Comparison of Ultrasound-Guided Lumbar ESPB and ACB for Knee Arthroplasty

Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Adductor Canal Block on Postoperative Analgesia Management in Patients Undergoing Knee Arthroplasty

Total knee arthroplasty (TKA) is a surgical procedure frequently associated with moderate-to-severe postoperative pain. While Adductor Canal Block (ACB) has demonstrated analgesic efficacy in TKA, the Erector Spinae Plane Block (ESPB) is also being utilized as part of multimodal analgesia for postoperative pain management in lower extremity surgeries. Currently, there is a gap in the literature as no studies have directly compared the efficacy of ACB and ESPB for pain management following TKA. The primary objective of this study is to compare the efficacy of these two analgesic methods in the context of postoperative analgesia management after total knee arthroplasty.

In our clinic, various regional blocks are applied for analgesia or anesthesia purposes in many surgeries, including knee surgery. For knee surgery, adductor canal block, lumbar epidural analgesia, genicular block, erector spinae plane block, and iPACK block can be used. In our clinic, erector spinae plane block and adductor canal block are routinely applied to knee surgery patients. In our study, we aimed to contribute to the literature by comparing patient satisfaction surveys and pain follow-up in patients undergoing knee arthroplasty who received adductor canal block versus lumbosacral erector spinae plane block, both applied with PROSPECT protocols for postoperative analgesia.

Inclusion Criteria Patients aged 18-65 years Patients scheduled for elective total knee arthroplasty under spinal anesthesia ASA physical status I-II Written informed consent Exclusion Criteria Refusal to participate Coagulopathy or inability to discontinue anticoagulant therapy appropriately Allergy or toxicity history to local anesthetics or opioids Infection at the injection site Severe cardiac, hepatic, or renal failure Diabetes mellitus-related neuropathy Peripheral neuropathy or motor-sensory deficit in the relevant extremity Psychiatric disease, cognitive impairment, or inability to cooperate Substance or alcohol abuse Pregnancy, suspected pregnancy, or breastfeeding Body mass index >40 kg/m² Failed spinal anesthesia or need for additional intraoperative anesthesia/analgesia