Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract

Purpose: A continuous adductor canal block (cACB) for pain control in total knee arthroplasty (TKA) is always performed by an anesthesiologist. A surgeon-performed cACB during surgery is somewhat questionable in terms of feasibility, reproducibility, and efficacy. Methods: This study was divided into 2 phases. In Phase I, an experimental dissection of 16 cadaveric knees to expose the Saphenous nerve and related muscles around the adductor canal was conducted. The extent of dye after injection via a catheter inserted into the adductor canal at the time of TKA was evaluated. In phase II, an RCT study comparing clinical outcomes between surgeon-performed (Group 1) and anesthesiologist-performed cACB (Group 2) during TKA in 63 patients was evaluated. The visual analog scale (VAS) at rest and during movement at several time points and functional outcomes during hospitalization were compared. Results: The phase I study demonstrated surgeon-performed cACB during surgery feasible and reproducible with consistent dye extension into the adductor canal after injection via a catheter. In the phase II study, 29 patients of Group 1 and 30 patients of Group 2 completed the evaluation with no differences in baseline parameters. The VAS during movement at 24 and 36 hours, quadriceps strength, time up and go test, and knee motion at different time points, and total morphine consumption showed no differences between both groups. There were no procedure-related complications. Conclusion: The surgeon-performed cACB during surgery was feasible and reproducible with similar VAS scores and functional outcomes during hospitalization to anesthesiologist cACB. Level of evidence Level I, prospective randomized trial. Keywords: adductor canal block, peripheral nerve block, total knee arthroplasty, surgeon-performed ACB

Does Proximal Adductor Canal Block Provide Better Analgesic Efficacy than Distal Adductor Canal Block in Patients Undergoing Knee Arthroplasty: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…In summary, a total of 6731 publications were identified from the following databases including PubMed (538), Cochrane library (1140), Web of science (1890), and Embase (3163), which yielded 3232 papers after removing duplicates (3499 articles). After screening the retrieved manuscripts based on titles and abstracts, we retrieved 20 full texts, 17–21,28–41 13 were excluded and seven were finally included in the review and meta‐analysis according to inclusion and exclusion criteria 17–21,28,29 . Trials were excluded for the following reasons: not randomized controlled trials (n = 1), 32 unsuitable control group (n = 2), 34,35 other comparison (n = 8), 30,31,33,36–40 cross‐over design (n = 1), 38 and not true ACB (n = 1) 41 …”

“…The year of publication of the included trials ranged from 2014 to 2023. Four trials were conducted in the United States, 17,18,29,28 one in China, 21 one in Korea, 19 and one in Thailand 20 . The number of participants in these studies varied from 49 to 63.…”

“…Five trials performed an ultrasound‐guided injection in both proximal and distal groups, 17–21,28,29 whereas the other two studies compared the analgesic effect of anesthesiologist administered proximal ACB with surgeon‐administered distal ACB 18,20 . The included studies used the local anesthetic in different concentrations.…”

“…Four trials used 0.2% ropivacaine, whether the other studies used 2% mepivacaine with epinephrine 29 and 0.5% ropivacaine 18 . Five studies performed the nerve block preoperatively, 17,18,21,28,29 and the other two studies conducted the block procedure postoperatively 19,20 . Most trial authors selected continuous postoperative administration of local anesthetic except for the study by Greenky et al, who performed a single injection procedure 18 .…”

“…However, Lee et al recently showed that patients in the distal ACB group experienced significantly less pain at rest and during movement than those in the proximal ACB group 19 . Moreover, other studies have reported no significant between‐group difference in terms of postoperative pain and total opioid consumption 20,21 . Accordingly, we lack consensus on the optimal location for ACB placement within the canal.…”