Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty

Abstract

A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA.Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis.Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea.Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists.

Comparison of femoral block and adductor canal block in the postoperative analgesia of patients undergoing arthroscopic knee surgery

“…Similarly, in a series of 100 patients undergoing anterior ligament repair, adductor canal block and femoral nerve block were found to be equal in terms of cumulative oral morphine consumption [15]. In the same way as our subjects, Dong et al [16] reported that adductor canal block (ACB) shows no superiority than femoral nerve block (FNB) group regarding muscle strength and pain control. However, Li et al [17] demonstrated that ACB preserved greater quadriceps strength more than FNB with similar pain control.…”

Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials

“…This uncertainty leads to the determination of which peripheral nerve blockade to adopt by the preference of the surgeons. Two meta-analyses were published on this topic recently2122. Dong et al .…”

Adductor Canal Block Combined with Sciatic Nerve Block Vs. Local Analgesic Infiltration for Pain Control after Total Knee Arthroplasty

“…Both FNB and ACB can give good postoperative pain relieve after TKR [33]. Recently, there has been a shifting trend from the use of FNB towards the use of adductor canal block for postoperative analgesia in patients undergoing TKA.…”

“…Recently, there has been a shifting trend from the use of FNB towards the use of adductor canal block for postoperative analgesia in patients undergoing TKA. The anterior branch of obturator nerve, the saphenous nerve, and a branch of the posterior femoral nerve within the adductor canal are sensory to the surrounding tissue of the knee joint [33,34]. Kim et al [35] femoral nerve block and adductor canal block and for post-operative pain management with TKR, they found that the comparative reduction of post-operative pain with less opioid consumption, additionally, adductor canal block had spring of the quadriceps with no difference in range of motion.…”

“…Moreover, a meta-analysis study [33] stated that the FNB and ACB had no significant difference as regards of VAS score with within 48 h postoperatively and the muscle strength of quadriceps muscle. Adrenaline has some advantages in peripheral nerve blocks like maintaining tissue levels of local anesthetic and decreasing bleeding [37].…”