A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique

Lee, Steven; Rooban, Nirooshan; Vaghadia, Himat; Sawka, Andrew; Tang, Raymond

doi:10.1016/j.arth.2017.11.018

Cited by 59 publications

(71 citation statements)

References 25 publications

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“…Recently, published studies have reported that the adductor canal block (ACB) provides effective postoperative analgesia. [ 11 – 15 ] The adductor canal runs distally from the apex of the femoral triangle to the adductor hiatus distally. The proximal block is positioned caudally beyond the femoral triangle, and the distal block is placed between the inguinal crease and the top of the patella.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Chen

et al. 2020

Medicine

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Background: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. Method: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). Results: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption ( P = .54), average visual analog scale (VAS) score ( P = .35), worst VAS score ( P = .19), block success rate ( P = .86), and time of catheter insertion ( P = .54). Conclusions: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.

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Section: Introductionmentioning

confidence: 99%

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

Zhang

Chen

et al. 2020

Medicine

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“…The methodological quality of all included RCTs was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions. Correspondingly, 9 RCTs discussed adequate randomization techniques like random number lists, [ 42 ] computer-generated block randomization, [ 38 – 41 , 43 – 46 ] and sealed random number envelope. [ 38 , 39 , 41 – 43 , 46 ] Allocation concealment was described in 2 trials [ 38 , 42 ] but was unclear in 7 trials.…”

Section: Methodsmentioning

confidence: 99%

“…Correspondingly, 9 RCTs discussed adequate randomization techniques like random number lists, [ 42 ] computer-generated block randomization, [ 38 – 41 , 43 – 46 ] and sealed random number envelope. [ 38 , 39 , 41 – 43 , 46 ] Allocation concealment was described in 2 trials [ 38 , 42 ] but was unclear in 7 trials. [ 39 – 41 , 43 – 46 ] The blinding of personnel and participants were mentioned in 3 trials [ 38 , 42 , 45 ] but was unclear in 6 trials.…”

Section: Methodsmentioning

confidence: 99%

“…[ 38 , 39 , 41 – 43 , 46 ] Allocation concealment was described in 2 trials [ 38 , 42 ] but was unclear in 7 trials. [ 39 – 41 , 43 – 46 ] The blinding of personnel and participants were mentioned in 3 trials [ 38 , 42 , 45 ] but was unclear in 6 trials. [ 39 – 41 , 43 , 44 , 46 ] Studies considered low risk for attrition bias with complete data were also included.…”

Section: Methodsmentioning

confidence: 99%

“…[ 39 – 41 , 43 – 46 ] The blinding of personnel and participants were mentioned in 3 trials [ 38 , 42 , 45 ] but was unclear in 6 trials. [ 39 – 41 , 43 , 44 , 46 ] Studies considered low risk for attrition bias with complete data were also included. Figures 2 and 3 summarized the specific risk of bias in methodological quality for the eligible RCTs.…”

Section: Methodsmentioning

confidence: 99%

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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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Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis

Weibel

Rücker

Eberhart

et al. 2020

Cochrane Database of Systematic Reviews

118

133

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A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique

Cited by 59 publications

References 25 publications

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

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

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

Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis

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