Abstract
BackgroundBoth adductor canal block (ACB) and local infiltration analgesia (LIA) are effective procedures for postoperative pain control in total knee arthroplasty (TKA) without motor blockade. However, whether ACB combined with LIA has synergistic effect than ACB alone remains unknown. We hypothesized that ACB combined with LIA would have better postoperative pain control, less rescue opioid consumption and faster rehabilitation than ACB alone, without higher adverse event rate.MethodsWe conducted a meta-analysis to identify relevant articles involving ACB + LIA and ACB alone in patients who underwent TKA from online register databases such as PubMed, Medline, Embase, Web of Science, and the Cochrane Library. The primary outcomes were visual analog scale (VAS) score and morphine consumption. Secondary outcomes were postoperative range of motion (ROM) and adverse event rate.ResultsAccording to the keyword search from online register databases, a total of 879 articles were identified, of which six articles that met the inclusion criteria were determined as eligible. There were three randomized controlled trials (RCTs) and three non-randomized prospective studies. As compared to the ACB alone group, the ACB + LIA group had lower VAS at rest on postoperative day 0 and 1, as well as significantly less morphine consumption on postoperative day 0 and 1 and significantly better postoperative ROM. There were no significant differences in adverse event rate.ConclusionAs compared to ACB alone, ACB + LIA provides better analgesia and faster functional rehabilitation in patients who underwent TKA.
Highlights
Total knee arthroplasty (TKA) is a very well-established surgical procedure for patients with end-stage knee osteoarthritis and rheumatoid arthritis. [1] Usually, patients who underwent total knee arthroplasty (TKA) had intense moderate to severe postoperative pain and difficulty to manage, which seriously affected life quality and postoperative rehabilitation.Effective analgesic regimens have been shown to result in earlier physical therapy and faster recovery leading to better clinical outcomes, shorter hospital stays and less postoperative complications
Search results A total of 879 articles were initially identified from online register databases by keyword search, and 823 articles were excluded after primary review of the titles and abstracts
Ma’s meta-analysis found that as compared to local infiltration analgesia (LIA) alone, adductor canal block (ACB) + LIA resulted in earlier ambulation, with no significant differences in visual analog scale (VAS) score, morphine consumption, complication rates and length of hospital stay [14]
Summary
Total knee arthroplasty (TKA) is a very well-established surgical procedure for patients with end-stage knee osteoarthritis and rheumatoid arthritis. [1] Usually, patients who underwent TKA had intense moderate to severe postoperative pain and difficulty to manage, which seriously affected life quality and postoperative rehabilitation.Effective analgesic regimens have been shown to result in earlier physical therapy and faster recovery leading to better clinical outcomes, shorter hospital stays and less postoperative complications. Several analgesic regimens including epidural analgesia (EA), femoral nerve block (FNB), patient-controlled analgesia (PCA), adductor canal block (ACB), and local infiltration analgesia (LIA) have been proven to provide effective postoperative pain control for TKA. Some recent studies reported that it was usually associated with postoperative weakness of the quadriceps, which may increase the risk of falling during postoperative rehabilitation process, thereby hindering early rehabilitation exercises. Both adductor canal block (ACB) and local infiltration analgesia (LIA) are effective procedures for postoperative pain control in total knee arthroplasty (TKA) without motor blockade. We hypothesized that ACB combined with LIA would have better postoperative pain control, less rescue opioid consumption and faster rehabilitation than ACB alone, without higher adverse event rate
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