Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy

Xin, Jiang; Zhang, Yabing; Li, Qian; Xu, Cheng; Lin, Yanjun; Liu, Bin; Zhou, Leng

doi:10.1007/s00167-019-05796-6

Cited by 7 publications

(19 citation statements)

References 28 publications

(28 reference statements)

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“…However, compared with the control or FNB group in ACL reconstruction, no superior analgesic benefits were found. 122 Another RCT of partial meniscectomy 157 and a systematic review of elective arthroscopic knee surgery 147 have produced similarly conflicting evidence in which a majority of outcomes demonstrated no significant analgesic benefits compared with a placebo or FNB 147 and an FNB alone. 157 Compared with the FNB's combined motor and sensory blockade, the ACB used for arthroscopic knee surgery appears to effectively decrease pain while also largely sparing quadriceps motor function.…”

Section: Knee Efficacymentioning

confidence: 99%

“…122 Another RCT of partial meniscectomy 157 and a systematic review of elective arthroscopic knee surgery 147 have produced similarly conflicting evidence in which a majority of outcomes demonstrated no significant analgesic benefits compared with a placebo or FNB 147 and an FNB alone. 157 Compared with the FNB's combined motor and sensory blockade, the ACB used for arthroscopic knee surgery appears to effectively decrease pain while also largely sparing quadriceps motor function. 1,2,47,98 In 2 ACL reconstruction trials, motor blockade was significantly greater with the FNB than the ACB at 1 hour 2 and at 0, 6, and 12 hours 47 after postoperative block administration, respectively, although other studies have found no differences in motor blockade throughout the 24 hours after administration.…”

Section: Knee Efficacymentioning

confidence: 99%

Section: Adductor Canal Blockmentioning

confidence: 99%

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A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

et al. 2022

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Background: Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons. Purpose: To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons. Study Design: Narrative literature review. Methods: A combination of the names of various lower extremity PNBs AND “hip arthroscopy” OR “knee arthroscopy” was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021. Results: A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit ( P > .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas. Conclusion: When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.

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Section: Knee Efficacymentioning

confidence: 99%

Section: Knee Efficacymentioning

confidence: 99%

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A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

et al. 2022

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“…We felt this was justified because numerous studies have established that the adductor canal block provides equivalent analgesia to the femoral nerve block for multiple different procedures involving the lower extremity. [26][27][28] There is likewise no evidence that the anterior and posterior proximal sciatic nerve blocks produce any significant differences in analgesia in adults undergoing knee surgery. 29,30 We did not find any significant differences in pain scores, opioid usage, PASS scores or any measured outcome in either the femoral or adductor CPNB groups or the anterior or posterior sciatic groups in the subgroup analysis.…”

Section: Dovepressmentioning

confidence: 99%

Peripheral Nerve Blockade for Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: The Addition of a Proximal Single-Injection Sciatic Nerve Block Provides Improved Analgesia

Halpern¹,

Kogan²,

Arnzen³

2022

LRA

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We tested the hypothesis that the addition of a single-injection proximal sciatic nerve block to an adductor canal block would significantly reduce pain scores and opioid requirements compared to a group of patients that received only an adductor canal or femoral nerve block for medial patellofemoral ligament reconstruction in pediatric patients. The primary end-point is the number of patients achieving a Patient Acceptable Symptom State (PASS) (pain score less than four) for the entire 24-hour postoperative period in patients with and without a proximal sciatic block. Patients and Methods: This is a retrospective cohort study of 144 consecutive pediatric patients, ages 10 to 18 years, undergoing medial patellofemoral ligament reconstruction with peripheral nerve blockade for postoperative analgesia from 2016-2020 at a pediatric orthopedics children's hospital. Patients were divided into 2 cohorts with and without a proximal sciatic nerve block: group A/F: adductor canal or femoral CPNB and group AS: adductor canal CPNB and a proximal single-injection sciatic nerve block. Results: There was strong evidence for an increase in the number of patients who reported a pain score less than four for the entire 24-hour postoperative period in the group that received the additional proximal sciatic block. (PASS: A/F 13/62 (21%) vs AS 43/82 (52%), p<0.001) There was strong evidence for a reduction in mean and maximum pain scores and opioid requirements in the first 24-hours after surgery in the proximal sciatic group. Conclusion:The addition of a proximal sciatic nerve block was associated with significantly reduced mean and maximum pain scores and opioid requirements after medial patellofemoral ligament reconstruction in pediatric patients and supports a randomized clinical trial to confirm these findings. Based on the results of this study we recommend the addition of a proximal sciatic nerve block, anterior or posterior, to an adductor canal block to provide improved analgesia and reduced opioid requirements in the 24-hours after MPFLR in pediatric patients.

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“…Pain, especially early postoperative pain, can seriously affect postoperative limb function rehabilitation and can easily lead to physical stress reactions and a continuous release of inflammatory factors 10 . Analgesia management after knee surgery has been reported in knee arthroplasty, knee arthroscopy, and knee ligament reconstruction 11–13 . The commonly used analgesic schemes include general analgesia (GA), peripheral nerve block, and local or joint cavity injection analgesia 11–14 .…”

Section: Introductionmentioning

confidence: 99%

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

Xiong

et al. 2023

Orthopaedic Surgery

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Objective: Patellar dislocation is a common injury in sports medicine. While surgical treatment is an important option, pain is severe after surgery. This study compared the analgesic effect and early rehabilitation quality between adductor canal block combined with general analgesia (ACB + GA) and single general analgesia (SGA) after recurrent patellar dislocation (RPD) for "3-in-1" procedure surgery.Methods: From July 2018 to January 2020, a prospective randomized controlled trial was conducted in analgesia management after RPD for "3-in-1" procedure surgery. The 40 patients in the experimental group received ACB (0.3% ropivacaine 30 mL) + GA, while the 38 patients in the control group received SGA. Patients in both groups received "3-in-1" procedure surgery, standardized anesthesia, and analgesia during hospitalization. The outcomes included the visual analog scale (VAS), quadriceps strength, Inpatient Satisfaction Questionnaire (IPSQ), Lysholm scores, and Kujala scores. Total rescue analgesic consumption and adverse events were also recorded. One-way analysis of variance (ANOVA) was used to compare continuous variables between groups and chi-square or Fisher's exact tests were used to compare count data. Nonparametric Kruskal-Wallis H tests evaluated ranked data.Results: No significant differences in resting VAS scores were observed at 8, 12, and 24 h postoperatively. However, the flexion and moving VAS scores of the ACB + GA group were significantly lower than those of the SGA group (p < 0.05). Meanwhile, the first triggering of rescue analgesics was advanced in the SGA group (p < 0.0001), and the dose of opioid analgesics was significantly higher (p < 0.0001). The quadriceps strength of the ACB + GA group was higher than that of the SGA group at 8 h postoperatively. The IPSQ of the ACB + GA group was significantly higher 24 h postoperatively. We observed no significant differences in Lysholm and Kujala scores between the two groups at 3 months after surgery. Conclusions:Early analgesia management of ACB + GA showed excellent analgesia effectiveness and a positive hospitalization experience for RPD patients undergoing "3-in-1" procedure surgery. Moreover, this management was good for early rehabilitation.

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Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy

Cited by 7 publications

References 28 publications

A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

Peripheral Nerve Blockade for Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: The Addition of a Proximal Single-Injection Sciatic Nerve Block Provides Improved Analgesia

Adductor Canal Block Combined with General Analgesia for Patients with Recurrent Patellar Dislocation Undergoing “3‐in‐1” Procedure Surgery: A Prospective Randomized Controlled Trial

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