Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block

Abstract

Purpose Moderate‐to‐severe postoperative pain remains a challenge for both patients and surgeons after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to systematically review the current evidence in the literature to compare adductor canal block (ACB) with femoral nerve block (FNB) in the treatment of ACLR. Methods A comprehensive search of the published literature in PubMed, Scopus, EMBASE, and Cochrane Library databases was performed. Only English randomized clinical trials (RCTs) were included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse events, patient satisfaction, and quadriceps strength. Results Eight RCTs with a total of 587 patients were included. No statistically significant difference was observed between the ACB and FNB groups in pain scores at 6 h, 12 h, 24 h, or 48 h; cumulative opioid consumption at 24 h or 48 h; patient satisfaction at 24 or 48 h; and postoperative adverse event. However, ACB showed superior quadriceps strength in the early postoperative period. Conclusions Both treatments provided similar overall pain relief after ACLR. The potential benefits of quadriceps preservation with ACB are worthy of future study. Therefore, ACB is recommended as an attractive alternative to FNB as the peripheral nerve block of choice for ACLR. Level of evidence Meta‐analysis of Level 1 was performed in this study.

A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon

“…90,112,122 In a larger review of adolescent ACL reconstruction cases, patients receiving an ACB consumed significantly fewer opioids in the first 3 postoperative days compared with those with an FNB, but there were no differences in overall pain scores, satisfaction, and return of strength. 60 Also, 2 recent level 1 meta–analyses of ACL reconstruction 97,129 and an aforementioned RCT 98 of elective arthroscopic knee surgery found the ACB to provide similar analgesia and a significant advantage in strength preservation and earlier ambulation after surgery compared with the FNB. 97,129 Investigations comparing the overall efficacy of pain control between the FNB and ACB in arthroscopic knee surgery are ongoing.…”

“…60 Also, 2 recent level 1 meta–analyses of ACL reconstruction 97,129 and an aforementioned RCT 98 of elective arthroscopic knee surgery found the ACB to provide similar analgesia and a significant advantage in strength preservation and earlier ambulation after surgery compared with the FNB. 97,129 Investigations comparing the overall efficacy of pain control between the FNB and ACB in arthroscopic knee surgery are ongoing. 159…”

Ultrasound-guided pericapsular nerve group block versus fascia iliac compartment block for pain control in lower limb orthopedic surgery: A meta-analysis from randomized controlled trials

“…In recent years, with the mature application of ultrasound technology, FICB has been promoted as a valuable technique for regional anesthesia and analgesia in lower limb orthopedic surgery [4]. However, FICB was found to decrease quadriceps muscle strength, and the duration of postoperative analgesia was shorter [5][6]. Recently, PENG has gradually become an emerging analgesic method because it can block the obturator nerve, accessory obturator nerve and femoral nerve which innervate the anterior capsule of hip joint and produce good analgesic effect without affecting the motor nerve [7].…”