Optimizing Post-operative Analgesia for Early Rehabilitation after Orthopedic Knee Surgery: A Randomized Comparison of Adductor Canal, Infiltration between the Popliteal Artery and Capsule of the Posterior Knee and Genicular Nerve Blocks.
Year: 2026
Type: article
Abstract: Introduction: Orthopedic knee surgery, including anterior cruciate ligament tear repair, patellar fracture fixation, and surgery for knee osteoarthritis, is often followed by moderate to severe pain that delays early mobilization, quadriceps activation, and physiotherapy. Motor-sparing, opioid-sparing analgesia is therefore preferred. Ultrasound-guided adductor canal block (ACB), infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block, and genicular nerve block (GNB) are three such options, but direct comparisons in orthopedic knee surgery are limited. Aims: To compare the post-operative analgesic efficacy of ultrasound-guided ACB, IPACK block, and GNB in patients undergoing knee surgeries under subarachnoid block. Materials and Methods: This prospective, randomized, single-blind comparative study was conducted in the Department of Anaesthesiology, N.S.C.B. Medical College and Hospital, Jabalpur, over 18 months after institutional ethics committee approval (IEC/2023/7335-1). Ninety-nine ASA physical status I-II patients aged 18-60 years scheduled for elective knee surgery were randomized equally into three groups (n = 33 each). Group A received ultrasound-guided ACB, Group I received ultrasound-guided IPACK block, and Group G received ultrasound-guided GNB. Each block was performed with 20 mL of 0.375% ropivacaine, followed by standardized spinal anesthesia. Post-operative pain was assessed using a Visual Analog Scale (VAS) over 24 h. Time to rescue intravenous paracetamol, tramadol requirement, and block-related complications were recorded. Results: Baseline demographic characteristics were comparable among groups. Group G had lower mean VAS scores at most post-operative time points, including 16, 20 and 24 h. The time to first rescue paracetamol was longest in Group G (5.87 ± 0.43 h), followed by Group A (5.62 ± 0.48 h) and Group I (5.42 ± 0.49 h). The second paracetamol dose was also delayed the longest in Group G (11.79 ± 0.83 h). Tramadol was required in 6.06% of patients in Group G, compared with 21.21% in Group A and 30.30% in Group I. Conclusion: In patients undergoing orthopedic knee surgery, all three ultrasound-guided motor-sparing blocks provided clinically useful post-operative analgesia. GNB was associated with lower pain scores at most intervals, delayed rescue analgesic requirement, and reduced tramadol use compared with ACB and IPACK block, making it a promising option to support early rehabilitation. Larger adequately powered trials with procedure-specific subgroup analysis and functional outcomes, such as quadriceps strength and range of motion, are warranted.
Source: PubMed
Institution: Netaji Subhash Chandra Bose Medical College
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225599544