Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery

Schnabel, Alexander; Reichl, Sylvia U; Weibel, Stephanie; Zahn, Peter; Kranke, Peter; Pogatzki-Zahn, Esther; Meyer-Frießem, Christine H

doi:10.1002/14651858.cd012262.pub2

Cited by 19 publications

(11 citation statements)

References 106 publications

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“…However, maximum postoperative pain control may have a price. Due to the problem of reduced patient motor function after surgery and femoral nerve block, many authors prefer LIA [ 24 ]. This is also underlined by the fact that the OME and NRS we have reported are much lower than in comparable studies.…”

Section: Discussionmentioning

confidence: 99%

“…A further argument for the use of LIA is the simple and fast application with a minimal side effect profile such as a reduced risk of potential neurological damage and muscle weakness, associated with peripheral regional anaesthesia [ 3 , 14 ]. Many authors prefer LIA because of the problem of reduced patient motor function after surgery and femoral nerve block [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Schittek

Reinbacher

Rief

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Introduction After primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound-guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA—LIA versus URSA with dexmedetomidine—were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA. Methods Fifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml−1) or two single-shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed. Results In the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5–57.0] mg versus 27.0 [IQR 0.0–33.5] mg (P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol. Conclusion This is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid-sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid-sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Schittek

Reinbacher

Rief

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…However, patients can suffer from severe postoperative pain [ 10 , 11 ] after surgery due to extensive bone resection [ 18 ] and soft tissue manipulation [ 19 , 20 ]. ACB has gained popularity for the treatment of postoperative pain in TKA patients in the recent years [ 14 , 21 , 22 ]. One of the interesting findings revealed in this study was that the hourly consumption of sevoflurane was similar among the three groups of patients, despite preoperative ACB being performed in Group B patients.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, ultrasound-guided ACB has gained popularity as a technique for postoperative pain control in TKA patients [ 13 ]. However, a recent systematic review [ 14 ] concluded that it was uncertain whether patients treated with ACB had a lower pain intensity, fewer opioid-related adverse events, and fewer accidental falls during postoperative care compared to those given sham treatment or compared to those treated with a femoral nerve block. The uncertainty of ACB’s role in reducing postoperative pain in TKA patients formed the impetus for our study with the primary aim of assessing three important issues.…”

Section: Introductionmentioning

confidence: 99%

Is There an Optimal Timing of Adductor Canal Block for Total Knee Arthroplasty?—A Retrospective Cohort Study

Poon

Yang

et al. 2021

JPM

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Adductor canal block (ACB) has gained popularity for postoperative pain control after total knee arthroplasty (TKA). However, its role in TKA has been questioned recently. Our study aimed to clarify the role of ACB in reducing postoperative pain after TKA and to elucidate an optimal timing to perform ACB for better outcomes. We conducted a comprehensive review of the perioperative records of 652 patients undergoing primary TKA from January 2019 to December 2019. Patients were divided into three groups: Group A received general anesthesia without ACB, Group B received ACB before inducing general anesthesia, and Group C received ACB at the post-anesthesia recovery unit (PACU). Patients in Groups B and C had lower pain visual analogue scale (VAS) scores than patients in Group A at the PACU. Opioid consumption was similar among the three groups; however, a slightly higher dose was required by Group A patients. Higher VAS scores were recorded in the ward in Group A than in Groups B and C with the leg at rest. In addition, higher VAS scores were recorded in Group A than in Groups B and C with the leg in continuous passive motion (CPM) training. More patients in Group A (34.9%) quit their first CPM training after a few cycles than those in Groups B (27.0%) and C (20.1%). Group A patients required a higher per kg dose of opioids in the ward than Groups B and C patients. Additionally, the hourly consumption of sevoflurane was similar among the three groups of patients, while Group A and C patients required a higher hourly per kg dose of intraoperative opioids than Group B patients. More patients in Group A (67.6%) and C (61.7%) developed intraoperative hypertension than patients in Group B (52.7%). There was no significant difference in PON (postoperative nausea), POV (postoperative vomiting), postoperative dizziness, or patient satisfaction among the three groups of patients. Group A patients had a longer length of hospital stay compared to Group B and C patients. In conclusion, preoperative ACB could be a better choice for patients undergoing TKA as it decreases intraoperative opioid consumption and facilitates a stable hemodynamic state during surgery.

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“…Anaesthetic technique can also influence the rate of PONV. Avoiding general anaesthesia, by using regional techniques [3] can make PONV less likely, but this is not always possible. Further, inhalational agents are more likely to cause PONV than intravenous anaesthesia [4] and depth of anaesthesia also seems to play a role [5].…”

Section: Safetymentioning

confidence: 99%

Anti‐emetic drugs for preventing postoperative nausea and vomiting: new evidence from a Cochrane network meta‐analysis

2021

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Twitter: @Dr_H_Collier; @ChrisDarwen3; @ProfAndyS Postoperative nausea and vomiting (PONV) is a common complaint of patients following a general anaesthetic.Without appropriate prophylaxis, around 30% of all patients will report such symptoms, but this can rise to nearly 80% in the presence of certain patient characteristics [1]. Apfel et al.suggested that the four key risk-factors of female sex, nonsmoker status, history of motion sickness and previous PONV were highly predictive [2]. Anaesthetic technique can also influence the rate of PONV. Avoiding general anaesthesia, by using regional techniques [3] can make PONV less likely, but this is not always possible. Further, inhalational agents are more likely to cause PONV than intravenous anaesthesia [4] and depth of anaesthesia also seems to play a role [5]. Avoiding opioids may also help [6], but pain in itself can also cause nausea [7] and the use of opioids may be necessary. We frequently fast patients before surgery, yet hydration status can also be a factor [8]. Most anaesthetists would have reviewed the physiology of nausea and vomiting during their training; the complexity of the systems involved cannot be understated. While the prevention and treatment of PONV are a routine part of anaesthetic practice, local variations in treatment persist; the drugs used, and doses employed, are variable. It is unsurprising that the prevention of PONV is a continuing area of research. There are hundreds of studies investigating PONV and its prevention, making the dissemination and interpretation of evidence challenging. In this issue of Anaesthesia, Weibel et al. publish an abridged version [9] of their recent Cochrane systematic review and network meta-analysis of drugs for preventing postoperative nausea and vomiting [10]. The review tries to bring some clarity to the abundance of published articles and studies on this topic by presenting the first network meta-analysis to compare all available anti-emetic drugs. The scope and scale of the work are truly impressive, with data being drawn from 585 randomised controlled trials (RCT) involving over 97,500 participants to allow comparison of efficacy and safety for single and multiple drug treatments. Frequently used, and widely studied, agents such as dexamethasone, ondansetron and droperidol, are included, as well as a wide range of less commonly given drugs. Six pharmacological classes feature: 5-hydroxytryptamine-3 antagonists; dopamine-2 antagonists; neurokinin-1 receptor antagonists; corticosteroids; antihistamines; and anticholinergics. Forty-four single agents and 51 combinations were assessed. Seventy-two per cent of the included studies investigated one drug and 66% included a placebo control for comparison. There was good quality evidence, expressed as relative risk (95%CI) of

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Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery

Cited by 19 publications

References 106 publications

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Is There an Optimal Timing of Adductor Canal Block for Total Knee Arthroplasty?—A Retrospective Cohort Study

Anti‐emetic drugs for preventing postoperative nausea and vomiting: new evidence from a Cochrane network meta‐analysis

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