Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor Canal Nerve Block—A Systematic Review and Meta-analysis

Sehmbi, Herman; Brull, Richard; Shah, Ushma Jitendra; El‐Boghdadly, Kariem; Nguyen, D.T.; Joshi, Girish P.; Abdallah, Faraj W.

doi:10.1213/ane.0000000000002570

Cited by 50 publications

(50 citation statements)

References 67 publications

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“…The incidence of side effects was similar between the two groups. Opioid-related adverse effects such as postoperative nausea and vomiting, antiemetic use, and postoperative sedation/drowsiness were reported in previous studies [39,40], but we did not find significant differences between the two groups in this study. This could be because the difference between the two groups in PCA consumption was not large enough to cause sufficient differences in side effects.…”

Section: Discussioncontrasting

confidence: 82%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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Background: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.

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Section: Discussioncontrasting

confidence: 82%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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“…In a 2part meta-analysis Vorobeichik and Sehmbi et al found that neither the femoral nerve or adductor canal block significantly reduced opioid requirements compared to multimodal analgesia following ACLR and did not support the routine use of either block for patients having ACLR [14]. Our results from the adductor canal only group support this recommendation for patients undergoing MPFLR.…”

Section: Discussioncontrasting

confidence: 64%

Regional Anesthesia and the Adolescent Opioid Epidemic

2019

Medical &Amp; Clinical Research

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Rationale: The legitimate use of prescription opioids in high school seniors increases the risk of future misuse after high school by 33%. Medial patellofemoral ligament reconstruction (MPFLR) is an operation to correct recurrent patellar instability occurring primarily in teenagers with joint hyperlaxity. MPFLR is associated with the extensive use of prescription opioids for significant postoperative pain and prolonged recovery. The hypothesis of this study is that the addition of a single injection proximal sciatic nerve block would significantly reduce opioid requirements and pain scores in adolescents undergoing MPFLR with an adductor canal continuous peripheral nerve block (CPNB). Objectives: The primary end-point of the study is cumulative post-operative opioid consumption (mg/kg morphine equivalents) while hospitalized after MPFLR between the two groups. Findings: We retrospectively compared 25 patients who received an adductor canal CPNB with a single injection proximal sciatic nerve block (Group A/S) and 23 patients who received only an adductor canal CPNB (Group A). Morphine consumption was less than half in group A/S compared to Group A. Eighty-eight percent of patients in Group A/S did not require opioids on the DOS. Maximum and mean pain scores on DOS and POD 1 were significantly lower in Group A/S than Group A. Conclusions: This study suggests the addition of a proximal sciatic nerve block to the adductor canal CPNB significantly reduces opioid requirements and pain scores in the first 24-32 hours after MPFLR in adolescent patients and supports a randomized clinical trial to confirm these findings.

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“…Multi‐modal analgesia alone is a common strategy in the management of ambulatory knee surgery due to its ease of adminsitration, long history of use and limited access globally to regional anaesthesia. This strategy, in the absence of any local anaesthetic administration, remains critical given that the difference in pain scores in minor arthroscopic procedures are only modestly worse compared with multi‐modal analgesia in conjunction with regional anaesthesia . Systemic analgesics avoid the potential risks of local anaesthetic toxicity, nerve damage, muscular weakness and local anaesthetic‐induced chondrotoxicity all together .…”

Section: Analgesic Strategiesmentioning

confidence: 99%

“…To date, the reported analgesic benefits of adductor canal blocks in the setting of ACL reconstruction are limited. When compared with either femoral nerve block or placebo in the context of multi‐modal analgesia, the adductor canal block does not reduce pain scores or analgesic consumption, nor does it have any effect on patient satisfaction . A brief assessment of the dermatomal distribution of these nerves alludes to why this might be the case (Fig.…”

Section: Analgesic Strategiesmentioning

confidence: 99%