Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty

Abstract

Background:This meta-analysis aimed to evaluate the efficiency and safety of the combined adductor canal block with peri-articular infiltration versus periarticular infiltration alone for pain control after total knee arthroplasty (TKA).Methods:PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify articles comparing the combined adductor canal block with peri-articular infiltration and periarticular infiltration alone for pain control after TKA. Main outcomes were numeric rating scale (NRS) at postoperative day (POD) 0–2 and opioid consumption. Meta-analysis was performed using Stata 11.0 software.Results:Four randomized controlled trial (RCTs) including 297 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between the groups regarding NRS score at POD 0 (weighted mean difference [WMD] = −0.849, 95% confidence interval [CI]: −1.345 to −0.353, P = .001), POD 1 (WMD = −0.960, 95% CI: −1.474 to −0.446, P = .000), and POD 2 (WMD = −0.672, 95% CI: −1.163 to −0.181, P = .007) after TKA. Significant differences were found in terms of opioid consumption at POD 0 (WMD = −3.761, 95% CI: −6.192 to −1.329, P = .002), POD 1 (WMD = −4.795, 95% CI: −8.181 to −1.409, P = .006), and POD 2 (WMD = −2.867, 95% CI: −4.907 to −0.827, P = .006).Conclusion:Combined adductor canal block with peri-articular infiltration could significantly reduce NRS scores and opioid consumption in comparison with periarticular infiltration alone following TKA. Additionally, there is a lower incidence of nausea and vomiting in the combined groups.

Comparison of femoral block and adductor canal block in the postoperative analgesia of patients undergoing arthroscopic knee surgery

“…However, Li et al [17] demonstrated that ACB preserved greater quadriceps strength more than FNB with similar pain control. Likewise again, the VAS pain scores were relatively lower in the two groups compared with baseline, no significant difference was observed in pain relief at any followup time between the groups, suggesting both ACB and FNB provided better analgesia without any statistical significance in the last meta analyze [18].…”

Adductor Canal Block Combined with Sciatic Nerve Block Vs. Local Analgesic Infiltration for Pain Control after Total Knee Arthroplasty

“…However, still there is a lack of clinical trials of the combined adductor canal block with periarticular infiltration versus periarticular infiltration alone for pain management after TKR. There is a study [5] indicated that the combined adductor canal block with periarticular infiltration could significantly reduce VAS scores at rest when compared with periarticular infiltration alone for pain management after TKR.…”

“…LAI usually administrates as periarticular or with intra-articular infiltration. Meanwhile, the efficacy of LAI was comparable to that of epidural anesthesia, femoral nerve block (FNB) [2], adductor canal block (ACB) [5], and intrathecal morphine [6]. Sciatic nerve block (SNB) and LAI are two major options to supplement FNB in relieving of pain after TKR, However, its short duration of action limited its clinical application [7][8][9].…”

“…The sensory fibers for knee joint involve both the femoral and sciatic nerves. FNB and LAI differ in their effects on these nerves because FNB has analgesic effects only in the femoral nerve area, whereas LIA involves the injection into the entire knee joint [5].…”

“…Thus, the risk of fall was low and the success rate is high. Combined LAI with ACB may improve and prolong analgesia [5]. The sensory fibers for knee joint involve both the femoral and sciatic nerves.…”