Ultrasound-Guided Adductor Canal Block Versus Femoral Nerve Block for Enhanced Recovery After Total Knee Arthroplasty : A Randomized Controlled Trial.

Knee surgeries, particularly total knee arthroplasty (TKA), are associated with significant intraoperative and postoperative pain, which can hinder early mobilization and functional recovery. Traditionally, femoral nerve block (FNB) has been the cornerstone of regional anaesthesia techniques to manage pain after Total knee arthroplasty surgeries due to its efficacy in providing profound analgesia. However, its widespread use is often limited by the associated quadriceps motor weakness, which increases the risk of falls and delays postoperative mobilization .

In recent years, the adductor canal block (ACB) has emerged as a motor-sparing alternative to FNB. The ACB primarily targets the saphenous nerve within the adductor canal, offering effective sensory blockade with minimal impact on quadriceps strength. Multiple studies and meta-analyses have highlighted the benefits of ACB in the postoperative setting, demonstrating comparable analgesic efficacy to FNB while preserving motor function and promoting earlier ambulation.

Ultrasound guidance has significantly enhanced the precision, safety, and success rates of both FNB and ACB. However, literature evaluating these blocks for enhanced recovery after total knee arthroplasty is limited. For long, systemic opioids and NSAID have remained a mainstay of postoperative analgesia and recovery. Understanding the role of FNB and ACB for postoperative analgesia thereby facilitating the qualitative improvement in early recovery and mobilization after TKA surgeries is of paramount importance.

Key goals of enhanced recovery after TKA surgery include:

Reducing complications and surgical stress

Optimizing pain management using multimodal, opioid-sparing techniques

Promoting early mobilization and rehabilitation

Shortening hospital stays and enabling a quicker return to normal function

Improving overall patient satisfaction and outcomes

 This approach involves coordinated efforts between surgeons, anesthesiologists, physiotherapists, nurses, and patients. Components may include preoperative education, nutritional support, regional anesthesia, minimally invasive techniques, and early initiation of physiotherapy.

This study aims to compare the efficacy of ultrasound-guided adductor canal block versus

femoral nerve block when used for enhanced recovery in patients undergoing elective TKA

surgeries. It seeks to determine which technique offers better analgesia, hemodynamic

stability, and preservation of motor function during the postoperative phase