Abstract
Purpose: The purpose of this study was to assess the efficacy of adductor canal block (ACB) as compared to femoral nerve block (FNB) in ambulation distance, opioid consumption, and physical therapy participation on postoperative days (PODs) 1 and 2 after total knee arthroplasty (TKA). We hypothesized ACB would have increased the ambulation distance and decreased the opioid consumption in comparison to FNB.Methods: All elective TKAs at a single institution, age 18 and older, without existing neurologic or anatomic deficit in the operative limb, were considered. Participants were randomized 1:1 to receive either an ACB (AC group) or a FNB (FN group), in addition to standard care. Visual analog pain scores (VAS) and oral morphine equivalents (OMEs) were recorded preoperatively, in post-anesthesia care unit (PACU), and on PODs 1 and 2. Postoperative ambulation distance was recorded on PODs 1 and 2. Patient satisfaction with analgesia and physical therapist-rated participation in therapy sessions was obtained as well. Results: From 2014 to 2015, 84 participants were recruited: 41 in FN, and 43 in AC. On POD 1, mean ambulation distances in AC and FN were 70.2 and 48.5 ft, respectively (p = 0.045). On POD 2, mean ambulation distances in AC and FN were 129.0 and 106.4 ft, respectively (p = 0.225). VAS, OME, satisfaction, and physical therapy participation were not significantly different.Conclusions: Ambulation after TKA is superior with ACB on the first POD, but there is no difference in VAS scores, OME, patient satisfaction, or ambulation on POD 2.
Highlights
Peripheral blockade of the femoral nerve (FN) has long been used for perioperative pain control in total knee arthroplasty (TKA)
Ambulation after TKA is superior with adductor canal block (ACB) on the first postoperative days (PODs), but there is no difference in Visual analog pain scores (VAS) scores, oral morphine equivalents (OMEs), patient satisfaction, or ambulation on POD 2
No significant differences were found between the adductor canal (AC) and FN cohorts with respect to VAS pain scores
Summary
Peripheral blockade of the femoral nerve (FN) has long been used for perioperative pain control in total knee arthroplasty (TKA). These blocks provide effective analgesia, which is reflected in patient satisfaction with surgical pain relief. There has been an increasing interest in performing a more targeted, distal block that avoids the motor blockade of the FNB. One of the proposed blocks is the adductor canal block (ACB), which is thought to avoid the quadriceps motor blockade while providing noninferior analgesia compared to FNB [12]. Current investigative reports have only provided preliminary data, leaving questions about ACB as compared to FNB unanswered with respect to ambulation postsurgery
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