Adductor Canal Block Research Articles

Comparison of the Effectiveness of Ultrasound-Guided Proximal, Mid, or Distal Adductor Canal Block after Knee Arthroscopy.

Adductor canal block has been used for effective post-operative analgesia; however, the optimal location of adductor canal block placement is still controversial. We aimed to assess the opioid consumption and pain intensity in patients undergoing proximal, mid, and distal adductor canal block after knee arthroscopy. A total of 90 patients who had undergone an arthroscopic knee surgery and proximal, mid, or distal adductor canal block for postoperative analgesia were examined. All groups received 20 mL of bupivacaine (0.375%) to the adductor canal. Post-operative pain scores, tramadol consumption, Bromage scores, additional analgesic need, and other complications were recorded. Our results demonstrated that proximal adductor canal block group significantly reduced opioid consumption compared to the midadductor canal block group (P < .001), and mid-adductor canal block group provided significantly decreased opioid consumption than the distal adductor canal block group (P = .004). The visual analog scale values were significantly lower in the proximal adductor canal block group compared to the mid-adductor canal block group at 0, 2, 4, 8, 12, and 24 hours, except in resting visual analog scale values at 24 hours. When the proximal and distal groups were compared, visual analog scale values were significantly lower in the proximal adductor canal block group. The Bromage score was 0 in all groups at each follow-up point. Post-operative nausea was observed in only 3 (3.3%) patients, all of these patients were in the distal adductor canal block group. Ultrasound-guided adductor canal block can be applied reliably at proximal, mid, and distal locations. The proximal adductor canal block approach provides significantly lower tramadol consumption and post-operative visual analog scale values than the mid- and distal adductor canal block groups.

VAS Scores, Pain-Free Duration, Range of Motion, and IL-6 Levels are Better in Adductor Canal Block Compared to Genicular Nerve Block in Patients with Chronic Pain of Degenerative Disease of the Knee Joint

Introduction: Chronic knee pain is the leading cause of functional limitations in the older age group and accounts for many visits to health care providers. This degenerative condition is progressive with functional impairment and a severe decrease in quality of life. Pain management with Adductor Canal Block (ACB) and Genicular Nerve Block (GNB) can be an alternative treatment option for chronic knee pain. This study aims to analyze the difference between clinical &amp; laboratory outcomes of the ACB and GNB groups. Material &amp; Methods: An experimental study with consecutive sampling was conducted on 34 patients with chronic knee pain divided into 2 groups of ACB and GNB procedures. The parameters measured were VAS score, pain-free duration, range of motion, and interleukin-6 (IL-6) levels. Results: Predominance of chronic knee pain patients found in older women. Based on statistical analysis, there was an improvement in VAS scores (p&lt;0,05), a similar pain-free duration (p&gt;0,05), an improvement in the range of motion (p&lt;0,05), and a decrease in IL-6 levels (p&lt;0,05) significantly in the ACB group compared to GNB. Conclusion: ACB can be used as an effective therapy in treating chronic knee pain.

Primary Total Knee Replacement: A Recipe for Dry Dressing.

To evaluate surgical outcomes using sets of techniques to achieve single dry dressing for two weeks post total knee replacement (TKR) at Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia. A prospective study comprised of 110 consecutive unilateral total knee replacements was conducted at the orthopedic department of Dr. Sulaiman Al-Habib Hospital, Suwaidi, Riyadh, KSA. Patients of both genders underwent knee replacement surgery due to primary knee osteoarthritis, Kellgren-Lawrence grades 3 and 4. Routine investigations and fitness evaluations of patients were carried out preoperatively. Preoperative minimal use of a tourniquet and release prior to arthrotomy closure; intravenous tranexamic acid, no drains; capsule infiltration with local anesthetics without adrenaline; tight closure with barbed sutures up to the skin in three layers; skin glue; Aquacel dressing; adductor canal block; and continuation of oral anticoagulant for four weeks. A total of 110 cases were included, of which 81 (73.6%) were females and 29 (26.4%) were males. The mean age of the study population was 60.5+10.3 years (48 to 88 years). The mean BMI in our patients was 30.57+10.5 kg/m2. Most patients were morbidly obese 13 (30.95%). The mean preoperative Hb% was 13.07+1.6 g/dl, while the mean postoperative Hb% was 12.58+1.9 mg/dl with a p-value of 0.28, which was non-significant statistically. Only two patients needed a change of Aquacel wound dressing for ooze. None of our patients developed deep venous thrombosis (DVT) or an infection. A sequential use of sets of techniques is observed to be associated with improved outcomes in terms of blood loss, wound infection, mobility, and patient satisfaction, leading to the ultimate end point of dry Aquacel wound dressing.

Analgesic efficacy of selective tibial nerve block versus partial local infiltration analgesia for posterior pain after total knee arthroplasty: a randomized, controlled, triple-blinded trial

BackgroundThe adductor canal block provides pain relief on the anterior aspect of the knee after arthroplasty. Pain on the posterior aspect may be treated either by partial local infiltration analgesia of the posterior capsule or by a tibial nerve block. This randomized, controlled, triple-blinded trial tests the hypothesis that a tibial nerve block would provide superior analgesia compared to posterior capsule infiltration in patients scheduled for total knee arthroplasty under spinal anesthesia with an adductor canal block. MethodsSixty patients were randomized to receive either infiltration of the posterior capsule by the surgeon with ropivacaine 0.2%, 25 mL, or a tibial nerve block with 10 mL of ropivacaine 0.5%. Sham injections were performed to guarantee proper blinding. The primary outcome was intravenous morphine consumption at 24 h. Secondary outcomes included intravenous morphine consumption, pain scores at rest and on movement, and different functional outcomes, measured at up to 48 h. When necessary, longitudinal analyses were performed with a mixed-effects linear model. ResultsThe median (interquartile range) of cumulative intravenous morphine consumption at 24 h was 12 mg (4–16) and 8 mg (2–14) in patients having the infiltration or the tibial nerve block respectively (p = 0.20). Our longitudinal model showed a significant interaction between group and time in favor of the tibial nerve block (p = 0.015). No significant differences were present between groups in the other above-mentioned secondary outcomes. ConclusionA tibial nerve block does not provide superior analgesia when compared to infiltration. However, a tibial nerve block might be associated with a slower increase in morphine consumption over time.

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy

A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR)

BackgroundTotal knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications.The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications.This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2µg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded.ResultsEpidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications.ConclusionsContinuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects.Trial registrationClinicalTrials.gov Identifier: NCT 05249478.

Surgeon-placed peripheral nerve block and continuous non-opioid analgesia in total knee arthroplasty is accessible intraoperatively: A cadaveric study

BackgroundPain management in TKA patients is challenged by a postoperative requirement for early ambulation along with the concurrent goal of reducing opioid consumption while simultaneously reducing the length of hospital stay. Peripheral nerve blocks (PNB) address these concerns to some degree, with femoral nerve and adductor canal blocks being the most-used regional nerve blocks for surgeries performed around the knee joint. PurposeThe authors hypothesized that placing a catheter between the muscles that make up the adductor canal during a standard surgical approach for a Total Knee Arthroplasty would provide equitable or superior access for a peripheral nerve block in the adductor canal. The nerves that are located between the muscles that make up the adductor canal transmit the majority of the pain after TKA. MethodsThis cadaveric study was conducted in 12 fresh-frozen human cadaveric lower limbs, comparing the standard technique of adductor canal block, placed under ultrasound guidance, to this experimental technique. Using colored indicator dyes to locate the site of surrogate peripheral nerves, the techniques were compared. ResultsThrough a standard anterior surgical approach to the knee, an intraoperative catheter placement technique can be performed to provide a peripheral nerve block to the saphenous nerve for patients undergoing TKA that is comparable to standard ultrasound guided anesthesia block techniques. ConclusionsThis cadaveric study demonstrates the availability for the surgeon to place a catheter between the muscles that form the adductor canal during a standard surgical approach for TKA. This novel technique can provide equivalent coverage of the nerves for an ACB when compared to a standard ultrasound guided ACB.

Comparative study between surgical wound catheter, femoral nerve block, and adductor canal block for postoperative analgesia after knee arthroplasty: A double blind randomized clinical trial.

The present study compared the surgical wound catheter (SWC), femoral nerve block (FNB), and adductor canal block (ACB) for postoperative analgesia after knee arthroplasty. The study included (180) patients scheduled for unilateral total knee replacement and were randomly allocated into three groups. Patients received postoperative analgesia via continuous infusion of ropivacaine 0.2% (10 ml bolus followed by continuous infusion of 5 ml/hour) through the SWC, FNB, or ACB groups. All groups received supplemental analgesia by IV morphine using patient controlled analgesia. Pain scores were assessed at rest and during movements, the worst and least pain scores, and how often were in worst pain during the first 72 hours. The functional activity and patient's satisfaction were also recorded. The study showed significant reductions in pain scores at rest and during movements in all groups compared to the baseline scores. Significant reductions in pain scores were observed in both ACB and FNB groups compared to the SWC group (P < 0.05). The worst pain scores were (6.15 ± 2.9, 5.85 ± 2.7, and 5.025 ± 1.513), least pain scores (2.06 ± 0.72, 1.92 ± 1.34 and 1.89 ± 1.76), percentage of time in worst pain (17.67 ± 9.15, 11.42 ± 7.50, and 9.8.8 ± 8.14) and the total morphine consumption (39.24 ± 6.82, 34.55 ± 7.86, and 26.40 ± 8.47 mg) in the SWC, FNB, and ACB groups, respectively. Functional assessments and patient's satisfaction, at 6 and 24 hours, were significantly better in ACB followed by SWC, and lastly FNB group (P < 0.5). No significant differences in the incidence of side effects (P > 0.05). Local anesthetic leak from the SWC was a continuous concern by the orthopedic surgeons. In terms of efficiency, ACB provided the highest quality of analgesia in terms of pain relief, functional activity, and patient's satisfaction. Both ACB and FNB provided higher quality of analgesia compared to the SWC. While ACB and SWC provided better functional improvements compared to FNB.

A peripheral nerve stimulator guided popliteal sciatic nerve block combined with adductor canal block in lower leg surgery- A sole anesthetic technique

In lower leg surgeries involving fractures of distal tibia, ankle surgeries, debridement and PVD surgeries choice of anesthesia is usually regional anesthesia. When these patients are associated with co-morbid cardio-respiratory problems then it will become challenge for anesthesiologist to maintain homeostasis with good surgical anesthesia. Ayukut urfalioglu suggested another alternative technique in the form of Adductor canal block plus Lateral approach popliteal sciatic block as good alternative for these surgeries with better Intra-operative Haemodynamic Stability, additional post-operative pain relief and less requirement of systemic analgesia post-operatively.In this prospective randomised controlled trial, we aim to explore the efficacy of Adductor canal block plus Popliteal Sciatic Block for Lower leg surgeries. Sixty patients (ASA I, II, III) undergoing lower limb surgeries were randomly allocated in 2 groups (30 patients in each group). In Group P patients received PNS guided Adductor canal block combined with popliteal sciatic block and in group S patients received unilateral spinal anesthesia.: The primary objectives were to evaluate duration of sensory and motor block and post-operative pain relief. Secondary objectives included intra operative requirements of additional anesthesia and intraoperative haemodynamic stability.There was significant intraoperative haemodynamic stability and post-operative pain relief attributable to Group P. Time for first requirement of rescue analgesia post-operatively was significantly higher in Group P compared to Group S (Group P Mean SD15.9±5.26 vs 6.05±1.23 in Group S with p= &amp;#60; 0.0001).Combined adductor canal block and popliteal sciatic block can be an alternative technique with advantage of prolonged post-operative analgesia and haemodynamic stability.

Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized Clinical Trial

BackgroundThe interspace between the popliteal artery and capsule of the posterior knee (iPACK) block and the genicular nerve block (GNB) are motor-sparing nerve blocks used for knee pain relief. We compared the analgesic efficacies of ultrasound-guided iPACK block and GNB when combined with continuous adductor canal block after total knee arthroplasty. MethodsIn this randomized control study, 132 total knee arthroplasty patients were assigned to the iPACK, GNB, and iPACK + GNB groups. All patients received combined spinal anesthesia and continuous adductor canal block. The primary outcome was the 8-hour postoperative pain score during movement. Secondary outcomes were pain scores, posterior knee pain, intravenous morphine consumption, and tibial and common peroneal nerve sensorimotor function. All included patients completed the study. ResultsThe 4-hour and 8-hour postoperative pain scores during movement were significantly lower in the iPACK + GNB group than that in the iPACK group (−2.5 [3.6, 1.3]; P < .001 and −2 [-3, −1]; P < .001, respectively). The differences in rating pain scores and posterior knee pain were not clinically relevant. The iPACK group demonstrated a significantly higher intravenous morphine consumption than did the GNB and iPACK + GNB groups during the first 48 hours postoperatively (P < .001) but were not clinically relevant. There was no incidence of complete sensorimotor blockade in any of the groups. ConclusionThe iPACK–GNB combination relieved pain during movement better than the iPACK block alone during the 8 hours postoperatively after total knee arthroplasty in setting of multimodal analgesia such as adductor canal block.

Changes in Neuraxial Anesthesia Protocols and Improved Efficiency of Same-Day Discharge Total Knee Arthroplasty in an Ambulatory Surgery Center: A Retrospective Cohort Study

This study evaluated the effect of bupivacaine versus mepivacaine spinal anesthesia and preoperative adductor canal block (ACB) on recovery, length of stay, pain, and complications of same-day discharge total knee arthroplasty (TKA) at a free-standing ambulatory surgery center. We performed a retrospective review of patients who underwent TKA between March 2018 and September 2019. The patients were grouped based on the neuraxial anesthetic regimen: bupivacaine with ACB, bupivacaine without ACB, and mepivacaine without ACB. Preoperative ACBs were discontinued in December 2018, and use of mepivacaine spinal anesthesia was initiated in March 2019. Length of stay in the postanesthesia care unit (PACU), time to controlled void and ambulation, postoperative pain, morphine milligram equivalents (MME), and transient neurologic symptoms were compared. Ninety consecutive patients who underwent TKA were identified. Fifty patients received bupivacaine with ACB, 20 received bupivacaine without ACB, and 20 received mepivacaine without ACB. Mepivacaine spinal anesthesia led to a 93-minute shorter PACU stay (P < 0.001), 115-minute quicker time to void (P < 0.001), 60-minute earlier ambulation (P = 0.024), and 109-minute shorter total facility time (P = 0.003) but increased total MME (P = 0.049) despite nonsignificant difference in pain at discharge (P = 0.908) compared with bupivacaine. Patients receiving bupivacaine with and without ACB had a nonsignificant difference in pain scores at discharge, time to ambulation, and time to discharge (P ≥ 0.1). No transient neurologic symptoms or overnight stays were observed. Mepivacaine spinal anesthesia for TKA safely facilitated more rapid same-day discharge through decreased times to controlled void and ambulation but with a slight increase in MME requirements. Discontinuing preoperative ACBs did not negatively affect PACU outcomes.

A comparative randomized controlled study of modified 4 in 1 block versus IPACK plus adductor canal block for post-operative analgesia in total knee arthroplasty.

Postoperative analgesia for Total Knee Arthroplasty (TKA) is paramount for early mobilisation and rehabilitation. The newer motor sparing peripheral nerve blocks for analgesia for TKA are 4 in 1 block, modified 4 in 1 block, infiltration between popliteal artery and capsule of the knee (IPACK) block along with adductor canal block (ACB). We hypothesised that Modified 4 in 1 block is as efficient as the already proven technique of combined IPACK and ACB in providing post-operative analgesia to the patients of TKA. Seventy patients fulfilling the inclusion criteria posted for TKA surgery were randomised into two groups: Modified 4 in 1 block group (Group - M) and combined IPACK + ACB group (Group - I). After thorough preoperative evaluation and with mimimum standard monitoring the patients received sub-arachnoid block followed by the desired peripheral nerve block as per the group. After the surgery the visual analog scale (VAS) pain score was compared at 3, 6, 12, 24 hours postoperatively and tabulated. The mean pain scores between both the groups was comparable at 3 hours, 6 hours and 24 hours. But at 12 hours after the surgery, VAS was less in Group-M in comparison to Group-I, Haemodynamic parameters were comparable between both the groups. None of the patients in both the groups showed any complications like muscle weakness in the post-operative period. Modified 4 in 1 block is a new and novel technique for the TKA surgeries and is comparable with already established combined IPACK+ACB technique for providing adequate postoperative analgesia after TKA.

Effect of Adductor Canal Block Combined with Local Infiltration Analgesia on Postoperative Pain of Knee Arthroscopy Under General Anesthesia: A Randomized Controlled Trial.

Postoperative pain in knee arthroscopy (KA) is a common and troublesome problem. The best local analgesic technique for relieving postoperative pain in patients with KA has not been well studied. This prospective trial aimed to observe whether adductor canal block (ACB) combined with local infiltration analgesia (LIA) could further decrease the incidence of postoperative pain undergoing KA. This randomized controlled study recruited 60 patients aged 18-65years, ASA I-II, who received KA, and randomly divided them into ACB + LIA group and LIA group. The primary outcome was the incidence of postoperative pain 24h after surgery. The secondary outcomes included the incidence of quadriceps femoris weakness, and the consumption of opioids during operation. A total of 60 participants completed the trial. The incidence of postoperative pain 24h after surgery in ACB + LIA group was lower than that in the LIA group (10% [3 of 30] vs. 33% [10 of 30]; P = 0.028). There was no difference in the incidence of quadriceps muscle weakness 24h after surgery between the two groups. The consumption of remifentanil and sufentanil in ACB + LIA group was significantly lower than that in LIA group (P = 0.006, P < 0.001). Compared with patients receiving LIA alone, ACB combined with LIA could reduce the incidence of postoperative pain while retaining the strength of the quadriceps femoris in patients undergoing KA and reduce the consumption of opioids during surgery. This study was registered at the Chinese Clinical Trial Registry with the registration number ChiCTR1800018463 on September 20, 2018. ( http://www.chictr.org.cn/showproj.aspx?proj=31192 ).

Adductor canal block as an adjuvant in a multimodal analgesia protocol vs. multimodal analgesia alone for total knee arthroplasty

Background &amp; Objective: Effective analgesia is necessary for early postoperative recovery following total knee arthroplasty (TKA). Various combinations of pain relief modalities have been used for postoperative pain in TKA. Adductor canal block (ACB) has been suggested to have a role in this scenario. We evaluated the effectiveness of ACB following spinal anesthesia (SA) in terms of postoperative pain relief, early ambulation and patient satisfaction.&#x0D; Methodology: A total of 72 patients were enrolled in the study. Out of these 36 patients (Group A) were randomized to receive ACB in addition to SA, while 36 patients (Group B) received only SA. Postoperative numerical rating scale (NRS) score, and morphine consumption were noted at shifting to PACU, at 6, 12, 18 and 24 h postoperatively as a primary outcome measure. As a secondary outcome measures, quadriceps muscle power, time to ambulation and patient satisfaction were evaluated.&#x0D; Results: A statistically significant drop in NRS was noted in Group A, at 6, 12, 18, and 24 h after surgery, but not in the postoperative care unit (P = 0.75), and a decrease in the total morphine use among patients who underwent an ACB. A significant change was noted in ambulation and patient satisfaction in the Group A, with no significant change in quadriceps muscular power among both groups.&#x0D; Conclusion: ACB as a part of pain management strategy is successful in reducing postoperative pain, morphine consumption, enabling early ambulation, and elevating patient satisfaction.&#x0D; Key words: Adductor canal block; Spinal Anesthesia; Total knee arthroplasty&#x0D; Citation: Ahmed RKA, Mohamed AS, John Nader Nassef JN, Abd Elsatar YH, El Fawal SMM. Adductor canal block as a part of multimodal analgesia protocol for total knee arthroplasty. Anaesth. pain intensive care 2022;27(1):31−36; DOI: 10.35975/apic.v27i1.1941&#x0D; Received: August 18, 2022; Reviewed: November 5, 2022; Accepted: November 19, 2022

Preliminary experience on systemic effects of perineural dexamethasone sodium phosphate and methylprednisolone acetate through adductor canal block in total knee arthroplasty: A single center retrospective study.

Glucocorticoids are commonly utilised as adjuvants to enhance nerve block quality and prolong the analgesic duration. Its systemic effects, after a single-injection adductor canal block (ACB) followed by a continuous infusion, are unclear. The aim of the study was to assess the systemic effects of a single dose of dexamethasone sodium phosphate (DEX), or a combination of DEX and methylprednisolone acetate (MPA), on fasting blood glucose (FBG) and white blood cell count (WBC) when administered perineurally via ACB. A single-center retrospective study on total knee arthroplasty (TKA) was performed and a total of 95 patients were included in the final analysis. Patients were divided into three groups based on adjuvants received in ACB: Control group (N = 41) and two treatment groups, DEX group (N = 33) and DEX/MPA group (N = 21). Our primary outcomes were the change of FBG from its preoperative baseline value on postoperative day (POD) 2. The secondary outcomes included change of FBG on POD 0 and POD 1, and change of WBC on POD 0, POD 1, and POD 2. The FBG change from baseline in the DEX group was significantly higher than that in the control group (difference = 14.04, 95% CI: 1.3 to 26.77), P = 0.031) on POD 0. The WBC change from baseline in the DEX/MPA group was statistically significant higher than control on POD 0 (2.62 (1.52 to 3.37), P < 0.0001). No significant differences between DEX and DEX/MPA group were found on any given postoperative days for FBG and WBC. This study provided preliminary safety data on the use of a combination of glucocorticoids with hydrophilic (DEX) and lipophilic (MPA) properties as local anesthetic adjuvants in ACB, which induced similar levels of changes on FBG and WBC as those from both control and DEX alone group.

Multimodal Analgesic for Knee Arthroplasty: Comment.

We read with great interest the article by Felipe Muñoz-Leyva et al.1 entitled “No Benefits of Adding Dexmedetomidine, Ketamine, Dexamethasone, and Nerve Blocks to an Established Multimodal Analgesic Regimen after Total Knee Arthroplasty” published in the July 2022 issue of Anesthesiology. We appreciate the authors’ great work. However, we also found two worthwhile issues that we would like to raise to the investigators.First, the dosages of some analgesics were not fixed in perioperative management. For example, all patients were administered 650 to 1,000 mg acetaminophen and 100 to 200 mg celecoxib in the perioperative period, and 5 to 10 mg immediate-release oral oxycodone or 1 to 2 mg hydromorphone was supplemented after surgery. What was the dosing rationale, and were the administered amounts different between groups?Second, the authors reported that the incidence of plantar flexion impairment on postoperative day 0 was 17.9% and 46.1% for control group and study group, respectively; and the incidence of dorsi flexion impairment on postoperative day 0 was 28.2% and 46.1%, respectively. According to previous studies,2 the interventions used in this study, including periarticular anesthetic infiltration, adductor canal block, and infiltration between popliteal artery and capsule of knee block, hardly block motor nerves and reduce lower limb muscle strength. Could the authors explain the potential reasons for the high incidence of ankle motor impairment in their study?This letter was supported by 1.3.5 Project of Sichuan University West China Hospital (Sichuan, China), grant No. ZYJC18040.The authors declare no competing interests.

Effects of a Continuous Adductor Canal Block After Total Knee Arthroplasty.

This retrospective cohort study analyzed the short-term outcomes of patients undergoing total knee arthroplasty receiving periarticular anesthetic injections (PAIs) with and without continuous adductor canal blocks (CACBs) regarding early postoperative narcotic use, pain scores, and range of motion with otherwise similar postoperative regimens. Two hundred ninety-four patients were included: 120 received PAIs with CACBs, and 174 received PAIs only. Matched analysis was performed for type of anesthesia. There were substantial decreases in early inpatient narcotic use with the addition of CACBs to PAIs with general and spinal anesthesia without an adverse effect on pain, knee range of motion, or length of stay. [Orthopedics. 2023;46(3):185-191.].

Research progress on analgesic effect of adductor canal block after knee arthroplasty

To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once "gold standard" femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.

Motor-Sparing Effect of Adductor Canal Block for Knee Analgesia: An Updated Review and a Subgroup Analysis of Randomized Controlled Trials Based on a Corrected Classification System.

Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy. We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system. The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = -22.44, 95%-CI [-35.37; -9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery. By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research.

Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction.

The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population. The purpose of this study was to survey current pain management practices for ACLR among pediatric orthopaedic surgeons. A cross-sectional survey study was conducted, in which orthopaedic surgeons were asked about their pain management practices for pediatric ACLR. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America. Inclusion criteria required that the surgeon perform anterior cruciate ligament repair or reconstruction on patients under age 18. Responses were anonymous and consisted of surgeon demographics, training, practice, and pain management strategies. Survey data were assessed using descriptive statistics. Of 64 included responses, the average age of the survey respondent was 48.9 years, 84.4% were males, and 31.3% practiced in the southern region of the United States. Preoperative analgesia was utilized by 39.1%, 90.6% utilized perioperative blocks, and 89.1% prescribed opioid medication postoperatively. For scheduled non-narcotic medications postoperatively 82.8% routinely advocated and 93.8% recommended cryotherapy postoperatively.Acetaminophen was the most used preoperative medication (31.3%), the most common perioperative block was an adductor canal block (81.0%), and the most common postoperative analgesic medication was ibuprofen (60.9%). Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols. Substantial variability exists in pain management practices in pediatric ACLR. There is a need for more evidence-based practice guidelines regarding pain management. Level V.