Background and Goal of Study: Retrospective data, prior studies and a recent meta-analysis suggest a synergistic analgesic effect of an Adductor Canal Blockade (ACB) added to Local Infiltration Analgesia (LIA) compared to LIA alone following Total Knee Arthroplasty (TKA). Our hypothesis was therefore that Physical Therapy (PT) milestones would be reached faster with ACB + LIA than LIA alone.
Materials and Methods: After IRB approval, patients scheduled for unilateral primary TKA were randomized to receive either ACB or a sham block (saline) in addition to the LIA administered by the surgeon. Exclusion criteria included significant systemic disease, substance abuse and chronic pain. Spinal anesthetic and postoperative pain management were standardized. ACB was performed at the mid-thigh level with 30 mL of 0.25% bupivacaine with 1:200,000 adrenaline. LIA was performed by the surgeon using bupivacaine, ketorolac, adrenaline and morphine, as well as liposomal bupivacaine.
Data collected included passive and active ROM of the knee in flexion and extension; quadriceps strength; bed mobility skill: transfer skill; 2-minute walk test; total distance ambulated on the day of surgery and the first and second post-operative days; ability to climb stairs; readiness for discharge; and pain complaints by NVS before, during and after physical therapy sessions.
Results: Preliminary results of 63 patients out of 150 planned are reported. Pain scores, measured as an AUC for the initial 48 hours, were not different between groups (186 ± 71 vs. 187 ± 80). However, total distances ambulated and 2-minute walk tests suggested that the group that received the ACB in addition to LIA achieved less on PT at each of the time points than the group that received LIA alone (total distances ambulated: DOS: 104 ± 90 vs. 137 ± 89 ft; POD1 am: 150 ± 106 vs. 249 ± 152 ft; POD1 pm: 142 ± 110 vs. 183 ± 92 ft; POD2 am: 135 ± 124 vs. 210 ± 36 ft; 2-minute walk test: DOS: 56 ± 50 vs. 76 ± 60 ft; POD1 am: 80 ± 71 vs. 129 ± 121 ft; POD1 pm: 78 ± 66 vs. 118 ± 65 ft; POD2 am: 80 ± 65 vs. 152 ± 75 ft).
Discussion: While these interim results remain to be confirmed, the data suggest that LIA alone is preferable to LIA + ACB, providing similar pain control with earlier achievement of physical therapy milestones.

DELAYED ATTAINMENT OF PHYSICAL THERAPY MILESTONES WITH THE ADDITION OF AN ADDUCTOR CANAL BLOCK TO LOCAL INFILTRATION ANALGESIA FOLLOWING TOTAL KNEE ARTHROPLASTY