Adductor Canal Block or Local Infiltrate Analgesia for Pain Control After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sardana, Vandit; Burzynski, Joanna; Scuderi, Giles R.

doi:10.1016/j.arth.2018.09.083

Cited by 54 publications

(45 citation statements)

References 54 publications

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“…These results suggest that LIA is a viable and safe alternative to FNB for postoperative pain management after TKA without impairment of quadriceps muscle function. Furthermore, a meta‐analysis conducted by Sardana V et al . showed that LIA could significantly improve postoperative pain and opioid consumption when compared with adductor canal block (ACB).…”

Section: Intraoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

243

165

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Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

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Section: Intraoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

243

165

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“…[ 5 ] Postoperative pain after knee surgery is increasingly more common in these patients. [ 6 ] Studies suggest that over 60% of patients [ 7 , 8 ] experience moderate to severe postoperative pain, [ 9 , 10 ] with many associated adverse effects. [ 8 ] Poor pain control has resulted in prolonged hospital stay, reduced patient satisfaction, delayed convalescence, and ambulation.…”

Section: Introductionmentioning

confidence: 99%

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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“…This has the benefit of controlling anterior knee pain without weakening the quadriceps muscle [10][11][12][13]. Previous studies have evaluated pain control with periarticular injections alone compared to peripheral nerve blocks alone [14]. It is less clear how patients do when these blocks are combined in a synergistic approach.…”

Section: Introductionmentioning

confidence: 99%

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Roberts

Foster

Shi

et al. 2019

Cureus

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Introduction: Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In an effort to reduce reliance on opioid pain medications, surgeons are relying on periarticular injections or peripheral nerve blocks. The purpose of this study was to compare numerical rating scale (NRS) pain scores and oral morphine equivalents (OMEs) in patients who underwent primary total knee arthroplasty (TKA) with a periarticular injection alone to those who underwent a collaborative approach with a periarticular injection in the posterior tissue and an adductor canal catheter for anterior knee analgesia. Methods: In this study, 236 patients underwent a primary TKA between December 2017 and April 2018. Forty patients received an adductor canal catheter and 196 underwent a periarticular injection alone. Results: We found no difference in patient demographics between the cohorts (p>0.05). The patients that underwent the collaborative approach with a periarticular injection and adductor canal catheter had lower NRS pain scores on post-operative day 0, 1, and 2 (all P≤0.033). These patients demonstrated a reduction of 43% in opioid consumption during the hospitalization (P<0.001). These patients also demonstrated improved range of motion (ROM) (96 vs. 92 degrees) on the day of discharge (P=0.013). Conclusion: This study provides strong evidence that in patients undergoing TKA, the collaborative approach with the adductor canal catheter and periarticular injection is associated with lower post-operative pain scores, fewer total OMEs per hospital day, and a greater ROM arc prior to discharge compared to patients receiving a periarticular injection alone.

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Adductor Canal Block or Local Infiltrate Analgesia for Pain Control After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 54 publications

References 54 publications

Postoperative Pain Management in Total Knee Arthroplasty

Postoperative Pain Management in Total Knee Arthroplasty

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

A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

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