Does combination therapy of popliteal sciatic nerve block and adductor canal block effectively control early postoperative pain after total knee arthroplasty?

Abstract

Purpose: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. Materials and Methods: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. Results: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. Conclusions: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.