Abstract
Femoral nerve blocks (FNB) can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty (TKA). Adductor canal block (ACB) is a relatively new alternative providing pure sensory blockade with minimal effect on quadriceps strength. The meta-analysis was designed to evaluate whether ACB exhibited better outcomes with respect to quadriceps strength, pain control, ambulation ability, and complications. PubMed, Embase, Web of Science, Wan Fang, China National Knowledge Internet (CNKI) and the Cochrane Database were searched for RCTs comparing ACB with FNB after TKAs. Of 309 citations identified by our search strategy, 12 RCTs met the inclusion criteria. Compared to FNB, quadriceps maximum voluntary isometric contraction (MVIC) was significantly higher for ACB, which was consistent with the results regarding quadriceps strength assessed with manual muscle strength scale. Moreover, ACB had significantly higher risk of falling versus FNB. At any follow-up time, ACB was not inferior to FNB regarding pain control or opioid consumption, and showed better range of motion in comparison with FNB. ACB is superior to the FNB regarding sparing of quadriceps strength and faster knee function recovery. It provides pain relief and opioid consumption comparable to FNB and is associated with decreased risk of falls.
Highlights
Total knee arthroplasty (TKA) is regarded as an effective treatment for end-stage knee osteoarthritis[1,2]
Adductor canal block (ACB) shows no superiority than Femoral nerve blocks (FNB) group
ACB provide better ambulation ability, Level II A, B, C, D, F, G, H faster recovery and better pain control at rest after total knee arthroplasty (TKA) compared to FNB
Summary
Total knee arthroplasty (TKA) is regarded as an effective treatment for end-stage knee osteoarthritis[1,2]. Over 50% of post-TKA patients suffer from moderate-to-severe postoperative pain, which results in immobility-related complications and prolonged hospitalization[4,5]. Femoral nerve block (FNB) is known to provide superior pain control and shortens the time of functional recovery and the length of hospital stay without associated side effects, in comparison with epidural or intravenous patient-controlled analgesia (PCA)[6,7]. The introduction of fast-track clinical pathways leads orthopedic surgeons to question risk–benefit ratio for FNB and explore an alternatively optimal analgesia modality, providing motor strength preservation with effective analgesia, to enable faster rehabilitation, shorter hospitalization, and earlier ambulation[8,9,10,11]. Adductor canal block (ACB) is a relatively new alternative for post-TKA pain management. Anatomical study of adductor canal showed that an adductor canal contained multiple afferent sensory nerves (e.g. saphenous nerve, medial femoral cutaneous, and medial retinacular nerve etc.) but only a single efferent motor nerve
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