Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty

Abstract

Background:Both adductor canal block (ACB) and periarticular infiltration (PI) have been shown to reduce pain after total knee arthroplasty (TKA) without the motor blockade. However, the efficacy and safety of combined ACB with PI (ACB + PI) as compared to PI alone for analgesia after TKA remains controversial. We therefore performed a meta-analysis to compare the effects of ACB + PI with PI alone on pain controll after TKA.Methods:PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies comparing ACB + PI with PI alone for TKA patients. The primary outcomes included pain score with rest or activity and morphine consumption. Secondary outcomes were distance walked, length of hospital stay, and postoperative complications. Relevant data were analyzed using RevMan v5.3.Results:Three studies involving 337 patients were included. Combined ACB with PI was associated with longer distances walked than PI alone (MD = 7.27, 95% CI: 0.43–14.12, P = 0.04) on postoperative day 1. The outcomes of pain, morphine consumption, length of hospital stay, and postoperative complications were not statistically different between the 2 groups (P > 0.05).Conclusion:Our meta-analysis suggests that combined ACB with PI may achieve earlier ambulation for patients after TKA without a reduction in analgesia when compared to PI alone in the early postoperative period. There were no significant differences in morphine consumption, length of hospital stay, and postoperative complications between the 2 groups. However, owing to the variation of included studies, no firm conclusions can be drawn.

The efficacy of combined adductor canal block with local infiltration analgesia for pain control after total knee arthroplasty

“…The pooled results indicated that ACB combined LIA was associated with a less pain scores at 24 h and 48 h after TKA, which was equivalent on a 110-point VAS to 7.42 points at 24 h and 4.72 points at 48 h. Ma et al [17] conducted a meta-analysis about the combined ACB with periarticular infiltration versus periarticular infiltration for analgesia after TKA. The results of their meta-analysis revealed that combined ACB with periarticular infiltration may not associate with a reduction in analgesia when compared to periarticular infiltration alone in the early postoperative period after TKA.…”

The ultrasound‐guided iPACK block with continuous adductor canal block for total knee arthroplasty

“…Although different analgesic techniques have been used for total knee arthroplasty such as epidural anaesthesia, FNB, ACB, intra-articular local anaesthetic infiltration, or systemic analgesia, there is no consensus on the ideal approach. FNB is a well-established technique, and was considered the standard of postoperative analgesia in TKA [3]. Recent studies have compared FNB to PCA regimens or other nerve block techniques demonstrating the analgesic utility of FNB in total knee arthroplasty, but also its association with quadriceps muscle weakness, delayed ambulation, and a risk of falling [4,5].…”

“…Although various analgesic techniques have been proposed, there is currently no consensus on the optimal protocol to improve functional outcomes following total knee arthroplasty. The ideal analgesic regimen should enable early ambulation and physical therapy, shorten hospital stay, reduce the risk of postoperative complications and improve patient satisfaction [3]. Ultrasoundguided femoral nerve block (FNB) is one of the most commonly used techniques that has been shown to significantly improve analgesia and reduce postoperative opioid consumption.…”

Adductor canal block combined with local infiltration analgesia versus isolated adductor canal block in reducing pain and opioid consumption after total knee arthroplasty: a systematic review and meta-analysis

“… 2 Recent research has indicated that ACB in combination with LIA may achieve satisfactory effects, as well as an improved functional outcome. 4 , 10 …”