Adductor canal block versus femoral nerve block for pain control after total knee arthroplasty: A systematic review and Meta-analysis

Abstract

Background: Femoral nerve block is a widely accepted nerve block method with evident reduction in consumption of opioid painkiller and minimization of the duration of hospital stay but may cause weakness of quadriceps muscle strength. Adductor canal block is another nerve block technique that attracts the attention of scientific community nowadays because of its possible superiority over Femoral nerve block regarding mobility and muscle strength. Methods: This is a systematic review and meta-analysis of 33 studies, aiming to compare femoral nerve block with adductor canal block following total knee arthroplasty regarding pain control and mobilization. Results: Adductor canal block showed better preservation of quadriceps muscle strength (MD = 0.28, 95% CI [0.11, 0.46], P = .002), and better mobilization up to 2 days postoperatively. However, no significant difference was found between the 2 interventions regarding pain control (MD = 0.06, 95% CI [−0.06, 0.17], P = .33) or opioid consumption (SMD = 0.08, 95% CI [−0.06, 0.22], P = .28) up to 2 days postoperatively. The better mobilization results of adductor canal block did not translate into a significant difference in the risk of falls or patients’ satisfaction; however, adductor canal block patients had less mean length of hospital stay than the patients with femoral nerve block. Conclusion: Both femoral nerve block and adductor canal block provide similar results regarding pain control and opioid consumption, however adductor canal block provides better preservation of quadriceps strength and mobilization, giving it more advantage over femoral nerve block.

Application of Preoperative Adductor Canal Block Coupled with General Anaesthesia in Elderly Patients Undergoing Total Knee Arthroplasty

“…Disease Markers response. Taken together, it has implied that preoperative ACB coupled with general anaesthesia could reduce the stress response generated by surgery and maintain the intraorganic environment [14,15]. In this study, no comparison of the use of other intraoperative anaesthetics was conducted to confirm alternative approaches to the suppression of surgical stress with anaesthesia.…”

“…The findings of this study disclosed that the plasma adrenaline and norepinephrine concentrations in group B were elevated compared to the preoperative period, differentially with group A, which indicated that group A exhibited a milder stress response. Taken together, it has implied that preoperative ACB coupled with general anaesthesia could effectively reduce the stress response generated by surgery and maintain the intraorganic environment [ 14 , 15 ].…”

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

“…However, femoral nerve block reportedly reduced quadriceps muscle strength, increased the risk of falls, and delayed rehabilitation 12–14 . Additionally, periarticular injection also effectively control pain combined with peripheral nerve block 18–20 . In the present trial, early analgesia management of ACB provided excellent analgesic effectiveness.…”

“…However, the risk of adverse reactions to opioids cannot be ignored in clinical practice. These reactions mainly include respiratory function inhibition, gastrointestinal dysfunction, nausea, vomiting, headache, dizziness, and even addiction, which may cause drug dependence 18,19 . ACB and femoral nerve block can also effectively relieve postoperative pain and reduce analgesic consumption 12,14,17,18 .…”

“…These reactions mainly include respiratory function inhibition, gastrointestinal dysfunction, nausea, vomiting, headache, dizziness, and even addiction, which may cause drug dependence 18,19 . ACB and femoral nerve block can also effectively relieve postoperative pain and reduce analgesic consumption 12,14,17,18 . However, femoral nerve block reportedly reduced quadriceps muscle strength, increased the risk of falls, and delayed rehabilitation 12–14 .…”