Investigation of the effect of USG-guided infiltration popliteal artery capsule knee block and adductor canal block on postoperative analgesia in patients undergoing total knee arthroplasty surgery under general anesthesia

Total knee arthroplasty (TKA) is an operation that is frequently applied to the older age group. Studies are continuing to manage pain after TKA, to increase patient satisfaction in the postoperative period, and to reduce opioid use. Intravenous patientcontrolled analgesia (PCA), continuous central neuraxial and peripheral nerve blocks (infiltration popliteal artery capsule knee block (IPACK), adductor canal block) are among these methods. In this study, we aimed to evaluate the effect of USG-guided ACB and IPACK block combination on postoperative analgesia before total knee arthroplasty. After obtaining the written consent of the ethics committee and the patients, 40 patients aged between 18-75 years who were in ASA I-III physical status, who were going to undergo TKA under general anesthesia as prospectively and randomized, were included in the study. Group A (ACB+IPACK) was administered ACB and IPACK block under USG, in each block application 10 mL of 0.5% Bupivacaine (Bustesin 0.5% 20 ml/100 mg-Vem) and 10 mL of 0.9% NaCl was used. No block was applied to the patients in Group B. Patients in both groups were given IV Patient Controlled Analgesia (PCA) 30 minutes before the end of the operation; Tramadol HCL in 100 cc normal saline, 4mg/ml concentration, with a background infusion of 2cc/hour, a maximum dose of 400mg was allowed within 24 hours, and doses of 20mg tramadol HCL could be administered at each push with a 30-minute lockout interval. Postoperative systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), visual analogue scale (VAS), analgesic consumption, nausea, vomiting, patient satisfaction were evaluated and recorded. There was no statistically significant difference between the groups in terms of demographic characteristics and anesthesia data (p>0.05). Resting VAS scores in Group A were statistically significantly lower at 1st, 2nd, 4th, 8th hours compared to vii Group B (p value <0.05). It was observed that the amount of tramadol consumption was statistically significantly higher in Group B compared to Group A in each time zone (p<0.05). In terms of patient satisfaction, the higher patient satisfaction rate in Group A compared to Group B was found to be statistically significant (p value <0.05). As a result; in total knee arthroplasty, tramadol administered with PCA reduces VAS values, when tramadol and USG-guided ACB and IPACK blocks are combined, it further decreases the postoperative VAS value, reduces total tramadol consumption, morphine need in the first postoperative hour, intraoperative remifentanil consumption, increases patient satisfaction and did not make a significant difference in terms of side effects. Keywords: Total knee arthroplasty, postoperative pain, adductor canal block, infiltration popliteal artery capsule knee block, bupivacain.