Moderate-to-severe postoperative pain remains a challenge for both patients and surgeons after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to systematically review the current evidence in the literature to compare adductor canal block (ACB) with femoral nerve block (FNB) in the treatment of ACLR.
A comprehensive search of the published literature in PubMed, Scopus, EMBASE, and Cochrane Library databases was performed. Only English randomized clinical trials (RCTs) were included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse events, patient satisfaction, and quadriceps strength.
Eight RCTs with a total of 587 patients were included. No statistically
significant difference was observed between the ACB and FNB groups in pain scores at 6 h, 12 h, 24 h, or 48 h; cumulative opioid consumption at 24 h or 48 h; patient satisfaction at 24 or 48 h; and postoperative adverse event. However, ACB showed superior quadriceps strength in the early postoperative period.
Both treatments provided similar overall pain relief after ACLR. The
potential benefits of quadriceps preservation with ACB are worthy of future study.
Therefore, ACB is recommended as an attractive alternative to FNB as the peripheral nerve block of choice for ACLR.
Level of evidence
Meta-analysis of Level 1 was performed in this study.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J et al (2016) Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 124(5):1053–1064
Akkaya T, Ersan O, Ozkan D, Sahiner Y, Akin M, Gümüş H et al (2008) Saphenous nerve block is an effective regional technique for post-meniscectomy pain. Knee Surg Sports Traumatol Arthrosc 16(9):855–858
Bailey L, Griffin J, Elliott M, Wu J, Papavasiliou T, Harner C et al (2019) Adductor canal nerve versus femoral nerve blockade for pain control and quadriceps function following anterior cruciate ligament reconstruction with patellar tendon autograft: a prospective randomized trial. Arthroscopy 35(3):921–929
Ballantyne BT, O'Hare SJ, Paschall JL, Pavia-Smith MM, Pitz AM, Gillon JF et al (1993) Electromyo-graphic activity of selected shoulder muscles in commonly used therapeutic exercises. Phys Ther 73(10):668–682
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL (2011) Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med 12(4):657–667
Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R et al (2001) Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 16(4):436–445
Chisholm MF, Bang H, Maalouf DB, Marcello D, Lotano MA, Marx RG et al (2014) Postoperative analgesia with saphenous block appears equivalent to femoral nerve block in ACL reconstruction. HSS J 10(3):245–251
El Ahl MS (2015) Femoral nerve block versus adductor canal block for postoperative pain control after anterior cruciate ligament reconstruction: a randomized controlled double blind study. Saudi J Anaesth 9(3):279–282
Ghodki PS, Shalu PS, Sardesai SP (2018) Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol 34(2):242–246
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928
Jaeger P, Grevstad U, Henningsen MH, Gottschau B, Mathiesen O, Dahl JB (1993) Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 56(8):1013–1019
Jæger 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(2):409–415
Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J et al (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38(6):526–532
Jenstrup MT, Jæger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O et al (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56(3):357–364
Kuang MJ, Ma JX, Fu L, He WW, Zhao J, Ma XL (2017) Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty 32(10):3238–3248
Kuang MJ, Xu LY, Ma JX, Wang Y, Zhao J, Lu B et al (2016) Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: a meta-analysis. Int J Surg 31:17–24
Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM (1993) Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 50(3):303–312
Kwofie MK, Shastri UD, Gadsden JC, Sinha SK, Abrams JH, Xu D et al (2013) The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 38(4):321–325
Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40(5):925–933
Lynch JR, Okoroha KR, Lizzio V, Yu CC, Jildeh TR, Moutzouros V (2019) Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med 47(2):355–363
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535
Myers H, Christopherson Z, Butler RJ (2018) Relationship between the lower quarter Y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. Int J Sports Phys Ther 13(2):152–159
Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM (2018) Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: a cross-sectional study. J Athl Train 53(5):475–485
Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113(5):1144–1162
Petersen W, Taheri P, Forkel P, Zantop T (2011) Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 134(10):1417–1428
Runner RP, Boden SA, Godfrey WS, Premkumar A, Samady H, Gottschalk MB et al (2018) Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded. Randomized Trial Orthop J Sports Med 6(9):2325967118797990
Seangleulur A, Manuwong S, Chernchujit B, Worathongchai S, Sorin T (2019) Comparison of post-operative analgesia between adductor canal block and femoral nerve block after arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial. J Med Assoc Thai 102(3):335–342
Secrist ES, Freedman KB, Ciccotti MG, Mazur DW, Hammoud S (2015) Pain management after outpatient anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Am J Sports Med 44(9):2435–2447
Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL (2010) Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 468(1):135–140
There is no funding source.
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Min, H., Ouyang, Y. & Chen, G. Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block. Knee Surg Sports Traumatol Arthrosc 28, 2675–2686 (2020). https://doi.org/10.1007/s00167-020-05933-6
- Anterior cruciate ligament reconstruction
- Adductor canal block
- Femoral nerve block
- Pain control