A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review

Abstract

Background:Patients undergoing total knee arthroplasty suffer from moderate-to-severe postoperative pain resulting in immobility-related complications and prolonged hospitalization. Femoral nerve block is associated with reduction in the quadriceps strength and increasing incidence of falls. Adductor canal block has been shown to be as effective as femoral nerve block without causing quadriceps weakness.Objectives:To compare outcomes of studies comparing adductor canal block and femoral nerve block in patients undergoing primary total knee arthroplasty.Data Sources:Original articles, published between July 2013 and April 2017, comparing the above interventions.Study Eligibility Criteria, Participants, and Interventions:Comparison of outcome measures of all original articles shortlisted by the PUBMED and Google Scholar databases search using key words, “adductor canal block; femoral nerve block; total knee arthroplasty; total knee replacement.”Study Appraisal and Synthesis Methods:The primary outcome measures reviewed were: pain scores; interventional failure; post-operative opioid consumption; patient fall or near fall during postoperative rehabilitation; and length of stay.Results:The opioid consumption was found to be comparable with both the interventions on the first and second postoperative day. Patients administered adductor canal block had better quadriceps power, longer ambulation distance, and shorter length of hospital stay.Limitations:Of the studies reviewed five were retrospective and thus data quality amongst the studies may have been compromised.Conclusions and Implications of Key Findings:Mobilization and ambulation, which are both important for recovery after total knee arthroplasty are both inhibited less by adductor canal block.

Regional Catheters for Postoperative Pain Control: Review and Observational Data

“…There is concern among surgeons and physiotherapists that continuous femoral nerve block (FNB) may hamper motoric function, thereby leading to delayed ambulation and increasing risk of falls (22). As a consequence, ACB has been promoted in order to provide adequate analgesia with less quadriceps weakness compared to femoral block (23,24). However, Schwenk and Gandhi 25focused on conclusions drawn from dynamometer data and emphasized that differences in motoric function between ACB and FNB were significant only during the first 8 postoperative hours, whereas fall accidents mostly occurred on the second postoperative day.…”

The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties

“…123,124 This technique targets the saphenous nerve, articular branches of the obturator nerve, medial retinacular nerve, and the nerve to the vastus medialis. 125 A recent systematic review by Karkhur et al did not find any difference in pain scores or opioid consumption between FNB or ACB following TKA. 125 While nerve blocks are commonly employed in multimodal pain management regimens, the ERAS Society does not recommend them as an essential component of multimodal analgesia following TKA.…”

“…125 A recent systematic review by Karkhur et al did not find any difference in pain scores or opioid consumption between FNB or ACB following TKA. 125 While nerve blocks are commonly employed in multimodal pain management regimens, the ERAS Society does not recommend them as an essential component of multimodal analgesia following TKA. 65 Additionally, local infiltration analgesia (LIA) can be used as an alternative or as an adjunct to nerve blocks, and was first described by Kerr et al in 2008.…”

An Update on Multimodal Pain Management After Total Joint Arthroplasty

“…In TKA, the use of blocks is more common and adductor canal blocks (ACBs) have become increasingly popular over FNBs because they preserve quadriceps strength better, thus preventing falls and facilitating early mobilization 99,105-107 . In addition, Li et al showed significantly better pain scores with ACBs over FNBs in a meta-analysis of 8 RCTs 108 .…”