Efficacy of the Adductor Canal Approach to Saphenous Nerve Block for Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: A Randomized Controlled Trial

Abstract

Background:For reconstruction of the anterior cruciate ligament (ACL) with hamstring autograft, perioperative analgesia can be achieved with multimodal analgesia and intra-articular local anesthesia infiltration with or without additional regional blocks. Saphenous nerve block (SNB) via the adductor canal is commonly used in our practice, but its benefit has not been well established in the literature.Purpose:To assess the efficacy of SNB in ACL reconstruction with hamstring autograft.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Consecutive patients undergoing arthroscopic ACL reconstruction with hamstring autograft were randomized into a control group (no SNB) and an intervention group (SNB). All patients received standardized anesthetic induction and maintenance agents with perioperative analgesia, per study protocol, with local anesthetic infiltration of the graft harvest site and intra-articular infiltration.Results:Sixty patients were randomized into the 2 groups (n = 30 each). There was no statistically significant difference in total opiate consumption between the groups (control, 34 mg; SNB, 31 mg; P = .40). There was no statistically significant difference in visual analog scale scores for pain at 0, 8, and 24 hours postsurgery, and no difference in overall satisfaction score. The control group had a significantly higher visual analog scale score at 4 hours postsurgery (3.0 vs 1.9, P = .04).Conclusion:SNB has a minimal effect on postsurgical care for ACL reconstruction with hamstring autograft in the presence of multimodal analgesia and local anesthetic infiltration.

Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types

“…As per routine, an ultrasound-guided saphenous nerve block is performed for perioperative pain management. 21 In instances of both ACL reconstruction as well as ACL repair, we endorse the “Early Active Rehabilitation” therapy strategy. While undergoing this program, patients focus on immediate full weight-bearing without postoperative bracing.…”

The Influence of Perioperative Nerve Block on Strength and Functional Return to Sports After Anterior Cruciate Ligament Reconstruction

“…Brull 7 noted that adductor canal blocks provide equivalent analgesia to femoral nerve blocks, with preservation of quadriceps function, and Kwofie et al 22 and Bailey et al 3 showed no change in quadriceps strength with the administration of an adductor canal block. However, Kejriwal et al 17 performed a randomized controlled trial in patients undergoing hamstring ACLR who received placebo or saphenous nerve block and found no difference in postoperative pain scores. Additionally, Christensen et al 9 showed a significant decrease in extension strength with the use of an adductor canal block at a 6-month evaluation.…”

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: a randomized, blinded study

“…At this level, the saphenous nerve was visualized as a hyperechoic structure lateral-anterior to the artery in the subsartorial region [4,5,11]. By using the in-plane technique, the injection site was confirmed with an injection of 5 mL of saline, and then 30 ml of 0.25% bupivacaine was injected (Figure 3).…”

“…3 Pain after arthroscopic knee surgery not only results in patient dissatisfaction but also may cause delayed mobilization. Therefore, it is important to manage postoperative pain [3][4][5]. Analgesia after this type of surgery can be provided most effectively with a peripheral nerve block as part of a multimodal analgesia regimen.…”

“…The adductor canal is a musculoaponeurotic tunnel functioning as a passageway for neurovascular structures (the femoral artery, femoral vein, saphenous nerve and the nerve to the vastus medialis) from the femoral triangle to the adductor hiatus [10]. It has been shown that selective blockade of the saphenous nerve in the adductor canal provides effective analgesia management after surgical knee procedures [4][5][6][7][8][9][10][11][12][13][14][15]. Because the saphenous nerve is a sensory branch of the femoral nerve, ACB has potential advantages over femoral block by avoiding motor blockade of the quadriceps muscle and providing early ambulation [16].…”