Earlier Is Better? Timing of Adductor Canal Block for Arthroscopic Knee Surgery under General Anesthesia: A Retrospective Cohort Study.

Shao-Chun Wu,Chih-Chun Chen,Yan-Yuen Poon,Hsiao-Feng Lu,Chih-Yi Hsu,Shao-Yun Hou

doi:10.3390/ijerph18083945

Abstract

The adductor canal block (ACB) is effective for treating postoperative pain during arthroscopic knee surgery, but its impact on anesthesia course and the optimal administration timing are unknown. This retrospective study addressed these questions. The aim of this study was to compare the effects of preoperative ACB and postoperative ACB on anesthesia course and postoperative recovery. We allocated 215 adult patients who underwent arthroscopic knee surgery under sevoflurane anesthesia between January 2019 and December 2019 to three groups. Group A received general anesthesia without ACB, Group B received ACB before general anesthesia induction, and Group C received ACB in the post-anesthesia recovery unit (PACU). Group B consumed significantly less sevoflurane (0.19 mL/kg/h) and milligram morphine equivalents (0.08 MME) intraoperatively than Groups A (0.22 mL/kg/h; 0.10 MME, respectively) and C (0.22 mL/kg/h; 0.09 MME, respectively). Groups B and C had lower visual analogue scale (VAS) scores upon PACU discharge than Group A. Dynamic, but not at-rest VAS scores, were significantly higher in Group A. Opioid consumption was similar in the ward, but Group A requested more intravenous parecoxib for pain relief. Length of hospital stay was similar. Thus, preoperative ACB reduced the amount of volatile anesthetic required and maintained stable hemodynamics intraoperatively. Preoperative or postoperative ACB improved postoperative pain control. Consequently, preoperative ACB is optimal for intraoperative stress suppression and postoperative pain control.

Highlights

Arthroscopy, i.e., inspection of a joint cavity, was initiated in the early 20th century by Professor Kenji Takagi [1] (1888–1963) and a Swiss surgeon, Dr Eugene Bircher [2](1882–1956)
We found that preoperative adductor canal block (ACB) reduced the amount of volatile anesthetic required and maintained stable hemodynamics intraoperatively
We concluded that preoperative ACB could modify the anesthesia course by reducing the concentration and consumption of volatile anesthetic during surgery

Summary

Introduction

Arthroscopy, i.e., inspection of a joint cavity, was initiated in the early 20th century by Professor Kenji Takagi [1] (1888–1963) and a Swiss surgeon, Dr Eugene Bircher [2](1882–1956). Due to the outbreak of the Second World War, arthroscopic knee surgery was not well-known in the orthopedic community until the late 1960s. Knee pain is one of the early signs of pathological change in joint cartilage, ligaments, meniscus or bone. Conservative treatment such as, intra-articular local anesthetic infiltration, oxygen-ozone therapy or hyaluronic acid [3], focal muscle vibration [4,5] is the usual treatment for these patients. Knee arthroscopy is a minimally invasive procedure that could reveal possible causes of knee pain and provide surgical repair of structural change in cartilage, ligament, meniscus or bone. While surgical wound size is smaller and tissue destruction is far less than that in conventional open knee surgeries, a substantial number of patients

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