Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty

Abstract

Aim: Total knee arthroplasty (TKA) is a major orthopedic procedure often associated with significant postoperative pain. Effective pain management is critical for early mobilization, rehabilitation, and reducing complications such as chronic pain. With the increasing use of ultrasound in regional anesthesia, the frequency of femoral nerve block (FNB) and adductor canal block (ACB) for analgesia after TKA is rising. This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative analgesia in patients undergoing unilateral knee arthroplasty. Material and Methods: The study was conducted with the approval of the ethics committee, and written consent was obtained from the patients. It was carried out on 70 patients aged 18–70, with an American Society of Anesthesiologists (ASA) score of I-II, who planned to undergo elective TKA surgery. The study was designed as a prospective, randomized, and single-blind trial. Demographic data of the patients were recorded, and routine monitoring and general anesthesia induction were performed. Patients were divided into two groups: those who received FNB (Group F) and those who received ACB (Group A). Both groups were administered 20 mL of 0.375% bupivacaine. Heart rate (HR) and mean arterial pressure (MAP) were recorded intraoperatively before and after induction and every 30 minutes. In the postoperative period, patient-controlled analgesia (PCA) with intravenous tramadol was applied. Total tramadol usage and the number of times analgesia was needed were recorded. HR, MAP, and visual analog scale (VAS) scores were recorded at postoperative 30 minutes, 1, 2, 4, 6, 12, and 24 hours. Complications (nausea/vomiting, hypotension, bradycardia, itching) were recorded for 24 hours. Results: Mean VAS scores were significantly lower in the FNB group at postoperative 0, 1, 2, and 6 hours (p<0.05). Total tramadol consumption and bolus requests were higher in the ACB group (p<0.001). Both techniques achieved VAS scores below 4, with no significant differences in additional analgesic use or complications. Nausea and vomiting rates were 5% (FNB) and 10% (ACB). No significant differences were observed in perioperative and postoperative MAP or HR between the groups. Conclusions: Femoral nerve block and ACB provide effective analgesia after TKA, with VAS scores below 3 and high patient satisfaction. However, FNB demonstrated superior early postoperative pain control and lower opioid consumption. ACB, as a sensory block, is advantageous for minimizing quadriceps weakness and should be considered part of multimodal analgesia strategies. It was concluded that femoral nerve block is more effective in providing postoperative analgesia for patients undergoing unilateral knee arthroplasty.

Keywords

• total knee arthroplasty
• femoral nerve block
• adductor canal block
• multimodal analgesia; postoperative analgesia

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