A prospective randomized comparative study of surgeon administered adductor canal block with epidural analgesia in primary TKA.

Background: Total knee replacement stands as a reliable solution for patients experiencing severe knee osteoarthritis, yet persistent discomfort following the procedure can significantly impede the return to mobility and rehabilitation efforts. While epidural techniques have long supported pain control after surgery, they can cause issues like limited movement ability and urinary challenges. This investigation compared intraoperative surgeon-delivered adductor canal blockade with epidural analgesia in patients undergoing primary unilateral total knee replacement, focusing on early analgesia and rehabilitation. Methods: A prospective analysis was performed in a tertiary orthopaedic hospital in northern India, involving 50 individuals undergoing lower limb joint replacement. Patients were divided equally into 2 groups one receiving adductor canal (25) or epidural (25) pain management approaches. All procedures were carried out under regional spinal anaesthetia. Postoperative discomfort was gauged using a Visual Analog Scale (VAS) at set intervals after surgery, and functional outcomes were captured with standardized knee scoring systems and joint movement measurements. Statistics were interpreted using appropriate tests, with significance assumed for values below 0.05. Results: ACB patients reported significantly lower pain scores on postoperative days 0-1 compared to CEA patients (p = 0.0001). Measures of knee function and mobility at day three favoured the adductor canal approach, and a greater proportion of these patients achieved robust knee flexion early in their recovery. Additionally, hospital discharge was expedited, and the return of quadriceps strength was more prevalent among those managed with the adductor canal block. Conclusion: In this small, pragmatic prospective randomized comparative study, surgeon-delivered adductor canal block was associated with lower early postoperative pain scores, reduced opioid consumption, faster functional recovery, and shorter hospital stay compared with continuous epidural analgesia within the first 72 h after total knee arthroplasty.