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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

Abstract

Introduction

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.

Methods

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.

Results

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)}.

Conclusions

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.

Keywords

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

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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

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