{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:38:06Z","timestamp":1787071086792,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Ultrasound-guided adductor canal block (ACB) has been increasingly used for postoperative analgesia in total knee replacement (TKR) surgery patients. We hypothesized that the addition of ketamine to levobupivacaine in ultrasonograsonography (USG)-guided ACB would result in prolonged and better postoperative analgesia in patients undergoing TKR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>This randomized prospective study was conducted on 90 patients undergoing unilateral TKR. In Group LK (n = 45), levobupivacaine 0.25% plus ketamine 1 mg\/kg (total volume 20 ml) was given, and in Group L (n = 45), 20 ml of 0.25% levobupivacaine was given. The primary objective was to compare the pain-free interval, i.e. the time until the first dose of rescue analgesia, between Group LK and Group L. The secondary objectives were to assess the amount of rescue analgesic, pain scores, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We observed that the time to the first dose of rescue analgesia in Group LK (9.33 h \u00b1 2.17) was significantly longer than in Group L. (5.02 h \u00b1 1.63) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value = 0.001; Cohen\u2019s d = 2.243). The total dose of rescue analgesic was significantly lower in Group LK (188.89 mg \u00b1 48.72) compared to Group L (271.11 mg \u00b1 50.55) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value = 0.001). Patients in Group L had significantly higher numerical rating scale compared to Group LK at rest at 4, 6, and 12 h and on movement at 2, 4, 6, and 12 h postoperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The addition of ketamine to levobupivacaine in ACB resulted in prolongation of the pain-free interval, decreased requirement for rescue analgesia, and better pain control during rest and movement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_249_25","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T11:00:20Z","timestamp":1761994820000},"page":"142-149","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of levobupivacaine versus ketamine and levobupivacaine for ultrasound-guided adductor canal block in patients undergoing unilateral total knee replacement: A randomized, double-blinded study"],"prefix":"10.4103","volume":"42","author":[{"given":"Jotkamal","family":"Kaur","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneh","family":"Samagh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopal K.","family":"Jalwal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh K.","family":"Singh","sequence":"additional","affiliation":[{"name":"Executive Director and CEO, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,1]]},"reference":[{"issue":"Suppl 1","key":"R1-20251226","first-page":"46","article-title":"India joining the world of hip and knee registries: Present status\u2014A leap forward","volume":"55","author":"Vaidya","year":"2020","journal-title":"Indian J Orthop"},{"key":"R2-20251226","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/j.1399-6576.2012.02737.x","article-title":"Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: A randomised study","volume":"56","author":"J\u00e6ger","year":"2012","journal-title":"Acta Anaesthesiol 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scale as a screening test in primary care","volume":"22","author":"Krebs","year":"2007","journal-title":"J Gen Intern Med"},{"key":"R13-20251226","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4103\/joacp.JOACP_112_20","article-title":"Comparison of two different volumes of 0.5%, ropivacaine used in ultrasound-guided adductor canal block after knee arthroplasty: A randomized, blinded, controlled noninferiority trial","volume":"38","author":"Govil","year":"2022","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R14-20251226","first-page":"485","article-title":"Efficacy and safety of ketamine added to local anesthetic in modified pectoral block for management of postoperative pain in patients undergoing modified radical mastectomy","volume":"19","author":"Othman","year":"2016","journal-title":"Pain Physician"},{"key":"R15-20251226","doi-asserted-by":"crossref","first-page":"e1206","DOI":"10.1097\/PR9.0000000000001206","article-title":"Efficacy of adding ketamine to levobupivacaine in paravertebral block on acute and chronic pain in thoracotomy: A randomized controlled double-blinded trial","volume":"9","author":"Moharam","year":"2024","journal-title":"Pain Rep"}],"container-title":["Journal of Anaesthesiology Clinical 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