Functional outcome and postoperative analgesia following total knee arthroplasty: Randomized double-blind comparison between continuous adductor canal block and preoperative radiofrequency of saphenous and genicular nerves
Juan-Francisco Asenjo, Maria-Fernanda Arboleda, Giuliano Michelagnoli, Fardin Yousefshahi, Juan Pineda, José Andres Correa, Eric Lenczner, Robert Marien, Franco Carli. Departments of Anesthesia and Orthopedics, Montreal General Hospital, McGill University, Montreal, Canada
•Over one million Total Knee Arthroplasties (TKA) are preformed every year in USA.
•High risk to develop severe acute postoperative and chronic pain, possibly slowing patients’ recovery.
•Radiofrequency (RF) could be useful in non-operative knee and hip painful osteoarthritis (OA).
•Prolonged analgesia and improvement of functional recovery in patients receiving preoperative RF have not been tested for TKA.
To measure meaningful functional outcomes (long-term effect) and postoperative analgesia obtained with preoperative Pulsed RF (pRF) of the saphenous nerve and Continuous RF (cRF) of the genicular nerves, when compared to the conventional continuous adductor canal block (CACB)
•Prospective randomized, double-blind trial
•Approved by the Research Ethics Board of the MUHC
•Written consent was obtained before participating
Timed Up and Go (TUG) test and opioid consumption
✓measured at baseline, 24 hours, 48 hours and after 6 weeks of intervention
Pain levels, six-minute walk test (6MWT), WOMAC index
✓measured at baseline and six-week follow-up.
✓ Patients in the RF group were discharged 1.4 days earlier than the control group.
✓ At 6 weeks, the WOMAC index was significantly better in the RF group (p<0.01)
✓At 6 weeks, compared with its preoperative values, the 6MWT was already 20% better in the RF group vs 12% worse in the control.
✓ Early analgesic requirements were similar.
•Our results show significant clinical improvements in all functional outcomes (TUG test, 6MWT and WOMAC index) at 6 weeks in the RF group after TKA.
•The delayed effect of the pRF could explain the lack of impact on the TUG at 48 hours compared to 6 weeks.
•This trial was based in Franco’s et al paradigm for knee innervation and used well validated tools to assess the functional outcomes (TUG test, 6MWT and WOMAC index).
•The results of this first prospective randomized study of RF in TKA require further validation. If confirmed, may contribute greatly to improve the functional recovery of patients undergoing TKA.
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