesia tramadol plus ketorolac (n=15), while group B received ACB (n=17) postoperatively. Numeric Rating Scale (NRS) was used to to assess the pain at rest and on motion. Range of Motion (ROM) on flexion and extension, was examined in both groups on postoperative days 0, 1, 2, 3, and 4. Patients who had NRS-rest and NRS-motion >3, received, intravenous fentanyl 50 µg. The data obtained were statistically analyzed using the One-Way ANOVA test and Spearman test on SPSS 18.0 software. Results: Intravenous analgesia group (Group A) significantly had greater ROM for flexion than the ACB group (P = 0.001), but not in the ROM-extension (P = 0.351). There was no significant difference in the NRS-rest and NRS-motion (P = 1.000). However, the NRS of the intravenous analgesia group was lower than the ACB group. Conclusion: Intravenous analgesia with tramadol ketorolac is better than adductor canal block in providing a greater range of motion. However, both techniques did not have a significant difference in the Numeric Rating Scale. Gender and age are considered to be confounding factors for the study. Abbreviations: ACB: Adductor Canal Block, ROM: Range of Motion, NRS: Numeric Rating Scale, NSAIDs: Non-Steroidal Anti-Inflammatory Drugs Keywords: Adductor Canal Block; Intravenous analgesia; Numeric Rating Scale; Pain; Pain management; postoperativetive pain; total knee replacement Citation: Laksono RM, Laksono BH, Firdaus FA, Isngadi, Basuki DR. Comparative analysis of the efficacy of intravenous tramadol plus ketorolac vs adductor canal block for postoperative pain in total knee arthroplasty. Anaesth. pain intensive care 2025;29(3):502-506. DOI: 10.35975/apic.v29i3.2534 Received: August 07, 2024; Revised: March 29, 2024; Accepted: April 09, 2025