The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block: A Double-Blinded Randomized Controlled Study

Elkassabany, Nabil; Antosh, Sean; Ahmed, Moustafa; Nelson, Charles L.; Israelite, Craig L.; Badiola, Ignacio; Cai, Lu; Rc, Williams; Hughes, Christopher; Mariano, Edward R.; Liu, Jiabin

doi:10.1213/ane.0000000000001237

Cited by 117 publications

(130 citation statements)

References 38 publications

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“…Another 3 studies were identified through manual search. After removing duplications, scanning titles and abstracts, and reading the full-text, 12 RCTs met the inclusion criteria151617181920232425313233.…”

Section: Resultsmentioning

confidence: 99%

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Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials

Wang

Yang

et al. 2017

Sci Rep

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Femoral nerve blocks (FNB) can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty (TKA). Adductor canal block (ACB) is a relatively new alternative providing pure sensory blockade with minimal effect on quadriceps strength. The meta-analysis was designed to evaluate whether ACB exhibited better outcomes with respect to quadriceps strength, pain control, ambulation ability, and complications. PubMed, Embase, Web of Science, Wan Fang, China National Knowledge Internet (CNKI) and the Cochrane Database were searched for RCTs comparing ACB with FNB after TKAs. Of 309 citations identified by our search strategy, 12 RCTs met the inclusion criteria. Compared to FNB, quadriceps maximum voluntary isometric contraction (MVIC) was significantly higher for ACB, which was consistent with the results regarding quadriceps strength assessed with manual muscle strength scale. Moreover, ACB had significantly higher risk of falling versus FNB. At any follow-up time, ACB was not inferior to FNB regarding pain control or opioid consumption, and showed better range of motion in comparison with FNB. ACB is superior to the FNB regarding sparing of quadriceps strength and faster knee function recovery. It provides pain relief and opioid consumption comparable to FNB and is associated with decreased risk of falls.

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Section: Resultsmentioning

confidence: 99%

“…Several more RCTs on this subject have been published without conclusive results20232425. In addition, Li et al .…”

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confidence: 99%

Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials

Wang

Yang

et al. 2017

Sci Rep

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“…[8][9][10][11][12][13][14][15][16][17] However, controversy exists regarding the ideal location of ACB placement within the adductor canal. A more proximal ACB may offer improved analgesia and a more remote insertion site away from the surgical field; however, the proximal block may produce greater quadriceps weakness by targeting several afferent branches of the femoral nerve.…”

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confidence: 99%

Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty

Meier

Auyong

Yuan

et al. 2018

Regional Anesthesia and Pain Medicine

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“…In recent years, considerable efforts have been deployed to develop quadriceps-sparing nerve blocks for total knee replacement. 7 Inexplicably, diaphragm-sparing blocks for shoulder surgery have received less attention. 8 This unfortunate situation needs remedy, as HDP can be as deleterious as quadriceps paralysis.…”

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confidence: 99%

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Tran

Elgueta

Aliste

et al. 2017

Regional Anesthesia and Pain Medicine

175

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Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

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The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block: A Double-Blinded Randomized Controlled Study

Abstract: ACB results in greater preservation of quadriceps muscle strength. Although we did not detect a significant reduction in fall risk when compared with FNB, based on the upper limit of the relative risk, it may very well be present. Further study is needed with a larger sample size.

Cited by 117 publications

References 38 publications

Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials

Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials

Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

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