August 15, 2025Open Access

Postoperative Pain Control for Robotic Unilateral Total Knee Replacement: A Retrospective Comparison of Continuous Adductor Canal Block Versus Single-shot Adductor Canal Blocks

NVNarendra VaidyaLokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College SSSrinivasan SMApollo Hospitals

Key Points

Continuous adductor canal block significantly reduces VAS pain scores compared to single-shot blocks, enhancing postoperative pain control.
Patients using continuous blocks waited longer for rescue analgesia, averaging 634.5 minutes versus 435.8 minutes for single-shot patients.
This retrospective comparison analyzed 60 robotic total knee replacement surgeries from December 2023 to December 2024, assessing analgesic techniques.
The findings support continuous adductor canal block as a preferable method for managing post-surgery pain, positively influencing rehabilitation.

Abstract

Background: A frequent treatment for end-stage osteoarthritis is total knee replacement (TKR), which can cause excruciating postoperative pain. Optimising recovery and rehabilitation results requires effective pain management. The analgesic effectiveness of continuous adductor canal block catheter (CACB) with posterior capsular infiltration and single-shot adductor canal block (SACB) in patients having unilateral robotic TKR was evaluated in this study. Methods: This retrospective study included 60 patients who underwent unilateral robotic TKR between December 2023 and December 2024. Patients were divided into two groups of 30 each: Group 1 received a SACB with posterior capsular infiltration, while Group 2 received a CACB with posterior capsular infiltration. The visual analog scale (VAS) was used to measure postoperative pain in the recovery room and at 12 hours, 24 hours, and 48 hours after surgery. This was the main primary measure. The time it took to provide rescue analgesics was the secondary outcome. Results: Both groups were comparable in terms of demographic characteristics and American society of anaesthesiologists (ASA) physical status. Group 2 (CACB) demonstrated significantly lower VAS pain scores at all time points compared to Group 1 (SACB) ( P < .001). In Group 2, the average duration before the first rescue analgesia was considerably longer (634.5 ± 71.2 minutes) compared to Group 1 (435.8 ± 26.9 minutes, P < .001). The groups’ differences in pain scores become more noticeable after one day, with Group 2 continuing to have superior analgesia. Conclusion: When paired with posterior capsular infiltration, continuous adductor canal block (ACB) offers better analgesia than the SACB for patients having robotic TKR. While both techniques provide effective pain relief in the first 24 hours, CACB demonstrates sustained analgesic efficacy beyond this period, resulting in delayed requirement for rescue analgesia and better pain control. This enhanced pain management approach may contribute to improved rehabilitation outcomes and shorter hospital stays.

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