Outcome comparison of femoral nerve block and adductor canal block during anterior cruciate ligament reconstruction: adductor canal block may cause an unexpected decrease in knee flexor strength at 6 months postoperatively

Sengoku, Takuya; Nakase, Junsuke; Mizuno, Yushin; Yoshimizu, Rikuto; Kanayama, Tomoyuki; Yanatori, Yusuke; Tsuchiya, Hiroyuki

doi:10.1007/s00402-023-04980-1

Cited by 3 publications

(4 citation statements)

References 35 publications

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“…In addition, the AC maintains anatomic continuity with the popliteal fossa, so the downward spread of local anesthetics within the AC may also affect the sciatic nerve and, in turn, impact quadriceps muscle strength, 29 – 32 and this impact could even be long-lasting. 33 In addition, in the context of our study, the insertion position of the ACB was similar to that used in the study by Bora Lee, 16 where continuous distal ACB (similar to our study) showed significant reductions in NRS scores during rest and early morning on postoperative day 2 (POD2) compared with continuous FTB. They proposed that administering local anesthetics continuously to the distal AC could enhance analgesic effects on posterior knee pain by spreading into the popliteal fossa.…”

Section: Discussionsupporting

confidence: 67%

“…Because the AC is connected to the FT through the entrance of the AC, when using a continuous nerve block with a large volume of local anesthetic, the local anesthetic may spread upward to the FT, blocking other femoral nerve branches and causing a decline in quadriceps muscle strength. In addition, the AC maintains anatomic continuity with the popliteal fossa, so the downward spread of local anesthetics within the AC may also affect the sciatic nerve and, in turn, impact quadriceps muscle strength, 29–32 and this impact could even be long-lasting 33 . In addition, in the context of our study, the insertion position of the ACB was similar to that used in the study by Bora Lee, 16 where continuous distal ACB (similar to our study) showed significant reductions in NRS scores during rest and early morning on postoperative day 2 (POD2) compared with continuous FTB.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block and Adductor Block After Total Knee Arthroplasty

Tan,

Chen,

et al. 2024

The Clinical Journal of Pain

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Objectives: This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these three. Methods: Patients undergoing TKA were randomly assigned to one of three groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary endpoint was the Numeric Rating Scale (NRS) score at movement at 24 hours post-surgery. Secondary endpoints included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion (ROM), effective PCNA utilization, and opioid consumption at various post-surgery time points. Results: Of the 94 valid datasets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary endpoint (H=7.003, P=0.03). Post-hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2-4]) compared to the ACB group (4 [3-5], Bonferroni-adjusted P=0.03). Regarding secondary endpoints, both the FNB and FTB groups had lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other endpoints. Discussion: Continuous FTB provides postoperative analgesia comparable to FNB, but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block and Adductor Block After Total Knee Arthroplasty

Tan,

Chen,

et al. 2024

The Clinical Journal of Pain

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“…Although knee arthroscopic surgery is less invasive, a minority of patients experience moderate to severe postoperative pain [ 3 , 21 ]. One study reported a visual analogue scale score of 2.0 (0.6) in the FNB group and 3.4 (1.0) in the ACB group following knee arthroscopy [ 27 ]. Another study reported a lower NRS score at 6 h after surgery of 1.66 (1.29) in the FNB group compared with 1.73 (1.12) in the ACB group [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown that after total knee arthroplasty surgery, ACB and FNB have similar clinical efficacy in pain scores, opioid consumption, opioid-associated adverse effects, patient satisfaction, and success rate of the blockade [ 8 , 14 , 35 ]. Other studies have shown different results, suggesting that FNB is still the most effective intervention after knee arthroplasty and knee arthroscopy [ 4 , 13 , 24 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy

Zhang,

Niu

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Femoral nerve block (FNB) is widely used in patients undergoing knee arthroscopy. However, the most commonly used concentration of ropivacaine (0.2% or above) may cause an unexpected decrease in the muscle strength of the quadriceps. Therefore, a lower concentration of ropivacaine (0.1%) for FNB was administered to investigate the effect on quadriceps strength and postoperative pain after knee arthroscopy. Methods This was a double-blind, randomized, controlled trial (ChiCTR2000041404). A total of 83 patients scheduled for elective knee arthroscopy were randomized to receive 0.1% or 0.2% ropivacaine for FNB under ultrasound guidance. The primary outcomes were quadriceps strength and numerical rating scale (NRS) pain score. Quadriceps strength was measured before surgery and 6 h and 24 h after surgery, while NRS score was recorded before surgery, at the postanaesthesia care unit (PACU), and 6 h and 24 h after surgery. Multiple linear regression tests were used to compare the differences in quadriceps strength and NRS score between the two groups. Two-factor analysis of variance, using the factors group and time of measurement, was used for repeated NRS scores. Secondary outcomes included knee mobility, side effects, patient satisfaction, and length of hospital stay. Results The mean (SD) quadriceps strength at 6 h after surgery was 7.5 (5.7) kg for the 0.1% ropivacaine group and 3.0 (4.4) kg for the 0.2% ropivacaine group. The mean difference adjusted for baseline characteristics was − 5.2 (95% CI − 7.2 to − 3.1) kg (P < 0.001). There was no significant difference between the two groups in quadriceps strength at 24 h after surgery. The mean differences in the average NRS score and maximum NRS score in the PACU were − 0.6 (P = 0.008) and − 1.0 (P < 0.001), respectively. There was no significant difference in NRS score at 6 h or 24 h after surgery. Two-factor analysis of variance showed no significant difference in the interaction factors of time and group for average NRS score and maximum NRS score. Conclusions Compared with 0.2% ropivacaine, 0.1% ropivacaine for FNB preserved quadriceps strength at 6 h after knee arthroscopy while providing similar analgesic effects. Level of evidence I.

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Should Femoral Nerve Blocks and Adductor Canal Blocks Be Used in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction?: A Systematic Review

Vivekanantha,

Sun,

Tapasvi

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Achieving adequate pain control is vital for proper rehabilitation, satisfaction, and earlier discharge after anterior cruciate ligament reconstruction. Opioids have traditionally been used for this purpose, however, can be associated with various negative outcomes. As such, multimodal analgesia was introduced to reduce postoperative opioid use. Regional nerve blocks constitute one modality of multimodal analgesia, with femoral nerve blocks (FNBs) and adductor canal blocks (ACBs) being standard. This review sought to evaluate the utility and adverse effects of FNBs and ACBs relative to controls, alternative regional anesthesia options, and each other in pediatric or adolescent anterior cruciate ligament reconstruction (ACLR). Methods: Three databases were searched on January 31, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The definition of pediatric was considered to be a mean age of 18 years or younger. Data on demographics, operative and anesthetic details, strength and functional outcomes, postoperative opioid consumption, revision rates and return to sport (RTS) rates, and Visual Analogue Scale (VAS) scores were extracted. Results: Eleven studies (1 level I, 10 level III) comprising 5453 patients were included in this review (54.1% female), with a mean age of 16.3 (range of means: 15.0 to 16.9) years. Two studies compared FNB with and without a sciatic-nerve block (SNB), finding lower opioid consumption (P=0.007) and VAS scores (P<0.0001) in the postanesthesia care unit (PACU) in the FNB + SNB group. Three studies compared FNB or ACB with controls, with no studies reporting a benefit in rates of RTS, isokinetic quadriceps or hamstrings strength, or functional test performance. There were minimal differences when comparing continuous and single nerve blocks and FNB with ACB. Conclusion: There is inconclusive evidence investigating the role of FNB and ACB in pediatric or adolescent ACLR. The addition of a SNB to FNB may result in improvements in opioid consumption and VAS scores in the early postoperative period. There was minimal evidence in support of continuous blocks over single-shot blocks. Future studies should compare the use of ACB, FNB, and no blocks for pediatric or adolescent ACLR, with primary endpoints of acute pain control, postoperative opioid use, and the presence of longer-term motor deficits. Level of Evidence: Level III.

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Outcome comparison of femoral nerve block and adductor canal block during anterior cruciate ligament reconstruction: adductor canal block may cause an unexpected decrease in knee flexor strength at 6 months postoperatively

Cited by 3 publications

References 35 publications

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block and Adductor Block After Total Knee Arthroplasty

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block and Adductor Block After Total Knee Arthroplasty

Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy

Should Femoral Nerve Blocks and Adductor Canal Blocks Be Used in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction?: A Systematic Review

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