Adductor Canal Block Does not Confer Better Immediate Postoperative Pain Relief after Total Knee Arthroplasty

Abstract

The adductor canal block (ACB) is a useful adjunct to control postoperative pain in total knee arthroplasty (TKA). The aim of our study was to compare postoperative day 1 (POD1) pain scores, ambulation distance, range of motion, active straight leg raise (SLR), and length of stay (LOS) in TKA patients receiving no ACB (NACB), ACB by surgeon (ACBS), or ACB by anesthetist (ACBA). After obtaining institutional ethics approval, a retrospective review of 135 patients who underwent TKA between September 2020 and March 2021 was performed. All patients underwent TKA by the same surgeon and received the same standardized postoperative rehabilitation. Operating theater time was shortest in the NACB group with 129.3 ± 23.1 minutes compared with 152.4 ± 31.6 minutes in ACBA and 139.2 ± 29.4 minutes in ABCS (p = 0.001). For the POD1 pain score after therapy, the NACB group scored 4.9 ± 3.1 compared with 3.5 ± 2.2 and 3.9 ± 1.8 scored by the ACBA and ACBS groups, respectively (p = 0.302). The mean POD1 ambulation distance was 21.1 ± 15.2 m in the NACB group compared with 15.4 ± 1.3 and 17.8 ± 13.2 m in the ACBA and ACBS groups (all p > 0.05), respectively. There were no significant differences in the median LOS between three groups or ability to perform active SLR (all p > 0.05). Our study found no significant differences when comparing ACBS and ACBA by POD1 pain score, ambulation distance, range of motion, and LOS. We recommend against the use of ACB and instead recommend surgeons to perform an adequate periarticular cocktail injection.

Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023

“…Between 2003 and 2013, only nine publications were identified, whereas 24 studies were published in the subsequent decade (2013–23). The primary indication for the saphenous nerve block was knee surgery (23 studies), 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 with one study examining tibial osteotomy. 86 …”

“…The majority of studies used ultrasound guidance ( n =22) for the saphenous nerve block. 63 , 64 , 65 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 75 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 In one study the block was performed by the surgeon, 66 whereas two others were unclear about the technique used to identify the nerve. 74 , 76 Pain scores were the primary outcome in most studies ( n =10), but the methods of assessment varied significantly across studies, with some reporting peak pain, others average pain, and some pain at rest or during exercise; the timing of assessments also differed.…”

“…Besides the saphenous nerve block, six studies used general anaesthesia only, 67 , 68 , 72 , 73 , 83 , 86 four used spinal anaesthesia only, 65 , 76 , 80 , 85 six combined spinal anaesthesia with local infiltration analgesia, 63 , 64 , 70 , 71 , 77 , 79 one combined general anaesthesia with local infiltration analgesia, 75 two used epidural analgesia, 78 , 81 and in five studies various methods were used or the anaesthetic method was unclear. 66 , 69 , 74 , 82 , 84 …”

“…Saphenous nerve block has been examined in a total of 10 RCTs ( n =612) 64 , 70 , 71 , 73 , 77 , 78 , 79 , 80 , 81 , 85 and six non-RCTs ( n =2319) 63 , 69 , 74 , 82 , 83 , 84 in patients undergoing knee arthroplasty, three RCTs ( n =139) for anterior cruciate ligament reconstruction, 67 , 75 , 76 and four RCTs ( n =269) for arthroscopic knee surgery. 65 , 66 , 68 , 72 …”

“…Of these studies, 12 showed a positive analgesic effect of saphenous nerve block compared with conventional systemic analgesia in patients undergoing total knee arthroplasty, 63 , 64 , 71 , 73 , 74 , 77 , 78 , 79 , 81 , 83 , 84 , 85 but one RCT showed an increase in pain measured at 12 and 24 h after surgery, 80 and three studies did not demonstrate any advantages in terms of pain therapy. 69 , 70 , 82 …”