Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement

Memtsoudis, Stavros G.; Yoo, Daniel; Stundner, Ottokar; Danninger, Thomas; Ma, Yan; Poultsides, Lazaros; Kim, David; Chisholm, Mary F.; Jules-Elysée, Kethy M.; Valle, Alejandro González Della; Sculco, Thomas P.

doi:10.1007/s00264-014-2527-3

Cited by 77 publications

(86 citation statements)

References 29 publications

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“…Finally, pain was assessed at 48 hours postoperation by 3 studies. 11,12,14 No significant difference was found between ACB and FNB at this follow-up time (SMD, −0.06; 95% CI, −0.33 to 0.21, I 2 = 0%, P = 0.68) (Fig. 5).…”

Section: Painmentioning

confidence: 86%

“…[12][13][14] All 6 of the studies assessed postoperative pain at various lengths of follow-up. Five of the studies assessed pain using the visual analog scale (VAS), [9][10][11][12][13] whereas only one reported pain using the numeric rating scale (NRS). 14 Similarly, quadriceps muscle strength was measured by 5 studies 9,11-14 ; however, the reporting of this outcome differed from study to study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[9][10][11][12][13][14] Three studies assessed pain at 4 hours postoperation using the visual analog scale. 9-11 At 4 hours postoperation, pain was not found to be significantly different between ACB and FNB (MD, −0.07; 95% confidence interval [CI], −2.59 to 2.45; I 2 = 61%, P = 0.96) (Fig.…”

Section: Painmentioning

confidence: 99%

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Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty

Hussain

Ferreri

Prusick

et al. 2016

Regional Anesthesia and Pain Medicine

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D ue to the invasiveness of total knee arthroplasty (TKA), the procedure is often associated with extreme postoperative pain. In fact, 23% of patients cite at home pain as "severe/ extreme" after surgery, whereas 54% of the patients indicate "severe pain at least some of the time." 1 Moreover, it has been suggested that postoperative pain can also interfere with the recovery process, 2 which can put patients at an increased risk for postoperative complications including infections, loosening of the joint, and reflex sympathetic dystrophy. 3 Different techniques can be used preoperatively to complement the effects of general anesthesia, including femoral nerve block (FNB) and adductor canal block (ACB)/saphenous nerve block.Femoral nerve block has traditionally been an efficient method to reduce postoperative pain after TKA. For instance, Chan et al 4 found that FNB decreased pain scores at 24 hours as compared with a sham procedure. Moreover, Jadon et al 5 observed that FNB is a more efficient method of analgesia as compared with IV fentanyl. However, FNB has been found to have postsurgical complications, including severe quadriceps muscle weakness. 6 Certainly, surgical causes such as tourniquet-related weakness or surgical quadriceps dysfunction must also be considered, but femoral nerve blockaderelated weakness can be explained by the anatomy of the nerve targeted in the FNB. The femoral nerve not only comprises sensory branches, but also contains motor branches that innervate muscles of the upper and lower leg. The motor nerve involvement of the FNB is what leads to muscle weakness, which can alter the ability of the patient to ambulate properly and can increase the risk of postoperative falls. As such, ACB is a method of analgesia that has recently sparked tremendous interest in the scientific community due to its potential benefits over FNB; however, this approach itself does not come without controversy.Adductor canal block is thought to be as effective as FNB in reducing postoperative pain. 7 In addition to having similar pain scores reported by patients, ACB has been thought to be associated with better quadriceps strength postoperatively in comparison to FNB. Theoretically, this is intuitive because the saphenous nerve, a component of the adductor canal and the nerve targeted in ACB, is a purely sensory branch of the femoral nerve. Due to the lack of motor impairment with ACB, quadriceps muscle function is preserved. This may ultimately lead to better ambulation after TKA.

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Section: Painmentioning

confidence: 86%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty

Hussain

Ferreri

Prusick

et al. 2016

Regional Anesthesia and Pain Medicine

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“…In other similar studies, different results in pain scores were obtained. In a study by Memtsoudis et al (6), no significant difference was found between the pain scores at any time in the ACB compared to the FNB group. In another study, which evaluated pain scores during 45° knee flexion at 0, 30, 60, 90 and 120 minutes after the block, no significant difference was observed between the two groups (13).…”

Section: Discussionmentioning

confidence: 99%

“…Several patients experience narcotic-related complications, such as sedation, respiratory depression, nausea, vomiting and constipation following excessive use of opioid analgesics. Peripheral nerve blocks offer effective analgesia and decrease the need for opioids, thereby reducing the complications associated with the use of this class of drug (3)(4)(5)(6). Moreover, postoperative pain relief is an important factor in the early ambulation and rehabilitation of patients after knee surgery (5,7).…”

Section: Introductionmentioning

confidence: 99%

Relieving Pain After Arthroscopic Knee Surgery: Ultrasound-Guided Femoral Nerve Block or Adductor Canal Block?

Rahimzadeh¹,

Faiz²,

Imani³

et al. 2017

Turk J Anaesth Reanim

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Objective:To compare the analgesic effects of femoral nerve block (FNB) and adductor canal block (ACB) after arthroscopic knee surgery. Methods:This was a prospective randomised clinical trial that enrolled 92 patients undergoing arthroscopic knee surgery. Ultrasound-guided FNB or ACB was performed immediately after surgery for pain relief. Visual analogue scale (VAS) scores and modified sedation-agitation scale (SAS) were recorded and analysed immediately following block and at 3, 6, 12 and 24 hours. The satisfaction level was also evaluated using a Likert-based patient questionnaire.Results: VAS scores decreased to 4.1±0.8 from 5.6±1.2 immediately after any nerve block, and within 3 hours, they continued to decrease to 2.0±0.6 in the FNB group and 3.4±1.0 in the ACB group (P=0.014). More patients in the FNB group were satisfied with the quality of the pain control compared to the ACB group. Additionally, patients in the ACB group required more supplemental analgesia compared to the FNB group. Conclusion:This study demonstrated that patients with FNB had denser analgesia after arthroscopic knee surgery and had less analgesic requirement compared with ACB. Greater satisfaction scores also reflected superior analgesia in patients receiving FNB.Keywords: Knee arthroscopy, femoral nerve, saphenous nerve, ultrasound Amaç: Bu çalışmanın amacı artroskopik diz cerrahisi sonrasında kullanılan femoral sinir bloğu (FSB) ve addüktör kanal bloğunun (AKB) analjezik etkilerini karşılaştırmaktır.Yöntemler: Bu prospektif randomize klinik çalışmaya artroskopik diz ameliyatı geçiren 92 hasta dahil edildi. Ağrıyı dindirmek amacıyla cerrahiden hemen sonra ultrason eşliğinde FSB veya AKB uygulandı. Bloğun hemen ardından ve 3., 6., 12. ve 24. saatlerde vizüel analog skalası (VAS) ve modifiye sedasyon-ajitasyon skalası (SAS) skorları kaydedildi ve analiz edildi. Aynı zamanda Likert tipi hasta anketi kullanılarak memnuniyet düzeyi de değerlendi-rildi.Bulgular: VAS skorları her iki sinir bloğundan hemen sonra 5,6±1,2'den 4,1±0,8'ye düştü ve 3 saat içerisinde FSB grubunda 2,0±0,6'ya ve AKB grubunda 3.4±1.0 değerine kadar düştü (p=0,014). AKB grubu ile kıyaslandığında, ağrı kontrolünün kalitesinden memnuniyet duyma oranı FSB grubunda daha yüksekti. Ek olarak, AKB grubundaki hastalarda ilave analjezi ihtiyacının, FSB grubundaki hastalara göre daha yüksek olduğu görüldü.Sonuç: Çalışmanın sonucuna göre, artroskopik diz cerrahisi sonrasında FSB daha yoğun analjezi ve AKB ile kıyaslandığında bu hastalarda daha az analjezik gereksinimi görülmüştür. Ayrıca daha yüksek memnuniyet skorları, FSB uygulanan hastalarda daha iyi analjezi sağlandığını göstermiştir.Anahtar Sözcükler: Diz artroskopisi, femoral sinir, safenöz sinir Abstract / Öz

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Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery

Schnabel

Reichl

Weibel

et al. 2019

Cochrane Database of Systematic Reviews

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Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement

Abstract: Although we could not confirm a benefit in motor function between ACB and FNB, given the equivalent analgesic potency combined with its potentially lower overall impact if neuropraxia should occur, ACB may represent an attractive alternative to FNB.

Cited by 77 publications

References 29 publications

Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty

Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty

Relieving Pain After Arthroscopic Knee Surgery: Ultrasound-Guided Femoral Nerve Block or Adductor Canal Block?

Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery

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