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Ultrasound-guided adductor canal block is superior to femoral nerve block for early postoperative pain relief after single-bundle anterior cruciate ligament reconstruction with hamstring autograft

  • Original Article–Orthopedics
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 04 July 2023

Abstract

Purpose

This study aimed to compare the combination of a lateral femoral cutaneous nerve (LFCN) block with a femoral nerve block (FNB) and an adductor canal block (ACB) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring autograft.

Methods

A non-randomized, prospective, controlled clinical trial was conducted. The FNB and ACB groups consisted of 41 and 40 patients, respectively. Thirty minutes prior to surgery, the patients received an ultrasound-guided LFCN block either with FNB or ACB. The following values were recorded and compared between the two groups: duration of surgery, pain management during surgery (including total amount of fentanyl administered), and numerical rating scale (NRS) scores at 30 min and 4, 8, 12, 24, 48, and 72 h after surgery. Factors affecting pain relief (NRS < 2) were evaluated, including block type, total amount of fentanyl administered, duration of surgery, age, sex, body mass index, and postoperative suppository use. Significant factors predicting pain relief were determined using the Cox proportional hazard regression model.

Results

There were no significant differences in pain management during the surgery. Pain scores were significantly lower in the ACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The Cox proportional hazard regression model identified ACB as a significant factor for pain relief (hazard ratio: 1.88; 95% confidence interval: 1.12–3.13; p = 0.018).

Conclusion

The combination of ACB with LFCN block during ACL reconstruction significantly reduced pain in the early postoperative period compared to FNB with LFCN block.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, JN. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

References

  1. Cohn BT, Draeger RI, Jackson DW. The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 1989;17:344–9.

    Article  CAS  PubMed  Google Scholar 

  2. Alford JW, Fadale PD. Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg. 2003;19:855–61.

    Article  Google Scholar 

  3. Beck PR, Nho SJ, Balin J, et al. Postoperative pain management after anterior cruciate ligament reconstruction. J Knee Surg. 2004;17:18–23.

    Article  PubMed  Google Scholar 

  4. Kocher MS, Steadman JR, Briggs K, et al. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Jt Surg Ser A. 2002;84:1560–72.

    Article  Google Scholar 

  5. Secrist ES, Freedman KB, Ciccotti MG, et al. Pain management after outpatient anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Am J Sports Med. 2016;44:2435–47.

    Article  PubMed  Google Scholar 

  6. Williams BA, Kentor ML, Vogt MT, et al. Economics of nerve block pain management after anterior cruciate ligament reconstruction. Anesthesiology. 2004;100:697–706.

    Article  PubMed  Google Scholar 

  7. Akinci SB, Saricaoǧlu F, Atay OA, et al. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery. Arthrosc J Arthrosc Relat Surg. 2005;21:1060–5.

    Article  Google Scholar 

  8. Mayr HO, Entholzner E, Hube R, et al. Pre-versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg. 2007;127:241–4.

    Article  PubMed  Google Scholar 

  9. Kurosaka K, Tsukada S, Nakayama H, et al. Periarticular injection versus femoral nerve block for pain relief after anterior cruciate ligament reconstruction: a randomized controlled trial. Arthrosc J Arthrosc Relat Surg. 2018;34:182–8.

    Article  Google Scholar 

  10. Kristensen PK, Pfeiffer-Jensen M, Storm JO, et al. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: A randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014;22:317–23.

    Article  PubMed  Google Scholar 

  11. Nakase J, Shimozaki K, Asai K, et al. Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial. Arch Orthop Trauma Surg. 2021;141:455–60.

    Article  PubMed  Google Scholar 

  12. Ogura T, Omatsu H, Fukuda H, et al. Femoral nerve versus adductor canal block for early postoperative pain control and knee function after anterior cruciate ligament reconstruction with hamstring autografts: a prospective single-blind randomised controlled trial. Arch Orthop Trauma Surg. 2021;141:1927–34.

    Article  PubMed  Google Scholar 

  13. Lynch JR, Okoroha KR, Lizzio V, et al. Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med. 2019;47:355–63.

    Article  PubMed  Google Scholar 

  14. Mall NA, Wright RW. Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthrosc J Arthrosc Relat Surg. 2010;26:404–16.

    Article  Google Scholar 

  15. Nielsen TD, Moriggl B, Barckman J, et al. The lateral femoral cutaneous nerve: description of the sensory territory and a novel ultrasound-guided nerve block technique. Reg Anesth Pain Med. 2018;43:357–66.

    Article  PubMed  Google Scholar 

  16. Nakase J, Toratani T, Kosaka M, et al. Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator. Knee. 2016;23:91–6.

    Article  PubMed  Google Scholar 

  17. Kwofie MK, Shastri UD, Gadsden JC, et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk. Reg Anesth Pain Med. 2013;38:321–5.

    Article  PubMed  Google Scholar 

  18. Wong WY, Bjørn S, Strid JMC, et al. Defining the location of the adductor canal using ultrasound. Reg Anesth Pain Med. 2017;42:241–5.

    Article  PubMed  Google Scholar 

  19. Manickam B, Perlas A, Duggan E, et al. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med. 2009;34:578–80.

    Article  PubMed  Google Scholar 

  20. Vilhelmsen F, Nersesjan M, Andersen JH, et al. Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: A randomized trial in healthy volunteers. BMC Anesthesiol. 2019;19:1–8.

    Article  CAS  Google Scholar 

  21. Ghodki PS, Shalu PS, Sardesai SP. Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol. 2018;34:242–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Beck P, Nho S, Balin J, et al. Postoperative pain management after anterior cruciate ligament reconstruction. J Knee Surg. 2010;17:18–23.

    Article  Google Scholar 

  23. Dauri M, Fabbi E, Mariani P, et al. Continuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction. Reg Anesth Pain Med. 2009;34:95–9.

    Article  PubMed  Google Scholar 

  24. Dauri M, Polzoni M, Fabbi E, et al. Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction. Acta Anaesthesiol Scand. 2003;47:20–5.

    Article  CAS  PubMed  Google Scholar 

  25. Frost S, Grossfeld S, Kirkley A, et al. The efficacy of femoral nerve block in pain reduction for outpatient hamstring anterior cruciate ligament reconstruction: A double-blind, prospective, randomized trial. Arthroscopy. 2000;16:243–8.

    Article  CAS  PubMed  Google Scholar 

  26. Guirro UBDP, Tambara EM, Munhoz FR. Femoral nerve block: Assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction. Brazilian J Anesthesiol. 2013;63:483–91.

    Article  Google Scholar 

  27. Luo TD, Ashraf A, Dahm DL, et al. Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patients. Am J Sports Med. 2015;43:331–6.

    Article  PubMed  Google Scholar 

  28. Christensen JJ, Krych AJ, Engasser WM, et al. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43:2510–4.

    Article  PubMed  Google Scholar 

  29. Magnussen RA, Pottkotter K, Di SS, et al. Femoral nerve block after anterior cruciate ligament reconstruction. J Knee Surg. 2017;30:323–8.

    PubMed  Google Scholar 

  30. Petersen W, Taheri P, Forkel P, et al. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg. 2014;134:1417–28.

    Article  PubMed  Google Scholar 

  31. Jæger P, Nielsen ZJK, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength. Anesthesiology. 2013;118:409–15.

    Article  PubMed  Google Scholar 

  32. Abdallah FW, Whelan DB, Chan VW, et al. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology. 2016;124:1053–64.

    Article  CAS  PubMed  Google Scholar 

  33. Bailey L, Griffin J, Elliott M, et al. 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. Arthrosc J Arthrosc Relat Surg. 2019;35:921–9.

    Article  Google Scholar 

  34. Runner RP, Boden SA, Godfrey WS, et al. Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded. Randomiz Trial Orthop J Sport Med. 2018;6:1–8.

    Google Scholar 

  35. Edwards MD, Bethea JP, Hunnicutt JL, et al. Effect of adductor canal block versus femoral nerve block on quadriceps strength, function, and postoperative pain after anterior cruciate ligament reconstruction: a systematic review of level 1 studies. Am J Sports Med. 2020;48:2305–13.

    Article  PubMed  Google Scholar 

  36. Christensen JE, Taylor NE, Hetzel SJ, et al. Isokinetic strength deficit 6 months after adductor canal blockade for anterior cruciate ligament reconstruction. Orthop J Sport Med. 2017;5:1–6.

    Article  Google Scholar 

  37. Lonchena TK, McFadden K, Orebaugh SL. Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle. Surg Radiol Anat. 2016;38:115–22.

    Article  PubMed  Google Scholar 

  38. Ritter JW. Femoral nerve “sheath” for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth. 1995;7:470–3.

    Article  CAS  PubMed  Google Scholar 

  39. Tubbs RS, Loukas M, Shoja MM, et al. Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat. 2007;29:569–73.

    Article  PubMed  Google Scholar 

  40. Elazab E. Subsartorial compartments and membranes in the adductor canal:morphological, histological and Immunohistochemical Study. Egypt J Anat. 2017;40:1–17.

    Article  Google Scholar 

  41. Goffin P, Lecoq JP, Ninane V, et al. Interfascial spread of injectate after adductor canal injection in fresh human cadavers. Anesth Analg. 2016;123:501–3.

    Article  CAS  PubMed  Google Scholar 

  42. Runge C, Moriggl B, Børglum J, et al. The spread of ultrasound-guided injectate from the adductor canal to the genicular branch of the posterior obturator nerve and the popliteal plexus: a cadaveric study. Reg Anesth Pain Med. 2017;42:725–30.

    Article  PubMed  Google Scholar 

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Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan

    Takeshi Oshima, Junsuke Nakase, Tomoyuki Kanayama, Yusuke Yanatori, Toshihiro Ishida & Hiroyuki Tsuchiya

  2. Asanogawa General Hospital, Kanazawa, Ishikawa, Japan

    Takeshi Oshima

Authors
  1. Takeshi Oshima
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  2. Junsuke Nakase
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  3. Tomoyuki Kanayama
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  4. Yusuke Yanatori
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  5. Toshihiro Ishida
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  6. Hiroyuki Tsuchiya
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Contributions

Conceptualization: JN. Project administration and supervision: JN and HT. Investigation, formal analysis, and validation: TO, YI, and YY. Writing-original draft: TO. Writing-review and editing: JN, TK, and HT.

Corresponding author

Correspondence to Junsuke Nakase.

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Conflict of interest

The authors declare that they have no conflicts of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

The study design was prospectively reviewed and approved by our institutional ethics committee (1842–3).

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Participants provided written consent for publication of images.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Oshima, T., Nakase, J., Kanayama, T. et al. Ultrasound-guided adductor canal block is superior to femoral nerve block for early postoperative pain relief after single-bundle anterior cruciate ligament reconstruction with hamstring autograft. J Med Ultrasonics 50, 433–439 (2023). https://doi.org/10.1007/s10396-023-01309-8

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  • DOI: https://doi.org/10.1007/s10396-023-01309-8

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