Adductor canal blocks (ACBs) have gained recognition in total knee arthroplasty (TKA) for their potential to enhance postoperative pain management, promote early mobilization, and reduce hospital stay1. However, routine implementation of these blocks may increase procedure time, costs, and necessitate specialized skills from anaesthesiologists2. Emerging evidence suggests that surgeon-performed blocks (sACB) could be integrated into standard periarticular analgesic injections, yet data on their clinical efficacy remains sparse2–3. Additionally, the influence of elevated pain catastrophizing scale (PCS) scores on pain reporting has not been examined in this setting4. The study compares the efficacy of sACBs to conventional anaesthesiologist-performed blocks (aACB). This study is a randomized controlled trial evaluating patients undergoing same-day discharge (SDD) TKA with pre-operative PCS scores not exceeding 16, as higher scores may hinder reliable pain reporting and lead to type II errors4. All patients received a spinal anaesthetic and a standardized periarticular injection (PAI) during the procedure. In the control group, preoperative ultrasound-guided ACBs were performed by anaesthesiologists (aACB), whereas in the treatment group, intraoperative ACBs were executed by the treating surgeon. The primary outcome of the study was patient-reported pain levels, assessed using the Numeric Pain Rating Scale (NPRS) at both admission and discharge. Secondary outcome was the time to discharge home. The sample included 66 eligible patients, 58% of whom were female, with a mean age of 66.56±8.09 years. Baseline NPRS scores averaged 0.8±1.47 for the aACB group and 2.3±2.54 for the sACB group. At discharge, NPRS scores were 3.41±1.67 for aACB and 2.8±2.25 for sACB. The mean time to discharge home was 6.08±1.12 hours for aACB and 6.14±1.51 hours for sACB. There were no statistically significant differences between patients who received blocks administered by an anesthesiologist compared to those performed by a surgeon. This study highlights the potential for sACBs to serve as a feasible alternative to aACBs in TKAs without compromising clinical outcomes. The similar efficacy between sACBs and aACBs suggests that integrating sACBs as a potential standard practice may optimize resource allocation, reduce procedure time, and obviate the need for specialized anesthesiology support. Lastly, this approach lowers costs and improves access to care through improvements in OR efficiency.
Dervin et al. (Wed,) studied this question.