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Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. 1.

    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

    CAS  Article  Google Scholar 

  2. 2.

    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

    Article  Google Scholar 

  3. 3.

    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

    Article  Google Scholar 

  4. 4.

    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

    CAS  Article  Google Scholar 

  5. 5.

    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

    Article  Google Scholar 

  6. 6.

    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

    CAS  Article  Google Scholar 

  7. 7.

    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

    Article  Google Scholar 

  8. 8.

    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

    Article  Google Scholar 

  9. 9.

    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

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    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

    Article  Google Scholar 

  11. 11.

    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

    Article  Google Scholar 

  12. 12.

    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

    Article  Google Scholar 

  13. 13.

    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

    Article  Google Scholar 

  14. 14.

    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

    CAS  Article  Google Scholar 

  15. 15.

    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

    Article  Google Scholar 

  16. 16.

    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

    Article  Google Scholar 

  17. 17.

    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

    Article  Google Scholar 

  18. 18.

    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

    Article  Google Scholar 

  19. 19.

    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

    Article  Google Scholar 

  20. 20.

    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

    Article  Google Scholar 

  21. 21.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  Google Scholar 

  22. 22.

    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

    Article  Google Scholar 

  23. 23.

    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

    Article  Google Scholar 

  24. 24.

    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

    Article  Google Scholar 

  25. 25.

    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

    Article  Google Scholar 

  26. 26.

    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

    PubMed  Google Scholar 

  27. 27.

    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

    Google Scholar 

  28. 28.

    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

    Article  Google Scholar 

  29. 29.

    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

    Article  Google Scholar 

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Correspondence to Gang Chen.

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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

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Keywords

  • Anterior cruciate ligament reconstruction
  • Adductor canal block
  • Femoral nerve block
  • Pain control
  • Meta-analysis