Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 3, pp 397–406 | Cite as

Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment: a randomised and blinded clinical trial

  • Thomas WiesmannEmail author
  • Karolin Piechowiak
  • Sonja Duderstadt
  • Daniela Haupt
  • Jan Schmitt
  • Daphne Eschbach
  • Carsten Feldmann
  • Hinnerk Wulf
  • Martin Zoremba
  • Thorsten Steinfeldt
Knee Arthroplasty



Continuous femoral nerve blocks for total knee arthroplasty can cause motor weakness of the quadriceps muscle and thus prevent early mobilisation. Perioperative falls may result as an iatrogenic complication. In this randomised and blinded trial, we tested the hypothesis that a continuous adductor canal block is superior to continuous femoral nerve block regarding mobilisation (‘timed up-and-go’ test and other tests) after total knee arthroplasty under general anaesthesia.


In our study, we included patients scheduled for unilateral knee arthroplasty under general anaesthesia into a blinded and randomised trial. Patients were allocated to a continuous adductor canal block (CACB) or a continuous femoral nerve block (CFNB) for three postoperative days (POD 1–3); with a bolus of 15 ml ropivacaine 0.375 %, followed by continuous infusion of ropivacaine 0.2 % and patient-controlled bolus administration. Both groups received an additional continuous sciatic nerve block as well as a multimodal systemic analgesic treatment. The primary outcome parameter was mobilisation capability, assessed by ‘timed up-and-go’ (TUG) test. Analgesic quality, need for opioid rescue and local anaesthetic consumption were also assessed.


Forty-two patients were included and analysed (21 patients per group). No significant difference was noted in respect to mobilisation at POD 3 (TUG [s]: CACB 45, CFNB 51). It is worth saying that pain scores (numeric rating scale, NRS) were similar in both groups at POD 3 {rest [median (interquartile range)]: CACB 0 (0–3), CFNB 1 (0–3); stress: CACB 4 (2–5), CFNB 3 (2–4)}.


Concerning the mobilisation capability, we did not actually observe a superior effect of CACB compared with CFNB technique in our patients following total knee arthroplasty. Moreover, no difference was observed concerning analgesia quality.


Adductor canal block Sciatic nerve Femoral nerve Knee arthroplasty Mobilisation Motor weakness Regional anaesthesia 


  1. 1.
    Ilfeld BM, Madison SJ (2011) The sciatic nerve and knee arthroplasty: to block, or not to block—that is the question. Reg Anesth Pain Med 36:421–423. doi: 10.1097/AAP.0b013e31822940d2 CrossRefPubMedGoogle Scholar
  2. 2.
    Bauer MCR, Pogatzki-Zahn EM, Zahn PK (2014) Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol 27:501–506. doi: 10.1097/ACO.0000000000000115 CrossRefPubMedGoogle Scholar
  3. 3.
    Chan E-Y, Fransen M, Parker DA, Assam PN, Chua N (2014) Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev 5:CD009941. doi: 10.1002/14651858.CD009941.pub2 PubMedGoogle Scholar
  4. 4.
    Wasserstein D, Farlinger C, Brull R, Mahomed N, Gandhi R (2013) Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty. J Arthroplasty 28:1121–1124. doi: 10.1016/j.arth.2012.08.018 CrossRefPubMedGoogle Scholar
  5. 5.
    Ilfeld BM (2011) Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 113:904–925. doi: 10.1213/ANE.0b013e3182285e01 CrossRefPubMedGoogle Scholar
  6. 6.
    Patterson ME, Bland KS, Thomas LC, Elliott CE, Soberon JR, Nossaman BD, Osteen K (2014) 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. doi: 10.1016/j.jclinane.2014.08.005 PubMedGoogle Scholar
  7. 7.
    Jenstrup MT, Jæger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56:357–364. doi: 10.1111/j.1399-6576.2011.02621.x CrossRefPubMedGoogle Scholar
  8. 8.
    Memtsoudis SG, Yoo D, Stundner O, Danninger T, Ma Y, Poultsides L, Kim D, Chisholm M, Jules-Elysee K, Valle AGD, Sculco TP (2014) Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop. doi: 10.1007/s00264-014-2527-3 Google Scholar
  9. 9.
    Hanson NA, Allen CJ, Hostetter LS, Nagy R, Derby RE, Slee AE, Arslan A, Auyong DB (2014) Continuous ultrasound-guided adductor canal block for total knee arthroplasty. Anesth Analg 118:1370–1377. doi: 10.1213/ANE.0000000000000197 CrossRefPubMedGoogle Scholar
  10. 10.
    Grevstad U, Mathiesen O, Lind T, Dahl JB (2014) Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth 112:912–919. doi: 10.1093/bja/aet441 CrossRefPubMedGoogle Scholar
  11. 11.
    Jaeger P, Koscielniak-Nielsen ZJ, Schrøder HM, Mathiesen O, Henningsen MH, Lund J, Jenstrup MT, Dahl JB (2014) Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One 9:e111951. doi: 10.1371/journal.pone.0111951 PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    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 38:526–532. doi: 10.1097/AAP.0000000000000015 CrossRefPubMedGoogle Scholar
  13. 13.
    Wiesmann T, Steinfeldt T, Wagner G, Wulf H, Schmitt J, Zoremba M (2014) Supplemental single shot femoral nerve block for total hip arthroplasty—impact on early postoperative care, pain management and lung function. Minerva Anestesiol 80(1):48–57PubMedGoogle Scholar
  14. 14.
    White PF, Song D (1999) New Criteria for Fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete’s scoring system. Anesth Analg 88(5):1069–1072PubMedGoogle Scholar
  15. 15.
    Morin AM, Eberhart LHJ, Behnke HKE, Wagner S, Koch T, Wolf U, Nau W, Kill C, Geldner G, Wulf H (2005) Does femoral nerve catheter placement with stimulating catheters improve effective placement? A randomized, controlled, and observer-blinded trial. Anesth Analg 100(5):1503–1510. doi: 10.1213/01.ANE.0000151160.93288.0A CrossRefPubMedGoogle Scholar
  16. 16.
    Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Lee DK, Maldonado RC, Ilfeld BM (2009) Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med 34:480–485. doi: 10.1097/AAP.0b013e3181ada57a CrossRefPubMedGoogle Scholar
  17. 17.
    Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRefPubMedGoogle Scholar
  18. 18.
    Yeung TSM, Wessel J, Stratford PW, MacDermid JC (2008) The timed up and go test for use on an inpatient orthopaedic rehabilitation ward. J Orthop Sports Phys Ther 38:410–417. doi: 10.2519/jospt.2008.2657 CrossRefPubMedGoogle Scholar
  19. 19.
    Barry E, Galvin R, Keogh C, Horgan F, Fahey T (2014) Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 14:1–14. doi: 10.1186/1471-2318-14-14 CrossRefGoogle Scholar
  20. 20.
    Foss NB, Kristensen MT, Kehlet H (2006) Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil 20:701–708CrossRefPubMedGoogle Scholar
  21. 21.
    Holm B, Kristensen MT, Myhrmann L, Husted H, Andersen LØ, Kristensen B, Kehlet H (2010) The role of pain for early rehabilitation in fast track total knee arthroplasty. Disabil Rehabil 32:300–306. doi: 10.3109/09638280903095965 CrossRefPubMedGoogle Scholar
  22. 22.
    Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fialka-Moser V (2008) Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 40:665–671. doi: 10.2340/16501977-0235 CrossRefPubMedGoogle Scholar
  23. 23.
    D’Alessio JG, Faul F, Rosenblum M, Erdfelder E, Shea KP, Lang A-G, Freitas DG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Meth 39:175–191CrossRefGoogle Scholar
  24. 24.
    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. Reg Anesth Pain Med 40:3–10. doi: 10.1097/AAP.0000000000000169 CrossRefPubMedGoogle Scholar
  25. 25.
    Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, Patt ML, Goon AK, Lee Y-Y, Ma Y, Yadeau JT (2014) Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology 120:540–550. doi: 10.1097/ALN.0000000000000119 CrossRefPubMedGoogle Scholar
  26. 26.
    Wulf H, Löwe J, Gnutzmann K-H, Steinfeldt T (2010) Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction. Acta Anaesthesiol Scand 54:414–420. doi: 10.1111/j.1399-6576.2009.02200.x CrossRefPubMedGoogle Scholar
  27. 27.
    Liu D, Graham D, Gillies K, Gillies RM (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26:207–213. doi: 10.5792/ksrr.2014.26.4.207 PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Petterson SC, Barrance P, Marmon AR, Handling T, Buchanan TS, Snyder-Mackler L (2011) Time course of quad strength, area, and activation after knee arthroplasty and strength training. Med Sci Sports Exerc 43:225–231. doi: 10.1249/MSS.0b013e3181eb639a PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Mizner RL, Petterson SC, Snyder-Mackler L (2005) Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 35:424–436. doi: 10.2519/jospt.2005.35.7.424 CrossRefPubMedGoogle Scholar
  30. 30.
    Boezaart AP, Parvataneni HK (2014) Adductor canal block may just be an (unreliable) indirect femoral nerve block. Reg Anesth Pain Med 39:556. doi: 10.1097/AAP.0000000000000137 CrossRefPubMedGoogle Scholar
  31. 31.
    Benthien JP, Huebner D (2015) Efficacy of continuous catheter analgesia of the sciatic nerve after total knee arthroplasty. Swiss Med Wkly 145:w14119. doi: 10.4414/smw.2015.14119 PubMedGoogle Scholar
  32. 32.
    Sato K, Adachi T, Shirai N, Naoi N (2014) Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty: a prospective, randomized, double-blind study. Reg Anesth Pain Med 39:225–229. doi: 10.1097/AAP.0000000000000076 CrossRefPubMedGoogle Scholar
  33. 33.
    Wegener JT, van Ooij B, van Dijk CN, Hollmann MW, Preckel B, Stevens MF (2011) Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med 36:481–488. doi: 10.1097/AAP.0b013e318228c33a CrossRefPubMedGoogle Scholar
  34. 34.
    Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 111:1552–1554. doi: 10.1213/ANE.0b013e3181fb9507 PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Thomas Wiesmann
    • 1
    Email author
  • Karolin Piechowiak
    • 1
    • 2
  • Sonja Duderstadt
    • 1
  • Daniela Haupt
    • 1
  • Jan Schmitt
    • 3
    • 4
  • Daphne Eschbach
    • 5
  • Carsten Feldmann
    • 1
  • Hinnerk Wulf
    • 1
  • Martin Zoremba
    • 1
  • Thorsten Steinfeldt
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital, Philipps University, MarburgMarburgGermany
  2. 2.Department of Anaesthesiology and Intensive CareUniversity Hospital of BernBernSwitzerland
  3. 3.Department of Orthopaedics and RheumatologyUniversity Hospital, Philipps UniversityMarburgGermany
  4. 4.Department of Orthopaedics and TraumatologyLahn-Dill-Klinikum WetzlarWetzlarGermany
  5. 5.Department of TraumatologyUniversity Hospital Marburg, University Hospital, Philipps UniversityMarburgGermany

Personalised recommendations