Key result
Ultrasound-guided 4-in-1 block reduces pain and nalbuphine use vs FNB or ACB after knee replacement.
Why the study?
Ultrasound-guided 4-in-1 block has been suggested as a good alternative to femoral nerve block and adductor canal block for pain control after total knee replacement surgery, but comparative data are needed.
Does ultrasound-guided 4-in-1 block improve pain control and early ambulation compared to FNB or ACB in patients undergoing total knee replacement?
RCT (n=93)
Not stated
Randomized
No
Does ultrasound-guided 4-in-1 block improve pain control and early ambulation compared to FNB or ACB in patients undergoing total knee replacement?
Ultrasound-guided 4-in-1 block provides superior pain control and preserves quadriceps muscle strength compared to FNB or ACB after total knee replacement.
May support 4-in-1 block after TKR; hypothesis-generating and requires confirmation in larger RCTs.
Background & Objective: Ultrasound-guided 4-in-1 block has been suggested as a good alternative to various other nerve blocks to control pain after total knee replacement (TKR) surgery. We compared the three regional techniques; 4-in-1 block, femoral nerve block (FNB) and adductor canal block (ACB) following TKR regarding pain scores, opioid consumption, quadriceps muscle strength and early ambulation. Methodology: We enrolled 93 patients and divided them into three equal groups of 31 each. Patients received either 4-in-1 block (Group A), FNB (Group B) or ACB (Group C) under ultrasound guidance. Outcome measures included assessment of VAS scores at 2, 4, 8, 12, 16, and 24 h). Nalbuphine consumption was calculated in the first 24 h. We also evaluated quadriceps muscle strength and early ambulation using straight leg raising (SLR) test at 12 and 24 h, and timed up-and-go (TUG) test at 24 h postoperatively. Results: Patients received 4-in-1 block showed lower pain scores and lower nalbuphine consumption compared to FNB or ACB. Also, the SLR test values at 12h were higher (p-value<0.001), and TUG test values were lower (p-value0.005) in 4-in-1 block and ACB groups compared to FNB group. Conclusion: The results of our study conclude that 4-in-1 block was found to be superior in pain control after TKR surgeries compared to FNB or ACB alone. It also facilitates early ambulation as it preserves quadriceps muscle strength. Trial Registration: PACTR202110830502351. Abbreviations: ACB - Adductor canal block; TKR - Total knee replacement; SLR - Straight leg raising test; FNB - Femoral nerve block; TUG test - Timed up-and-go test Key words: Total knee replacement; Nerve block; Nerve Block / methods; Pain Management / methods; Pain, Postoperative / complications; Pain, Postoperative / drug therapy; Four in one block; Femoral nerve block; Adductor canal block Citation: Salem IMI, Elkadi GAM, Said SGA, Ammar MAA, Rashed MM. A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery. Anaesth. pain intensive care 2022;26(2):191–198; DOI: 10.35975/apic.v26i2.1834 Received: December 25, 2021, Reviewed: January 19, 2022, Accepted: January 28, 2022
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Salem et al. (2022) conducted an RCT in Total knee replacement (TKR) surgery (n=93). Ultrasound-guided 4-in-1 block vs. Femoral nerve block (FNB) or Adductor canal block (ACB) was evaluated on Postoperative pain using the visual analog scale (VAS) score at 4 hours (p=<0.001). Ultrasound-guided 4-in-1 block significantly reduced postoperative pain scores and nalbuphine consumption compared to femoral nerve block or adductor canal block alone after total knee replacement.
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