Sonawane Kartik, Saxena Shlok, Mistry Tuhin, Balavenkatasubramanian Jagannathan, Rajan Soundar, Shanmuganathan Rajasekran
Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND.
Orthopedics and Joint Replacement, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND.
Cureus. 2025 Aug 27;17(8):e91147. doi: 10.7759/cureus.91147. eCollection 2025 Aug.
Background Total knee arthroplasty (TKA) is often associated with intense postoperative pain, which can delay mobilization and hinder recovery. While motor-sparing blocks such as the femoral triangle block (FTB) and adductor canal block (ACB) are commonly used, both offer incomplete analgesic coverage. To overcome these limitations, the dual subsartorial block (DSB) was introduced as a procedure-specific, motor-sparing technique that combines and modifies FTB and ACB into a dual-injection approach for enhanced efficacy. Objective The objective of this study is to compare the analgesic efficacy, motor-sparing effect, opioid-sparing potential, and patient satisfaction among three regional analgesia (RA) techniques, FTB, ACB, and DSB, in patients undergoing TKA. Methods This prospective, double-blind, monocentric trial enrolled 120 patients undergoing unilateral primary TKA, randomized equally into FTB, ACB, or DSB groups (n = 40 each). All patients received standardized spinal anesthesia followed by the assigned ultrasound-guided block. The primary outcome was postoperative quadriceps strength. Secondary outcomes included visual analog scale (VAS) pain scores, rescue opioid use, pain location mapping, patient satisfaction, and block duration. Results Quadriceps strength was preserved in all groups. DSB showed significantly better static and dynamic pain control (p < 0.001), with zero opioid use compared to minimal use in FTB and highest use in ACB. Pain mapping revealed incomplete coverage with ACB, particularly at upper incision sites. DSB provided the longest block duration (>24 hours) and the highest satisfaction scores. Conclusions DSB, which strategically integrates and modifies FTB and ACB, offers superior, comprehensive, and motor-sparing analgesia. Its enhanced anatomical precision and functional benefits suggest that DSB can be considered a reliable, procedure-specific RA technique with a strong potential to improve outcomes in modern TKA care pathways.
全膝关节置换术（TKA）术后常伴有剧烈疼痛，这可能会延迟活动并阻碍恢复。虽然诸如股三角阻滞（FTB）和收肌管阻滞（ACB）等保留运动功能的阻滞方法常用，但两者的镇痛覆盖范围均不完全。为克服这些局限性，引入了双股薄肌下阻滞（DSB），这是一种针对手术的、保留运动功能的技术，它将FTB和ACB结合并改良为双注射法以提高疗效。
本研究的目的是比较FTB、ACB和DSB这三种区域镇痛（RA）技术在接受TKA的患者中的镇痛效果、保留运动功能的效果、减少阿片类药物使用的潜力以及患者满意度。
这项前瞻性、双盲、单中心试验纳入了120例行单侧初次TKA的患者，将其平均随机分为FTB组、ACB组或DSB组（每组n = 40）。所有患者均接受标准化的脊髓麻醉，随后进行指定的超声引导下阻滞。主要结局是术后股四头肌力量。次要结局包括视觉模拟量表（VAS）疼痛评分、补救性阿片类药物使用、疼痛部位映射、患者满意度和阻滞持续时间。
所有组的股四头肌力量均得以保留。DSB在静态和动态疼痛控制方面表现明显更好（p < 0.001），与FTB组的少量使用和ACB组的大量使用相比，DSB组阿片类药物使用量为零。疼痛部位映射显示ACB的覆盖不完全，尤其是在上部切口部位。DSB的阻滞持续时间最长（> 24小时），满意度评分最高。
DSB通过策略性地整合和改良FTB和ACB，提供了卓越、全面且保留运动功能的镇痛效果。其增强的解剖学精确性和功能优势表明，DSB可被视为一种可靠的、针对手术的RA技术，在现代TKA护理路径中有很大潜力改善治疗结果。
