Comparison of adductor canal block for analgesia in arthroscopic surgery with ropivacaine alone and ropivacaine and clonidine

Arora, Saurabh; Sadashivappa, Chethan; Sen, Indu; Sahni, Neeru; Gandhi, Komal; Batra, Yatindra Kumar; Dhillon, Mandeep S

doi:10.1016/j.bjane.2018.12.013

Cited by 3 publications

(20 citation statements)

References 17 publications

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“…The full details of the regional anaesthetic techniques are shown in online Supporting Information (Appendix S3). Briefly, ultrasound guidance alone was used by 14 studies [69, 70, 75, 83, 84, 89, 92, 95, 101, 102, 108, 110, 112, 116], nerve stimulation alone in 18 studies [81, 85, 87, 90, 93, 96, 97, 103, 105, 106, 111, 114, 115, 120, 121, 123, 124, 129] or either ultrasound and/or nerve stimulation guidance in eight studies [71, 72, 77, 78, 82, 91, 109, 113]. One study [104] did not specify nerve localisation technique.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 34 were excluded due to their lack of randomised nature or being a crossover design (n = 2) [35, 36]; having an ineligible surgery or not having data for the ACL subgroup (n = 5) [37–41]; not having an active comparator group (n = 2) [42, 43]; or being the only study identified evaluating the specific comparison (n = 25) [44–68]. Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 35 studies (2315 patients) [69-73, 76, 78, 79, 82-85, 89-91, 94-96, 98, 99, 103-109, 113, 114, 117, 118, A total of 40 studies (2733 patients)[69-71, 73, 76-79, 81-85, 87, 89-92, 94-96, 98-101, 103-109, 111, 113, 114, 116, 118, 120, 122, 124] reported rest pain severity at 24 h.The AUC was calculated for trials that reported rest pain severity at all pre-defined time points (PACU, and 6 h, 12 h and 24 h). A total of 14 studies (1266 patients)[69,70,76,82,89,94,96,103,104,106,107,109,113,124] were included in analysis. Across the included studies, there were a total of 16 pairwise comparisons and eight regional anaesthetic techniques investigated: single-injection FNB; single-injection ACB; single-injection LIA; single-injection FNB combined with single-injection SNB; single-injection FNB combined with single-injection LIA; continuous FNB; graft-donor site infiltration; and control (systemic analgesia)…”

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confidence: 99%

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Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

et al. 2022

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Summary Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta‐analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid‐related adverse effects and functional recovery. Network meta‐analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft‐donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single‐injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid‐related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single‐injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

et al. 2022

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“…Inclusion criteria: ①Patients aged > 18 years; ②Grade I-III according to the American Society of Anesthesiologists (ASA) classification standard; ③Patients with a clear clinical diagnosis and scheduled laparotomy; ④Patients with a Montreal Cognitive Assessment (MoCA) score [ 10 ] ≥26 points; ⑤The study was in accordance with the Declaration of Helsinki [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Analgesic effects of different concentrations of ropivacaine in transversalis fascia plane block during laparotomy

Tian

Zhan²,

Ke³

et al. 2022

BMC Anesthesiol

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Objective To explore the analgesic effects of different concentrations of ropivacaine in transversalis fascia plane (TFP) block during laparotomy. Methods Ninety patients who underwent laparotomy admitted to our hospital from March 2019 to March 2020 were selected as the study subjects and were divided equally into a low concentration group, a medium concentration group, and a high concentration group according to the randomized grouping method. The low concentration group adopted 0.4% ropivacaine 40 ml, the medium concentration group was given 0.5% ropivacaine 40 ml, and the high concentration group was given 0.6% ropivacaine 40 ml. The hemodynamic indexes and the incidence of adverse reactions in the two groups were compared. The Numerical Rating Scale (NRS) was used to assess the postoperative pain in the three groups, the Bruggrmann comfort scale (BCS) was used to assess the comfort level in the three groups, and the Mini-mental State Examination (MMSE) was used to evaluate the postoperative cognitive function of the three groups of patients. Results The mean artery pressure (MAP) and heart rate (HR) levels at T1 and T2 were significantly lower in the medium concentration group than in the other two groups (P < 0.05). The low concentration group had a significantly higher NRS score at T2 than the medium concentration group and the high concentration group (P < 0.05). A significantly higher BCS score was observed in the high concentration group than the other two groups (P < 0.05). There were significantly higher Ramsay scores and MMSE scores in the medium concentration group than in the low concentration and high concentration groups (P < 0.05). The overall incidence of adverse reactions of the high concentration group was significantly higher than that of the low concentration group (P < 0.05), but showed similar results with the medium concentration group. Conclusion The medium concentration group exhibits a better analgesic effect than the low concentration group and higher safety than the high concentration group. Therefore, the use of medium concentration ropivacaine in TFP block may provide a referential basis for clinical treatment.

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“…The adductor canal is a musculoaponeurotic tunnel functioning as a passageway for neurovascular structures (the femoral artery, femoral vein, saphenous nerve and the nerve to the vastus medialis) from the femoral triangle to the adductor hiatus [10]. It has been shown that selective blockade of the saphenous nerve in the adductor canal provides effective analgesia management after surgical knee procedures [4][5][6][7][8][9][10][11][12][13][14][15]. Because the saphenous nerve is a sensory branch of the femoral nerve, ACB has potential advantages over femoral block by avoiding motor blockade of the quadriceps muscle and providing early ambulation [16].…”

Section: Introductionmentioning

confidence: 99%

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: a randomized, blinded study

Ekinci

Çiftçi

Demiraran

et al. 2021

Korean J Anesthesiol

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Comparison of adductor canal block for analgesia in arthroscopic surgery with ropivacaine alone and ropivacaine and clonidine

Cited by 3 publications

References 17 publications

Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

Analgesic effects of different concentrations of ropivacaine in transversalis fascia plane block during laparotomy

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: a randomized, blinded study

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