Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Zhang, Lukai; Chen, Cheng; Du, Weibin; Zhou, Hua-ten; Quan, Renfu; Liu, Junsheng

doi:10.1097/md.0000000000022667

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…The conclusions of this review were consistent with those of a previously published meta‐analysis 43 . Specifically, both reviews revealed no significant between‐group differences in total opioid consumption, catheter insertion time, or block success rate.…”

Section: Discussionsupporting

confidence: 88%

“…The conclusions of this review were consistent with those of a previously published meta‐analysis. 43 Specifically, both reviews revealed no significant between‐group differences in total opioid consumption, catheter insertion time, or block success rate. However, our review found that proximal ACB could provide less pain during rest at 2 h and 24 h after surgery, which contrasts with their results.…”

Section: Discussionmentioning

confidence: 93%

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Does Proximal Adductor Canal Block Provide Better Analgesic Efficacy than Distal Adductor Canal Block in Patients Undergoing Knee Arthroplasty: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Li,

Zhuang,

Chen

et al. 2024

Orthopaedic Surgery

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To compare the analgesic efficacy and adverse events of proximal versus distal ACB for adults undergoing knee arthroplasty, we searched PubMed, Cochrane, Web of Science, and Embase to identify all eligible randomized controlled trials (RCTs). The study quality of the RCTs was evaluated using the Cochrane risk of bias assessment tool. Heterogeneity among studies was examined by Cochrane Q test. Our primary outcomes were pain intensity at rest/during movement and morphine consumption. Statistical analyses were conducted by RevMan Software. Seven eligible studies involving 400 subjects were included in this meta‐analysis with 202 participants in the proximal ACB group and 198 participants in the distal ACB group. The results demonstrated that proximal ACB provided significantly better pain relief at rest at 2 h (SMD −0.27, 95% CI −0.54 to −0.01, four trials, 222 participants, I2 = 0, p = 0.04) and 24 h (SMD −0.28, 95% CI −0.48 to −0.08, seven trials, 400 participants, I2 = 0, p = 0.006) following the surgery. We found no evidence of a difference in postoperative pain intensity at other timepoints. Furthermore, we noted no evidence of a difference in cumulative morphine consumption and occurrence of adverse events. Proximal ACB provides better pain relief and comparable adverse effects profile compared with distal ACB. The analgesic benefit offered by proximal ACB, however, did not appear to extend beyond the first 24 h. The overall evidence level was mostly low or very low, which requires more well‐organized multicenter randomized trials in the future.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 93%

Does Proximal Adductor Canal Block Provide Better Analgesic Efficacy than Distal Adductor Canal Block in Patients Undergoing Knee Arthroplasty: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Li,

Zhuang,

Chen

et al. 2024

Orthopaedic Surgery

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“…Another important factor to consider is relative block success rates among providers. For TKA, for example, while the adductor canal block may have >90% success rates in experienced hands,36 those less experienced may have lower success rates, reducing their confidence in RA for the surgery. Providers less confident in RA-based techniques may be less inclined to offer RA for common surgeries, starkly different from centers that may have standardized RA delivery protocols in place irrespective of provider preferences.…”

Section: Discussionmentioning

confidence: 99%

Association of patient characteristics with the receipt of regional anesthesia

Beletsky

Currie

Shen

et al. 2023

Reg Anesth Pain Med

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BackgroundRegional anesthesia (RA) may improve patient-related outcomes, including decreased operative complications, shortened recovery times, and lower hospital readmission rates. More analyses are needed using a diverse set of databases to examine characteristics associated with the receipt of RA.MethodsA national hospital database was queried for patients 18 years or older who underwent total shoulder arthroplasty (TSA), total knee arthroplasty (TKA), anterior cruciate ligament reconstruction (ACLR), carpal tunnel release, ankle open reduction, and internal fixation and arteriovenous fistula creation between January 2016 and June 2021. Regional techniques included neuraxial anesthesia and various upper and lower extremity peripheral nerve blocks to create a binary variable of RA receipt. Univariate statistics were used to compare characteristics associated based on RA receipt and multivariable regression identified factors associated with RA receipt.ResultsA total of 51 776 patients were included in the analysis, of which 2111 (4.1%) received RA. Factors associated with decreased odds of RA receipt included black race (vs white race; OR 0.73, 95% CI 0.62 to 0.86), other non-white race (vs white race; OR 0.71, 95% CI 0.61 to 0.86), American Society of Anesthesiologists (ASA) class (vs ASA 1; OR 0.85, 95% CI 0.79 to 0.93), and Medicaid insurance (vs private insurance; OR 0.65, 95% CI 0.51 to 0.82) (all p<0.05). When compared with TKA, ACLR (OR 0.67, 95% CI 0.53 to 0.84), ankle open reduction and internal fixation (OR 0.68, 95% CI 0.58 to 0.81), and carpal tunnel release (OR 0.68, 95% CI 0.59 to 0.78) demonstrated lower odds of RA receipt, whereas TSA (OR 1.31, 95% CI 1.08 to 1.58) demonstrated higher odds of RA receipt (all p<0.05).ConclusionRA use varies with respect to race, insurance status, and type of surgery.

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“…12,13 However, a recent meta-analysis of proximal versus distal sites of injection found no difference in opioid use or in mean or maximum pain scores between the two approaches. 14 Perhaps this reflects what some anatomic 8,15 and clinical 15 studies have shown: injectate has the capacity to flow within the subsartorial canal, and even traverse the boundaries between the distal FT, the anatomic AC, and the popliteal fossa.…”

mentioning

confidence: 86%