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Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement

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Abstract

Purpose

Providing effective analgesia for total knee arthroplasty (TKA) patients remains challenging. Femoral nerve block (FNB) offers targeted pain control; however, its effect on motor function, related fall risk and impact on rehabilitation has been the source of controversy. Adductor canal block (ACB) potentially spares motor fibres of the femoral nerve, but the comparative effect of the two approaches has not yet been well defined due to considerable variability in pain perception. Our study compares both single-shot FNB and ACB, side to side, in the same patients undergoing bilateral TKA.

Methods

Sixty patients scheduled for bilateral TKA were randomised to receive ultrasound-guided FNB on one leg and ACB on the other, in addition to combined spinal epidural anaesthesia. The primary outcome was comparative postoperative pain in either extremity at six to eight, 24 and 48 hours postoperatively. Secondary comparative outcomes included motor strength (manually and via dynamometer), physical therapy milestones and patient satisfaction.

Results

While pain levels were lowest at six to eight hours postoperatively and increased thereafter (P < 0.001), no significant differences were seen between extremities at any time point with regard to pain in the quantitative comparison using visual analogue scale (VAS) scores (P = 0.4154), motor strength (P = 0.7548), physical therapy milestones or patient satisfaction. However, in the qualitative comparison, a significant proportion of patients reported the leg receiving ACB to be more painful than that receiving FNB at 24 h [50.9 % (n = 30) vs 25.42 % (n = 15), P = 0.0168)].

Conclusions

Although we could not confirm a benefit in motor function between ACB and FNB, given the equivalent analgesic potency combined with its potentially lower overall impact if neuropraxia should occur, ACB may represent an attractive alternative to FNB.

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Notes

  1. http://www.asahq.org/Home/For-Members/Clinical-Information/ASA-Physical-Status-Classification-System.

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Acknowledgments

We thank Isabelle Kao and Heather Reel for assisting with data collection and management.

Funding

This study was performed with funds from the Hospital for Special Surgery, Department of Anesthesiology, New York, NY, USA, and the Anna-Maria and Stephen Kellen Physician-Scientist Career Development Award, New York, NY, USA (Stavros G. Memtsoudis). Research was supported in part by the Clinical and Translational Science Center (CTSC) at Weill Cornell Medical College through grant no. UL1TR000457-06. Contribution of Dr. Ma on this project was supported in part by the Agency for Healthcare and Quality Research (AHRQ, Rockville, MD) grant no. R01HS021734. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding source, AHRQ, based in Rockville, MD, USA.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, USA

    Stavros G. Memtsoudis, Daniel Yoo, Ottokar Stundner, Thomas Danninger, David Kim, Mary Chisholm & Kethy Jules-Elysee

  2. Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria

    Ottokar Stundner & Thomas Danninger

  3. Division of Biostatics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, USA

    Yan Ma

  4. Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, USA

    Lazaros Poultsides, Alejandro Gonzalez Della Valle & Thomas P. Sculco

Authors
  1. Stavros G. Memtsoudis
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  2. Daniel Yoo
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  3. Ottokar Stundner
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  5. Yan Ma
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  7. David Kim
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  9. Kethy Jules-Elysee
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  10. Alejandro Gonzalez Della Valle
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Correspondence to Stavros G. Memtsoudis.

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Memtsoudis, S.G., Yoo, D., Stundner, O. et al. Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. International Orthopaedics (SICOT) 39, 673–680 (2015). https://doi.org/10.1007/s00264-014-2527-3

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  • DOI: https://doi.org/10.1007/s00264-014-2527-3

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