Adductor Canal Blockade Following Total Knee Arthroplasty—Continuous or Single Shot Technique? Role in Postoperative Analgesia, Ambulation Ability and Early Functional Recovery: A Randomized Controlled Trial

Shah, Nilen A.; Jain, Nimesh; Panchal, Karnav

doi:10.1016/j.arth.2015.03.006

Cited by 81 publications

(86 citation statements)

References 43 publications

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“…Forty-one trials investigated other interventions: Adductor canal block [88–91]; clonidine, tramadol, fentanyl, magnesium or buprenorphine added to FNB [92–95]; single and continuous sciatic plexus nerve block [96–100]; obturator nerve block [101, 102]; continuous lumbar plexus block [103]; morphine, ketamine or epinephrine added to intraarticular injections of local anaesthetics [104–107]; continuous intraarticular injection of local anaesthetics [108–110]; ketorolac added to periarticular injection of local anaesthetic [111]; steroids added to LIA [112–114]; epidural analgesia with ropivacaine and morphine [115]; magnesium, midazolam or morphine added to epidural bupivacaine/ropivacaine [116, 117]; fentanyl patch [118, 119]; i.v. tramadol [120]; i.v.…”

Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

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IntroductionThe aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA).MethodsThis PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis.ResultsThe included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low.ConclusionA low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

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Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

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“…24 The midpoint of the thigh was proximal to the AC in all cadaver sides, similar to the findings by Bendtsen et al 7 and Wong et al 14 Several studies have made the claim that the midpoint of the thigh-defined as the midpoint between the ASIS and the base of the patella-is within the AC. 8,9,[25][26][27][28][29][30][31][32][33][34] Thus, studies comparing the analgesic efficiency of a femoral triangle block with a nerve block technique where the local anesthetic is injected into the AC proper should be interesting for future research.…”

Section: Discussionmentioning

confidence: 99%

The Spread of Ultrasound-Guided Injectate From the Adductor Canal to the Genicular Branch of the Posterior Obturator Nerve and the Popliteal Plexus

Runge

Moriggl

Børglum

et al. 2017

Regional Anesthesia and Pain Medicine

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“…However, previous trials have found that FTB provides analgesia after TKA with better preservation of quadriceps motor function than FNB. 20,[22][23][24][25] In the current study, we only injected 10 mL of local anesthetic in the FTB to minimize proximal spread to the other motor branches of the femoral nerve. Several previous studies have found no difference in morphine consumption (20-25 mg) between adductor canal block (ACB) and femoral block during the first 24 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The total intravenous morphine consumption during the first 24 postoperative hours was 2 mg (interquartile range [IQR], 0-15) in the combined ONB and FTB group, 20 mg (IQR, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] in the FTB group (P = 0.0007), and 17 mg (IQR, in the LIA group (P = 0.002). The combined ONB and FTB group displayed reduced pain, nausea, and vomiting compared with the other groups.…”

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confidence: 99%