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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 8, pp 2614–2619 | Cite as

Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty

  • Dong Li
  • Guo-guang MaEmail author
Knee

Abstract

Purpose

Femoral nerve blocks (FNBs) provide effective analgesia after total knee arthroplasty, but have been associated with quadriceps weakness. Adductor canal block (ACB) is a promising alternative option that delivers a primarily sensory blockade. The aim of this study was to determine whether ACB provides superior quadriceps strength and similar pain control than FNB.

Methods

A systematic search of PubMed, the Cochrane Library, EMBASE and Web of Science was conducted without publication data or language restriction. Comparative studies comparing ACB with FNB were included. Two authors independently assessed data extraction and quality of the studies.

Results

Nine studies with 639 patients were identified. Results of meta-analysis showed that compared with FNB, ACB preserved quadriceps muscle strength better than FNB [MD24h = 1.14, 95 % CI (0.38, 1.91), p < 0.01; MD48h = 0.40, 95 % CI (0.16, 0.64), p < 0.01], while there were no significant differences in pain score during rest at 24 h [SMD = − 0.04, 95 % CI (−0.17, 0.26); n.s] or 48 h [SMD = − 0.10, 95 % CI (−0.27, 0.08); n.s], pain score during activity at 24 h [SMD = 0.13, 95 % CI (−0.36, 0.62); n.s] or 48 h [SMD = − 0.13, 95 % CI (−0.37, 0.12); n.s], opioid consumption at 24 h [SMD = − 0.01, 95 % CI (−1.68, 1.66); n.s] or 48 h [SMD = − 0.92, 95 % CI (−6.86, 5.01); n.s], length of hospital stay [MD = 0.05, 95 % CI (−0.91, 1.00); n.s] and nausea or vomiting [RR = 1.17, 95 % CI (0.62, 2.20); n.s] between ACB and FNB.

Conclusions

ACB preserved the strength of quadriceps more than FNB and achieves similar analgesic effects in post-operative pain.

Level of evidence

Level III.

Keywords

Total knee arthroplasty Femoral nerve blocks Adductor canal block Quadriceps muscle strength 

References

  1. 1.
    Feibel RJ, Dervin GF, Kim PR, Beaule PE (2009) Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty 24:132–137CrossRefPubMedGoogle Scholar
  2. 2.
    Fowler SJ, Symons J, Sabato S, Myles PS (2008) Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 100:154–164CrossRefPubMedGoogle Scholar
  3. 3.
    Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB (2015) Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med 40:3–10CrossRefPubMedGoogle Scholar
  4. 4.
    Grosu I, Lavand’homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 22:1744–1758CrossRefPubMedGoogle Scholar
  5. 5.
    Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB (2013) Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 118:409–415CrossRefPubMedGoogle Scholar
  6. 6.
    Jaeger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38:526–532CrossRefPubMedGoogle Scholar
  7. 7.
    Jiang J, Teng Y, Fan Z, Khan MS, Cui Z, Xia Y (2013) The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J Arthroplasty 28:1882–1887CrossRefPubMedGoogle Scholar
  8. 8.
    Johnson RL, Kopp SL, Hebl JR, Erwin PJ, Mantilla CB (2013) Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. Br J Anaesth 110:518–528CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, Patt ML, Goon AK, Lee YY, Ma Y, Yadeau JT (2014) Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology 120:540–550CrossRefPubMedGoogle Scholar
  10. 10.
    Liu Y, Zhang YZ, Tan Z, Liao R, Shen B (2014) Comparison of postoperative analgesia between ultrasound guided adductor canal block and femoral nerve block in patients after total knee arthroplasty. West China Med J 29:2231–2235Google Scholar
  11. 11.
    Lund J, Jenstrup MT, Jaeger P, Sorensen AM, Dahl JB (2011) Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 55:14–19CrossRefPubMedGoogle Scholar
  12. 12.
    Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R (2009) Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med 34:578–580CrossRefPubMedGoogle Scholar
  13. 13.
    Memtsoudis SG, Dy CJ, Ma Y, Chiu YL, Della Valle AG, Mazumdar M (2012) In-hospital patient falls after total joint arthroplasty: incidence, demographics, and risk factors in the United States. J Arthroplasty 27(823–828):e821Google Scholar
  14. 14.
    Memtsoudis SG, Yoo D, Stundner O, Danninger T, Ma Y, Poultsides L, Kim D, Chisholm M, Jules-Elysee K, Valle AG, Sculco TP (2015) Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop 39:673–680CrossRefPubMedGoogle Scholar
  15. 15.
    Mudumbai SC, Kim TE, Howard SK, Workman JJ, Giori N, Woolson S, Ganaway T, King R, Mariano ER (2014) Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res 472:1377–1383CrossRefPubMedGoogle Scholar
  16. 16.
    Oxford Center for Evidence-Based Medicine, Oxford. www.cebm.net
  17. 17.
    Patterson ME, Bland KS, Thomas LC, Elliott CE, Soberon JR Jr, Nossaman BD, Osteen K (2015) The adductor canal block provides effective analgesia similar to a femoral nerve block in patients undergoing total knee arthroplasty: a retrospective study. J Clin Anesth 27:39–44CrossRefPubMedGoogle Scholar
  18. 18.
    Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113:1144–1162CrossRefPubMedGoogle Scholar
  19. 19.
    Pelt CE, Anderson AW, Anderson MB, Van Dine C, Peters CL (2014) Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplasty 29:1154–1157CrossRefPubMedGoogle Scholar
  20. 20.
    Shah NA, Jain NP (2014) Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty 29:2224–2229CrossRefPubMedGoogle Scholar
  21. 21.
    Zhang W, Hu Y, Tao Y, Liu X, Wang G (2014) Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement. Chin Med J (Engl) 127:4077–4081Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  1. 1.Department of OrthopaedicsLinzi District People’s Hospital of Shandong ProvinceZiboChina
  2. 2.Department of Critical Care MedicineZhongshan Hospital, Fudan UniversityShanghaiChina

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