Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty

Zhang, Lukai; Zhang, Boya; Quan, Renfu; Xu, Hong; Sun, Yujie; Zhou, Jianhong

doi:10.1097/md.0000000000015539

Cited by 21 publications

(18 citation statements)

References 26 publications

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“…11 Studies have shown that continuous adductor canal block was superior to single shot. 12 Studies have shown that iPACK with adductor canal block showed better post op VAS score and better range of knee motion. 13 in our study we placed a catheter in adductor canal to give 0.25% of bupivacaine 20 ml 6 th hry on day 0 and 0.25% 10 ml 6 th hry on day 1 for all patients.…”

Section: Discussionmentioning

confidence: 99%

Comparing Continuous Adductor Canal Block Alone, with Combined Continuous Adductor Canal Block with iPACK in Terms of Early Recovery and Ambulation in Patients Undergoing Unilateral Total Knee Replacement- A Prospective Randomized Double Blinded Study

Vijay¹

2020

jebmh

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BACKGROUND Adductor canal block which blocks saphenous nerve which is purely sensory preserves motor functions and hence patients can be mobilized early decreasing complications and enabling early discharge. However, it does not relieve posterior knee pain. iPACK has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. Our aim was to make patients mobile on the same day of surgery and decrease the hospital stay, aiming for early discharge that is on second post-operative day. METHODS 100 patients of ASA grade 1 and 2 posted for unilateral knee replacement were randomly selected. Group A received ACB + iPACK and group B patients received ACB alone. Post-operative ambulation score, muscle control score, knee flexion in degrees was checked on day 0, 1 and 2. VAS sore was checked at 6, 12 and 24 hrs. RESULTS Patients with combined iPACK with adductor canal block were completely painless after surgery. Whereas patients who received only adductor canal block (continuous) had mild pain on day 0. On day 1 patients in both the groups were absolutely pain free and required no additional dose of analgesics. But patients from both groups of patients were able to walk on the day of surgery comfortably and discharged on day 2. CONCLUSIONS iPACK with adductor canal block is the best mode in multimodal analgesia in treating post-operative pain after total knee replacement leading to decreased post-operative complications (due to quadriceps weakness), decreased nosocomial complications, early patient discharge and better patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Comparing Continuous Adductor Canal Block Alone, with Combined Continuous Adductor Canal Block with iPACK in Terms of Early Recovery and Ambulation in Patients Undergoing Unilateral Total Knee Replacement- A Prospective Randomized Double Blinded Study

Vijay¹

2020

jebmh

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“…To our knowledge, this is not the first meta-analysis of RCTs comparing the efficacy and safety of SACB with CACB to get command of pain after TKA. However, the authors believe that this meta-analysis is more complete than the previous meta-analysis published by Zhang et al [ 51 ] Our study included 5 recent high-quality RCTs, [ 38 – 41 , 46 ] thus decreasing publication bias and statistical bias. We extract data more objectively, bringing about more precise conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…First, the research by Zhang et al included only 4 RCTs with a total of 322 patients. [ 51 ] The results showed that the patients who received CACB had a better efficacy in VAS scores at 48 hours (both of rest-VAS and mobilization-VAS) than those who underwent SACB. However, the SACB group had similar efficacy compared with the CACB group in terms of morphine consumption, time to first opioid request, range of motion, and VAS scores(both of rest-VAS and mobilization-VAS) at 24 hours and 48 hours, also without increasing the risk of complications and length of stay.…”

Section: Discussionmentioning

confidence: 99%

Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?

Wang

Zhuo

et al. 2020

Medicine

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Background: Adductor canal block (ACB) has emerged as an attractive alternative for femoral nerve blocks (FNB) as the peripheral nerve block of choice for total knee arthroplasty (TKA), preserving quadriceps motor function while providing analgesia comparable to FNB. However, its optimal application for TKA remains controversial. The objective of this meta-analysis was to compare continuous-injection ACB (CACB) vs single-injection ACB (SACB) for postoperative pain control in patients undergoing TKA. Methods: This study attempts to identify the available and relevant randomized controlled trials (RCTs) regarding the analgesic effects of CACB compared to SACB in patients undergoing TKA according to electronic databases, including PubMed, Medline, Web of Science, EMbase, and the Cochrane Library, up to September 2019. Primary outcomes in this regard included the use of a visual analogue scale (VAS) pain score with rest or activity, while secondary outcomes were cumulative opioid consumption, length of hospital stay (LOS), complications of vomiting and nausea, and rescue analgesia. The corresponding data were analyzed using RevMan v5.3. Ethical review: Because all of the data used in this systematic review and meta-analysis has been published, the ethical approval was not necessary Results: This research included 9 studies comprised of 739 patients. The analyzed outcomes demonstrated that patients who received CACB had a better at rest-VAS scores at 4 hours ( P = .007), 8 hors ( P < .0001), 12 hours ( P < .0001), 24 hours ( P = .02), mobilization-VAS score at 48 hours ( P < .0001), and rescue analgesia ( P = .03) than those who underwent SACB. Nevertheless, no significant differences were present between the 2 strategies in terms of pain VAS scores 48 hours at rest ( P = .23) and 24 hours at mobilization ( P = .10), complications of vomiting and nausea ( P = .42), and length of hospital stay ( P = .09). Conclusion: This meta-analysis indicated that CACB is superior to SACB in regard to analgesic effect following TKA. However, due to the variation of the included studies, no firm conclusions can be drawn. Further investigations into RCT are required for verification.

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“…However, subgroup analysis showed the increased risks of each of these complications were only observed in particular subsets of patients, which suggests continuous FNBs may not be an independent or universal risk factor for all patients. Previous studies have failed to demonstrate a higher risk of DVTs associated with continuous FNBs than with single-shot FNBs [ 13 , 29 ]. Although the present study did not find a significant increase in the risk of PJI for patients receiving a regional nerve block, which was similarly seen by Kopp et al [ 30 ], there may be other factors that indirectly influence the risk of infections such as antibiotic timing, the type of anticoagulant prophylaxis, the use of a drain, and postoperative blood transfusion [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Femoral Nerve Anesthesia on Short-Term Clinical Outcomes and Opioid Claims After Total Knee Arthroplasty

et al. 2020

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Background: The impact of femoral nerve blocks (FNBs) during primary total knee arthroplasty (TKA) on clinical outcomes and pain management remains unclear. The present research investigates the impact that continuous and single-shot FNBs during TKA have on postoperative opioid claims and short-term clinical outcomes. Methods: An administrative claims database was queried to identify patients who underwent primary TKA with a continuous FNB, single-shot FNB, or no FNB. More than 300,000 patients were analyzed from the database. Rates of opioid claims were compared via achi-square analysis. Incidence of postoperative complications was compared with multivariable logistic regression. Results: Patients receiving a FNB had a significantly higher risk of falls both at 6 months (odds ratio [OR], 1.30) and 1 year postoperatively (OR, 1.25), as well as readmissions within 90 days (OR, 1.18) compared with patients without FNBs. The FNB cohort exhibited a higher risk of deep vein thrombosis (OR, 1.57), myocardial infarction (OR, 1.79), and cerebrovascular accident (OR, 1.20) during the inpatient stay. Relative to single-shot FNBs, continuous FNBs were associated with a higher risk of readmissions within 90 days and systemic complications, although the risk varied by age, sex, and Charlson Comorbidity Index score. More patients without FNBs filed opioid claims within 1 year postoperatively, but the average total morphine milligram equivalents prescribed was comparable to patients who received FNBs. Conclusions: FNBs during TKA place patients at a significantly higher risk of falls, readmissions, and systemic complications in the short term. The risk of readmission and systemic complications was higher for continuous FNBs. More patients without FNBs filed opioid claims postoperatively than patients who received FNBs.

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Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty

Cited by 21 publications

References 26 publications

Comparing Continuous Adductor Canal Block Alone, with Combined Continuous Adductor Canal Block with iPACK in Terms of Early Recovery and Ambulation in Patients Undergoing Unilateral Total Knee Replacement- A Prospective Randomized Double Blinded Study

Comparing Continuous Adductor Canal Block Alone, with Combined Continuous Adductor Canal Block with iPACK in Terms of Early Recovery and Ambulation in Patients Undergoing Unilateral Total Knee Replacement- A Prospective Randomized Double Blinded Study

Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?

The Impact of Femoral Nerve Anesthesia on Short-Term Clinical Outcomes and Opioid Claims After Total Knee Arthroplasty

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