STUDY OF GENICULAR NERVE BLOCK GUIDED BY ULTRASOUND COMBINED TO ADDUCTOR CANAL BLOCK IN TOTAL KNEE ARTHROPLASTY

Background: In pain of total knee arthroplasty, distal motor spring nerve blocks have gained a wide popularity. Genicularnerve block with adductor canal block is a superior technique used for managing the postoperative pain of total kneearthroplasty. The present study was aimed to assess the efficacy of genicular nerve block guided by ultrasound combined toadductor canal block in total knee arthroplasty. Materials and Methods: The study assessed 200 subjects where 100 subjectswere allotted in Group I where ultrasound guided adductor canal block was used guided by ultrasound using 20 mL of 0.25%ropivacaine and 4 mg dexamethasone along with ultrasound guided inferomedial (IM), superolateral (SL), and superomedial(SM) genicular nerve block using 5 mL of 0.25% ropivacaine and 2 mg of dexamethasone at each location. In group II, 100subjects were given ultrasound guided ACB with 20 mL of 0.25% ropivacaine, 4 mg dexamethasone, and ultrasound guidedthree location GNB with 15 mL of 0.9% saline. The outcomes assessed were the time to rescue analgesia, pain scores over 24hours, and 24 hour morphine consumption. Data gathered were analyzed statistically. Results: The study results showed thatmean total morphine consumption was 5.94±2.71 and 15.50±2.65 in groups I and II respectively which was significantly higherin Group II with p<0.001. Mean time for first rescue analgesia was 20.71±7.26 and 24.02±0.02 hours respectively which wasnon-significantly higher in Group II with p=0.43. Pain severity at rest was significantly less in Group I at 6, 12, and 24 hourswith p=0.02, 0.002, and 0.001. Pain scores in in Group I at movement were significantly lesser at 6 and 12 hours with p=0.007and <0.001. Conclusion: The present study concludes that combination of adductor canal block with genicular block result insignificantly reduced consumption of opioids and in superior postoperative analgesia in comparison to adductor canal blockalone