Comparative Study between Ultrasound-Guided Fascia Iliaca Block Versus Adductor Canal Block for Postoperative Analgesia in Patients undergoing Knee Surgeries

Background: Peripheral nerve block may provide effective unilateral postoperative analgesia following knee and hip surgeries with a lower incidence of opioid-related and autonomic side-effects, less motor block. Fascia iliaca block (FIB) and adductor canal block (ACB) have been shown to be a successful technique for postoperative pain relief after knee surgeries. The aim of our study was to compare the effect of ultrasound guided FIB versus ultrasound guided ACB for postoperative analgesia in patients undergoing knee surgeries.

Methods: Our randomized controlled trial was conducted over 105 patients aged between 18 and 65 years, (ASA) class I and II undergoing knee surgeries. Patients divided into three groups: Group I control (C): Patients received spinal anesthesia alone. Group II (FIB): Patients received spinal anesthesia with postoperative ultrasound guided FIB. Group III (ACB): Patients received spinal anesthesia with postoperative ultrasound guided ACB.

Results: Both FIB and ACB provided better pain control compared to control group. The need for first dose of supplemental analgesic was earlier in the control group than FIB and ACB groups postoperatively. Additionally, the total 24-h pethidine consumption was highest in the control group compared to fascia FIB and ACB groups. FIB was shown to reduce the strength of the quadriceps muscle, which resulted in delayed early postoperative mobilization and influencing patient satisfaction. There was statistically significant increase in heart rate and mean arterial blood pressure in group I as compared to group II and group III at 6hrs and 12hrs postoperatively.

Conclusions: Both FIB and ACB provide excellent postoperative analgesia after knee surgeries, however the ACB is superior to FIB because it has no prolonged muscle weakness and FIB did.