Efficacy of Adductor Canal Blocks in Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m2 and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS (p < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; p < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.

Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023

“…Between 2003 and 2013, only nine publications were identified, whereas 24 studies were published in the subsequent decade (2013–23). The primary indication for the saphenous nerve block was knee surgery (23 studies), 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 with one study examining tibial osteotomy. 86 …”

“… 63 , 64 , 65 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 75 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 In one study the block was performed by the surgeon, 66 whereas two others were unclear about the technique used to identify the nerve. 74 , 76 Pain scores were the primary outcome in most studies ( n =10), but the methods of assessment varied significantly across studies, with some reporting peak pain, others average pain, and some pain at rest or during exercise; the timing of assessments also differed. From studies with a pre-specified primary outcome, six demonstrated a reduction in pain in patients who received the saphenous nerve block.…”

“…Besides the saphenous nerve block, six studies used general anaesthesia only, 67 , 68 , 72 , 73 , 83 , 86 four used spinal anaesthesia only, 65 , 76 , 80 , 85 six combined spinal anaesthesia with local infiltration analgesia, 63 , 64 , 70 , 71 , 77 , 79 one combined general anaesthesia with local infiltration analgesia, 75 two used epidural analgesia, 78 , 81 and in five studies various methods were used or the anaesthetic method was unclear. 66 , 69 , 74 , 82 , 84 …”

“…Saphenous nerve block has been examined in a total of 10 RCTs ( n =612) 64 , 70 , 71 , 73 , 77 , 78 , 79 , 80 , 81 , 85 and six non-RCTs ( n =2319) 63 , 69 , 74 , 82 , 83 , 84 in patients undergoing knee arthroplasty, three RCTs ( n =139) for anterior cruciate ligament reconstruction, 67 , 75 , 76 and four RCTs ( n =269) for arthroscopic knee surgery. 65 , 66 , 68 , 72 …”

Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial

“…7,10 Therefore, the ACB has become more popular among PNB due to its effective pain control with a more negligible effect on quadriceps strength. [6][7][8]11 In addition, a recent meta-analysis reported that continuous ACB (cACB) provided a longer duration of effective pain control than a single-short ACB (sACB). 12 During an ACB procedure, the anesthesiologist uses an ultrasound as a guided tool to locate the target area of injection.…”