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Abstract
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Background and Aims A 65-year-old female was listed for bilateral unicompartmental knee replacement (medial compartment) in one sitting as a robotic assisted surgery. Her background medical history included hypertension, high BMI and osteo-arthritis. Patient was consented for spinal anaesthesia and bilateral adductor canal nerve block. A separate consent form for medical illustration and publication was explained, requested and signed by the patient.
Methods Upon arrival to the anaesthetic room, bilateral adductor canal blocks were performed under ultrasound (USG) guidance in accordance with AAGBI full monitoring guidelines for peripheral nerve blocks using 12 millilitres of ropivacaine for either side. Given the nature of bilateral surgery and possible extended duration, a combined spinal epidural (CSE) was sited and the patient was given 2.8mls of bupivacaine intrathecally. Surgery was successfully completed by topping up the epidural catheter using to extend the neuraxial blockade without any untoward incidents and the epidural catheter was removed before transferring to the recovery. Post-operative pain was assessed using pain scores during the immediate post-op, 8hours and 14 hours following surgery. Regular analgesia including paracetamol and codeine were prescribed with morphine available as needed for breakthrough pain.
Results Patient was pain free in recovery and pain scores at 8 and 14 hours (at rest and with movement) were 0. She was discharged 16 hours after surgery.
Conclusions Adductor canal block can be an effective means for postoperative analgesia for unicompartmental knee replacements. The presence of vastoadductor membrane (VAM) should be considered for superior analgesia.
Adductor canal US image showing the VAM
Pain score at 8 hours
Pain score at 14 hours