Background and Aims Multimodal regimens, are the mainstay of postoperative analgesia. This study compares analgesic efficacy of, Programmed Intermittent Bolus (PIB) and Continuous. Infusion (CI) pumps, ultrasound guided Adductor Canal Block (ACB) with catheter, for unilateral knee arthroplasty.
Methods Ethical and Clinical Trial Registry approved, included patients were randomized into two groups, intraoperatively, either general, or spinal anaesthesia, pericapsular infiltration, postoperatively, ACB, received 0.2% Ropivacaine. Group-I, PIB pump 10 milliliters every 3 hours, Group-II, 6 milliliters/hour as CI. Additionally, both groups received Patient Controlled Analgesia (PCA) with 5 milliliters boluses and 30 minutes lockout interval. The Numerical Rating scale (NRS) score, plasma concentration of 0.2% Ropivacaine, adjunct analgesics, quadricep strength by straight leg rising (SLRT) test, Medical Research Council (MRC) scale for motor power, monitored at 0, 1, 4, 8, 24, 48, 72 hours, and Likert scale for patient satisfaction, measured at 72 hours. Sample size calculation, a difference in the NRS of two points to be clinically meaningful. Power of 0.80 and Standard Deviation(SD) of 2 points, it took at least seventeen patients from each group to detect a 2-point difference in NRS pain levels.
Results PIB group,patients experienced better analgesia only in the first 24 hours and motor power, in the first and fourth hour after recovery. Ropivacaine plasma concentration, at regular intervals were independent to the pain scores with movement and rest. Rescue analgesia was inconclusive in both groups.
Conclusions PIB option, proved better analgesia in the post operative period.
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