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Clinical Orthopaedics and Related Research®

, Volume 472, Issue 5, pp 1377–1383 | Cite as

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

  • Seshadri C. Mudumbai
  • T. Edward Kim
  • Steven K. Howard
  • J. Justin Workman
  • Nicholas Giori
  • Steven Woolson
  • Toni Ganaway
  • Robert King
  • Edward R. MarianoEmail author
Symposium: Perioperative Pain Management in Orthopaedic Surgery

Abstract

Background

Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established.

Questions/purposes

We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay.

Methods

Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients’ care reviewed their medical records to record the parameters noted above.

Results

Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10th–90th percentiles]: 37 m [0–90 m] versus 6 m [0–51 m]; p < 0.001) and POD 2 (60 m [0–120 m] versus 21 m [0–78 m]; p = 0.003). Adjusted linear regression confirmed the association between adductor canal catheter use and ambulation distance on POD 1 (B = 23; 95% CI = 14–33; p < 0.001) and POD 2 (B = 19; 95% CI = 5–33; p = 0.008). Pain scores, daily opioid consumption, and hospital length of stay were similar between groups.

Conclusions

Adductor canal CPNB may promote greater early postoperative ambulation compared to femoral CPNB after TKA without a reduction in analgesia. Future randomized studies are needed to validate our major findings.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Keywords

Ropivacaine Clinical Pathway Femoral Nerve Femoral Nerve Block Adductor Canal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Dr. Ronald Pearl, Chair, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, for his general support of this research and Dr. Todd Wagner, Associate Director, Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, for his guidance on statistical methods.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Seshadri C. Mudumbai
    • 1
  • T. Edward Kim
    • 1
  • Steven K. Howard
    • 1
  • J. Justin Workman
    • 1
  • Nicholas Giori
    • 2
  • Steven Woolson
    • 2
  • Toni Ganaway
    • 1
  • Robert King
    • 1
  • Edward R. Mariano
    • 1
    • 3
    Email author
  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineStanford University School of MedicineStanfordUSA
  2. 2.Department of Orthopaedic SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Anesthesiology and Perioperative Care ServiceVeterans Affairs Palo Alto Health Care SystemPalo AltoUSA

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