Postoperative Analgesia after Combined Obturator Nerve and Adductor Canal Block in Total Knee Arthroplasty

The purpose of this study was to evaluate adding an obturator nerve block to adductor canal block may reduce tramadol consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with single adductor canal block. This study was carried out retrospectively in order to compare the effect of the single injection adductor nerve block, which was applied to the patients undergoing total knee arthroplasty (TKA) under spinal anesthesia by the Anesthesiology and Reanimation Clinic for the postoperative analgesia, and the single injection obturator block added to this on postoperative analgesia and participation in physiotherapy in relation to analgesia. The sample of this study was comprised of 60 patients who underwent knee arthroplasty under spinal anesthesia and peripheral nerve block for postoperative analgesia at the end of the operation by the Orthopedics and Traumatology clinic between January 2015 and January 2016. The patients were between 45-80 years old and in ASA I-II-III group. For the purpose of this study, patient records, pain follow-up forms and physiotherapy follow-up forms were retrospectively examined. The data related to patients’ demographic characteristics, postoperative VAS scores, tramadol consumption, and tramadol related side effects, satisfaction levels and compliance with postoperative physical therapy were evaluated from printed data. The data of 30 out of the 60 patients to whom receiving only adductor canal block for analgesia were referred to as Group I and the data of the remaining 30 patients to whom receiving adductor canal block and obturator nerve block together for analgesia were defined as Group II were compared. The data of 3 patients in Group II were not included in the study because of the lack of records and a total of 57 patients were examined. No significant difference was identified between the groups in terms of age, gender, height, weight, ASA distribution and tourniquet duration. The rate of diabetes mellitus (DM) in Group I was significantly higher than in Group II and the mean surgical time was significantly lower (p = 0.005, p = 0.030). Patients’ VAS scores at 12th hour were significantly higher in group I and no significant difference was found at 1st, 4th and 24th hours. No significant difference was found between the groups in terms of tramadol consumption levels, nausea, vomiting, additional analgesic demand rates, satisfaction level distribution, maximum flexion to which the knee evaluated in physical therapy was able to reach and VAS score during that time, walking distance and chair test results (p = 0.506, p = 0.390, p = 0.656, p = 0.217, p = 0.240, p = 0.364, p = 0.571, p = 0.183, p = 0.386). In conclusion, combination of obturator nerve block to adductor canal block did not provide a statistically significant contribution over single adductor canal block in terms of total tramadol consumptions, postoperative analgesia and early mobilization of the patients.