Adductor Canal Research Articles

Addition of Surgeon-Administered Adductor Canal Infiltration to the Periarticular Infiltration in Total Knee Arthroplasty: Effect on Pain and Early Outcomes

BackgroundOur aim was to study the additive effect of surgeon-administered adductor canal infiltration (SACI) over routine periarticular infiltration (PAI) on pain control [morphine consumption and pain score by the visual analog scale (VAS)] and early function [flexion and Timed Up and Go (TUG) test] post–total knee arthroplasty (TKA). MethodsWe prospectively randomized 60 patients into 2 groups. Group I patients received the standard PAI, whereas in Group II, the patients received a SACI in addition to the PAI. The total volume of the injected drug and the postoperative pain management protocol were the same for all. The number of doses of patient-controlled analgesia (PCA) used for breakthrough pain was recorded as PCA consumption. For early function, flexion and the TUG test were used. The VAS score and PCA consumption were compared between the 2 groups by using analyses of variance with post hoc tests as indicated. The TUG test and flexion were compared using Student t tests. The level of significance was set at 0.05. ResultsThe PCA consumption in the first 6 hours was significantly higher in Group I (P = .04). The VAS at 6 hours was significantly lower in Group II (P = .042). The TUG test was comparable between the 2 groups preoperatively (P = .72) at 24 hours (P = .60) and 48 hours (P = .60) post-TKA. The flexion was comparable between the 2 groups preoperatively (P = .85) at 24 hours (P = .48) and 48 hours (P = .79) post-TKA. ConclusionsAdding a SACI to PAI provides improved pain relief and reduces opioid consumption without affecting early function post-TKA. A SACI avoids the need for an anesthesiologist or specialized equipment with no added operating time and minimal added cost. We recommend routine use of SACI for all patients undergoing TKA.

A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty

Background Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA.MethodsThis single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes.ResultsA total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups.ConclusionThe study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research.Trial registrationThis project was retrospectively registered with clinicaltrials.gov (NCT05635916) on 2 December 2022.

Efficacy and safety of different bupivacaine concentrations in periarticular infiltration combined with adductor canal block for bilateral total knee arthroplasty: a randomized controlled trial

BackgroundPain management for bilateral total knee arthroplasty (BTKA) often combines adductor canal block (ACB) with periarticular infiltration (PAI). However, concerns arise regarding local anesthetic toxicity. This study evaluated the efficacy and safety of different bupivacaine concentrations in simultaneous BTKA.MethodsPatients undergoing simultaneous BTKA under spinal anesthesia were included in the study. They received ACB with 50 mg bupivacaine for each thigh. The patients were then randomized into two groups. Group A was administered a PAI of 100 mg bupivacaine per knee (totaling 300 mg bupivacaine for ACB and PAI). Group B received a PAI with 50 mg bupivacaine per knee (totaling 200 mg bupivacaine for ACB and PAI). Postoperative pain was assessed using a visual analog scale at 4-h intervals for 48 h after surgery. Plasma bupivacaine concentrations were measured at eight specified times. Postsurgery walking ability was also evaluated.ResultsAmong the 57 participants analyzed, visual analog scale pain scores revealed no significant differences between the two groups. An interim analysis of plasma bupivacaine concentrations in both groups indicated no significant disparities. In group B, 93.1% managed to walk with assistance within 48 h, as opposed to group A’s 71.4% (P = 0.041).ConclusionsCombining ACB with 100 mg bupivacaine and PAI with another 100 mg bupivacaine provided effective pain relief. This combination also had a better safety profile and led to more patients walking postsurgery than when combining ACB with 100 mg bupivacaine and PAI with 200 mg bupivacaine. Thus, ACB combined with PAI with a total dose of 200 mg bupivacaine appears suitable for simultaneous BTKA.Trial registration: ClinicalTrials.gov (NCT03249662).

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks.

Peripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP). This prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA. 166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg). Peripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.

What Is the Role of a Periarticular Injection for Knee Arthroplasty Patients Receiving a Multimodal Analgesia Regimen Incorporating Adductor Canal and Infiltration Between the Popliteal Artery and Capsule of the Knee Blocks? A Randomized Blinded Placebo-Controlled Noninferiority Trial.

Optimal analgesic protocols for total knee arthroplasty (TKA) patients remain controversial. Multimodal analgesia is advocated, often including peripheral nerve blocks and/or periarticular injections (PAIs). If 2 blocks (adductor canal block [ACB] plus infiltration between the popliteal artery and capsule of the knee [IPACK]) are used, also performing PAI may not be necessary. This noninferiority trial hypothesized that TKA patients with ACB + IPACK + saline PAI (sham infiltration) would have pain scores that were no worse than those of patients with ACB + IPACK + active PAI with local anesthetic. A multimodal analgesic protocol of spinal anesthesia, ACB and IPACK blocks, intraoperative ketamine and ketorolac, postoperative ketorolac followed by meloxicam, acetaminophen, duloxetine, and oral opioids was used. Patients undergoing primary unilateral TKA were randomized to receive either active PAI or control PAI. The active PAI included a deep injection, performed before cementation, of bupivacaine 0.25% with epinephrine, 30 mL; morphine; methylprednisolone; cefazolin; with normal saline to bring total volume to 64 mL. A superficial injection of 20 mL bupivacaine, 0.25%, was administered before closure. Control injections were normal saline injected with the same injection technique and volumes. The primary outcome was numeric rating scale pain with ambulation on postoperative day 1. A noninferiority margin of 1.0 was used. Ninety-four patients were randomized. NRS pain with ambulation at POD1 in the ACB + IPACK + saline PAI group was not found to be noninferior to that of the ACB + IPACK + active PAI group (difference = 0.3, 95% confidence interval [CI], [-0.9 to 1.5], P = .120). Pain scores at rest did not differ significantly among groups. No significant difference was observed in opioid consumption between groups. Cumulative oral morphine equivalents through postoperative day 2 were 89 ± 40 mg (mean ± standard deviation), saline PAI, vs 73 ± 52, active PAI, P = .1. No significant differences were observed for worst pain, fraction of time in severe pain, pain interference, side-effects (nausea, drowsiness, itching, dizziness), quality of recovery, satisfaction, length of stay, chronic pain, and orthopedic outcomes. For TKA patients given a comprehensive analgesic protocol, use of saline PAI did not demonstrate noninferiority compared to active PAI. Neither the primary nor any secondary outcomes demonstrated superiority for active PAI, however. As we cannot claim either technique to be better or worse, there remains flexibility for use of either technique.

Effectiveness of Ultrasound-guided Adductor Canal Block for Postoperative Pain Management in below Knee Orthopaedic Surgeries: A Randomised Controlled Study

Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2 , respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries.

Comparison of the Effects of Adductor Canal and Femoral Nerve Blocks on Postoperative Opioid Consumption and Inflammatory Factor Levels in Elderly Patients After Total Knee Arthroplasty: A Prospective Observational Study.

Total Knee Arthroplasty (TKA) is a highly invasive procedure causing severe postoperative pain, which hampers early mobility. Effective pain management is crucial for optimal recovery. This study aimed to evaluate how adductor canal block (ACB) and femoral nerve block (FNB) affect opioid use and inflammation factor levels in elderly TKA patients. This prospective observational study included 120 patients who received TKA, and divided them into three groups, based on the different nerve block technique: ACB, FNB, and no intervention before general anesthesia (CON). Postoperative opioid consumption, pain assessment, inflammation factor, knee function recovery and other clinical indicators were recorded. The CON group had significantly higher cumulative sufentanil consumption compared to the ACB and FNB groups at both 12 h and 48h postoperative (P<0.001). Compared with the CON group, the ACB and FNB groups persistently had lower pain scores until 12 h at rest and 24 h during motion after surgery. The ACB group showed significantly lower serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) compared to the CON group at 24 h postoperative (P=0.017, P=0.009), and IL-6 levels remained significantly lower at 72 h postoperative (P=0.005). Both ACB and FNB groups achieved earlier ambulation compared to the CON group (P=0.002). On the first day postoperative, both the ACB and FNB groups showed significantly better knee motion (P<0.001), quadriceps strength (P<0.001), and daily mobilization (P<0.001) compared to the CON group. Additionally, the ACB group exhibited superior quadriceps strength (P<0.001) and daily mobilization (P<0.001) compared to the FNB group. The ACB and FNB groups exhibited comparable clinical efficacy outcomes in terms of pain scores and opioid consumption. However, the ACB group experienced reduced postoperative inflammation and improved knee recovery, especially in quadriceps strength.

Adductor Canal Block + Local Infiltration Versus Local Infiltration Alone in Post-Operative Pain Management in Total Knee Replacement

Abstract Background: Adductor canal blocks (ACBs) are an emerging concept for post-operative pain management in total knee replacement (TKR). The present study was designed to evaluate the duration of analgesia, patient satisfaction, use of opioids, pain score, and ease of ambulation after ACB + intra-articular local infiltration for TKR surgery and compare it with local infiltration alone. Materials and Methods: This retrospective observational study included a total of 260 cases of TKR selected as per inclusion/exclusion criteria. All patients underwent surgery under spinal, epidural, or general anesthesia. For post-operative analgesia, intra-articular local infiltration of a cocktail [12.5 mL of 0.5% sensocaine + 2 mL ketorolac + 0.5 mg adrenaline + 95 mL normal saline] was administered to all patients, with some patients also receiving ACB (15 mL of 0.2% ropivacaine + 1 mcg/kg dexmedetomidine) by random selection. Thus, two groups of patients were formed: (i) those who received ACB and local infiltrative analgesia and (ii) those who received only local infiltrative analgesia. The two groups were matching in terms of demography, comorbidities, and complexity of osteoarthritis. Variables were compared between these two groups by using outcome measures, including (i) time to attain SLR (straight leg raise), (ii) the total amount of opioid doses given in 24 h, (iii) the pain score by visual analogue score (VAS) at 24 h, (iv) success of early ambulation, and (v) complications. Results: Out of the 260 cases of TKR, 126 were of Group 1 and 134 were of Group 2. In the local infiltration alone group, the average VAS at 24 h was 3.8, the average amount of opioid doses given in 24 h was 1.54, the average time of ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. In the adductor canal plus local infiltration group, the average VAS was 3.32, the average amount of opioid use was 0.9, the average time for ambulation was 3 h post-surgery, and the average time to attain SLR was 3 h post-surgery. No major complications were noted in either group. Conclusion: According to our study, ACB is certainly a useful tool in reducing the post-operative pain and increasing ambulation and patient satisfaction. However, a larger study is required to establish its effectiveness conclusively.

A comparative study between neostigmine and dexamethasone as an adjuvant to bupivacaine in adductor canal block after knee arthroscopy (RCT)

Background Adjuvants to adductor canal block are used to improve the quality and duration of the block for better analgesia after knee surgeries. This study evaluates and compares the effect of adding dexamethasone and neostigmine to bupivacaine in adductor canal blocks after knee arthroscopy (KA). Methods In this randomized, double-blinded, controlled study, 90 patients scheduled for knee arthroscopy were randomly allocated into three groups to receive adductor canal block after the end of the arthroscopy. The control group received 20 ml bupivacaine 0.5%+2 ml normal saline, the dexamethasone group received 20 ml bupivacaine 0.5%+2 ml dexamethasone (8 mg) and the neostigmine group received 20 ml bupivacaine 0.5%+1 ml neostigmine (500 mcg) +1 ml normal saline. Outcomes: time of first rescue analgesia, sensory blockade duration, total opioid consumption, and visual analog score (VAS). Results Time of first rescue analgesia and Sensory block duration, were longer in dexamethasone and neostigmine groups compared with control group, with no significant difference between dexamethasone and neostigmine groups, however, clinically there was 3 h prolongation in sensory block duration in dexamethasone group. Mean morphine consumption and Visual analog score were lower in dexamethasone and neostigmine groups compared with control group, with no difference between dexamethasone and neostigmine groups, Conclusion Both dexamethasone and neostigmine were effective adjuvants to bupivacaine in ACB with more prolonged postoperative analgesia and less opioid consumption. Though there was no statistically significant difference between both drugs, however, dexamethasone showed some clinical superiority.

Meta-analysis of the analgesic effect and adverse reactions of ultrasound-guided adductor canal block combined with popliteal artery and posterior capsule space block in patients undergoing total knee arthroplasty

Meta-analysis of the analgesic effect and adverse reactions of ultrasound-guided adductor canal block combined with popliteal artery and posterior capsule space block in patients undergoing total knee arthroplasty

Continuous adductor canal block versus continuous femoral nerve block for postoperative pain in patients undergoing knee arthroplasty: An updated meta-analysis of randomized controlled trials.

Continuous adductor canal block (CACB) is almost a pure sensory nerve block and can provide effective analgesia without blocking the motor branch of the femoral nerve. Thus, the objective of this study was to systematically evaluate the efficacy of CACB versus continuous femoral nerve block (CFNB) on analgesia and functional activities in patients undergoing knee arthroplasty. PubMed, Embase and the Cochrane Central Register of Controlled Trials (from inception to 3 October 2023) were searched for randomized controlled trials (RCTs) that compared CACB with CFNB in patients undergoing knee arthroplasty. Registration in the PROSPERO International prospective register of the meta-analysis was completed, prior to initiation of the study (registration number: CRD42022363756). Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. Revman 5.4 software was used for meta-analysis and the summary effect measure were calculated by mean differences and 95% confidence intervals. Eleven studies with a total of 748 patients were finally included. Pooled analysis suggested that both CACB and CFNB showed the same degree of pain relief at rest and at motion at 12 h, 24 h and 48 h in patients undergoing knee arthroplasty. Compared with CFNB, CACB preserved the quadriceps muscle strength better (P<0.05) and significantly shortened the discharge readiness time (P<0.05). In addition, there was no significant difference in opioid consumption, knee extension and flexion, timed up and go (TUG) test, or risk of falls between the two groups. Thus, Compared with CFNB, CACB has similar effects on pain relief both at rest and at motion and opioid consumption for patients undergoing knee arthroplasty, while CACB is better than CFNB in preserving quadriceps muscle strength and shortening the discharge readiness time.

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty-A Prospective, Randomised, Double-Blinded Clinical Trial.

This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. There were significant differences between the sham block and iPACK + ACB group in pain scores p < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (p < 0.0001) and functional recovery (p < 0.0001). Also, NLR and PLR levels 12 h (p < 0.0001) and 24 h (24 h) after surgery (p < 0.0001) were much lower in the iPACK + ACB group. After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery.

Distal subsartorial compartment block of the saphenous nerve - A dissection study and a patient case series

Study objectiveA saphenous nerve block is an important tool for analgesia after foot and ankle surgery. The conventional midthigh approach to saphenous nerve block in the femoral triangle may impede ambulation by impairing quadriceps motor function. Primary objective: Developing a selective saphenous nerve block targeting the nerve distal to its emergence from the adductor canal in the subsartorial compartment. DesignThis study consists of A) a dissection study and B) Data from a clinical case series. SettingA) Medical University of Innsbruck, Austria (dissection of 15 cadaver sides) and.B) Aarhus University Hospital, Denmark (5 patients). InterventionsA) Five mL of methylene blue was injected into the subsartorial compartment distal to the intersection of the saphenous nerve and the tendon of the adductor magnus guided by ultrasound. B) Five patients undergoing major hindfoot and ankle surgery had a subsartorial compartment block with 10 mL of local anesthetic in addition to a popliteal sciatic nerve block. MeasurementA) The frequencies of staining the saphenous and medial vastus nerves. B) Assessment of postoperative pain by NRS score (0−10) and success rate of saphenous nerve block by presence of cutaneous anesthesia in the anteromedial lower leg, and motor impairment by ability to ambulate. Main resultsA) The saphenous nerve was stained in 15/15 cadaver sides. A terminal branch of the medial vastus nerve was stained in 2/15 cadaver sides. B) All patients were fully able to ambulate without support. No patients had any post-surgical pain from the anteromedial aspect of the ankle and foot (NRS score 0). The success rate of saphenous nerve block was 100%. ConclusionThe saphenous nerve can be targeted in the subsartorial compartment distal to the intersection of the nerve and the tendon of the adductor magnus. The subsartorial compartment block provided efficient analgesia without quadriceps motor impairment.

Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia After Total Knee Arthroplasty: A Retrospective Cohort Study

Background: There is no consensus on whether adductor canal block (ACB) combined with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can further increase analgesia and reduce opioid consumption after total knee arthroplasty (TKA) compared with ACB and periarticular infiltration analgesia (PIA). Purpose: This study aimed to evaluate the effectiveness of combining ACB and PACK block on analgesia and functional recovery following TKA. Methods: A retrospective cohort study was conducted involving 386 patients who underwent primary unilateral TKA at our institution from January 2020 to October 2022. Patients were divided into 3 groups and treated with PIA, ACB, or ACB combined with IPACK block, respectively. Primary outcomes were postoperative morphine consumption and visual analogue scale (VAS) pain scores. Secondary outcomes included functional recovery, evaluated by knee range of motion, quadriceps strength, daily mobilization distance, and postoperative length of stay. Other outcomes included incidence of complications. Results: Patients in the ACB + IPACK group had significantly less morphine consumption on postoperative day 1 and during hospitalization than patients in the PIA and ACB groups. Furthermore, the ACB + IPACK group had significantly lower VAS scores at rest and during motion at 6, 12, and 24 hours postoperatively (but not at other time points), better knee range of motion on postoperative days 1 and 2 (but not day 3), and a greater daily mobilization distance on postoperative day 1 (but not days 2 and 3). The ACB + IPACK group had significantly lower incidences of postoperative nausea and vomiting than the PIA and ACB groups. Conclusion: This retrospective cohort study suggests that a combination of ACB and IPACK block may have a greater effect than PIA or ACB alone on analgesia following TKA, while providing better functional recovery. Further study is warranted.

Femoral-popliteal bypass graft: a caveat when performing an adductor canal block

Femoral-popliteal bypass graft: a caveat when performing an adductor canal block

Efficacy of Periarticular Infiltration with Dexamethasone and Bupivacaine plus Adductor Canal Block Relative to That of Adductor Canal Block Alone for Patients Undergoing Total Knee Arthroplasty: A Retrospective Case-Matched Study.

Periarticular infiltration (PI) is a common procedure during total knee arthroplasty (TKA) for postoperative pain management. This retrospective, case-matched study aimed to evaluate the effectiveness of PI with dexamethasone and bupivacaine in combination with an adductor canal block (ACB) and compare it with that of ACB alone in reducing postoperative pain in patients with TKA. Data were collected from 66 patients who underwent TKA performed by a single surgeon. Thirty-three of them received ACB + PI, and 33 received ACB alone. However, both groups underwent identical surgical techniques and postoperative care protocols. The pain scores and fentanyl consumption of the two groups were compared. The ACB + PI group had significantly lower pain scores than the ACB alone group at 8, 16, 24, and 48 hours postoperatively (p=0.033, 0.004, 0.038, and 0.049, respectively). The percentage of patients requiring fentanyl as a rescue medication was significantly higher for the ACB alone group (90.9%) than for the ACB + PI group (69.7%, p=0.03). The total fentanyl consumption was also lower for the ACB + PI group (p < 0.001). The periarticular injection of the combination of dexamethasone and bupivacaine plus ACB was more effective than ACB alone in reducing postoperative pain and fentanyl consumption in patients undergoing TKA. Further studies comparing different doses of dexamethasone or other cocktail regimens may provide additional insights into this approach.

The Effectiveness of Adductor Canal Block Compared to Femoral Nerve Block on Readiness for Discharge in Patients Undergoing Outpatient Anterior Cruciate Ligament Reconstruction: A Multi-Center Randomized Clinical Trial.

This study evaluated the effect of adductor canal block (ACB) versus femoral nerve block (FNB) on readiness for discharge in patients undergoing outpatient anterior cruciate ligament (ACL) reconstruction. We hypothesized that ACB would provide sufficient pain relief while maintaining motor strength and safety, thus allowing for earlier discharge. This was a randomized, multi-center, superiority trial. From March 2014 to July 2017, patients undergoing ACL reconstruction were enrolled. The primary outcome was the difference in readiness for discharge, defined as Post-Anesthetic Discharge Scoring System score ≥ 9. Twenty-six patients were allocated to FNB and twenty-seven to ACB. No difference in readiness for discharge was found (FNB median 1.8 (95% CI 1.0 to 3.5) vs. ACB 2.9 (1.5 to 4.7) hours, p = 0.3). Motor blocks and (near) falls were more frequently reported in patients with FNB vs. ACB (20 (76.9%) vs. 1 (3.7%), p < 0.001, and 7 (29.2%) vs. 1 (4.0%), p = 0.023. However, less opioids were consumed in the post-anesthesia care unit for FNB (median 3 [0, 21] vs. 15 [12, 42.5] oral morphine milligram equivalents, p = 0.004) for ACB. Between patients with FNB or ACB, no difference concerning readiness for discharge was found. Despite a slight reduction in opioid consumption immediately after surgery, FNB demonstrates a less favorable safety profile compared to ACB, with more motor blocks and (near) falls.

Comparison of migration rates between traditional and tunneled adductor canal block catheters: a randomized controlled trial

IntroductionTotal knee arthroplasty is associated with significant postoperative pain. Continuous adductor canal blocks via an inserted adductor canal catheter are effective analgesia interventions with the advantage of decreasing quadriceps weakness...

Incidence and Etiology of Rare Saphenous Nerve Injury After Knee Surgery with Adductor Canal Block: A Retrospective Observational Study.

Adductor canal block (ACB) is commonly included in multimodal analgesia regimens for knee surgery. Nonetheless, the incidence, etiology, and procedure-specific risk of saphenous nerve injury after knee surgery with ACB have not been established. We sought to identify the risk of saphenous nerve injury during knee surgery with ACB. We conducted a retrospective cohort study of patients at a single institution who underwent elective knee surgery with ultrasound-guided ACB between January 1, 2014, and December 31, 2018, and had subsequent saphenous nerve injury. The primary outcome was the incidence of saphenous nerve injury within 3 months of surgery, by surgical type and approach. Secondary outcomes included attribution of the most likely etiology and clinical outcome of the injury. In 28,196 cases of knee surgery with ACB, we identified 18 cases (0.06%) of saphenous nerve injury. The most common surgery associated with saphenous nerve injury was anterior cruciate ligament (ACL) reconstruction with autograft (8/18 cases); 3 cases of injury were seen after TKA, 2 after medial patellofemoral ligament reconstruction, 2 after arthroscopy/meniscal surgery, and 1 after patellar fixation. The most likely etiology of nerve injury was attributed to ACB in 5 of 18 cases (28%) and to non-ACB cause in 13 of 18 (72%). Prognosis was rated as unknown in 11 of 18, poor in 2 of 18, favorable in 3 of 18, and full recovery in 2 of 18. This 5-year retrospective, single-institution cohort study found a low overall incidence of saphenous nerve injury after knee surgery with ACB, but the injury likelihood varied based on surgery and approach. Although not statistically significant, ACL reconstruction with hamstring autograft and ACB performed for postoperative rescue analgesia were most frequently associated with nerve injury.

Post-Operative Analgesic Effect of Intra-Articular Local Anesthetic Infiltration versus Adductor Canal Block after Knee Arthroscopic Surgeries

Abstract Background Knee arthroscopic surgery is one of the most common orthopaedic procedures. Postoperative pain after Knee arthroscopy is caused by irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection. Aim of the Work To compare between intra-articular local anaesthetic infiltration and ultrasound guided adductor canal block to achieve effective and safe postoperative analgesia after knee arthroscopic surgeries as regarding duration of postoperative analgesia, need for analgesic supplements postoperatively, patient satisfaction, time of ambulation, and presence of any associated complications or side effects. Patients and Methods A prospective randomized comparative study was conducted in Ain Shams University hospitals, on patients aged from 20 to 60 years, ASA class I-II-III assigned for knee arthroscopic surgeries. For six to eight months started after approval from ethical committee of Ain Shams University. A written informed consent had been obtained from all patients. Every patient received an explanation for the purpose of the study and research results only used for scientific purposes. Results The study showed that adductor canal group had lower Pain perception (VAS-10) at rest, but the differences were statistically significant beginning from hour-8. Also, adductor canal group had lower Pain perception (VAS-10) during movement, but the differences were statistically significant beginning from hour-8. Rescue analgesia was significantly less frequent in adductor canal group. High satisfaction (Good/excellent) grades were significantly more frequent in adductor canal group. Conclusion The findings of our study revealed that ACB Provides better postoperative analgesia after knee arthroscopic surgeries than intra-articular local anaesthetic infiltration at rest and movement. Furthermore it facilitated earlier mobility than local anaesthetic infiltration. However, in clinical practice intra-articular local anaesthetic infiltration is easier to perform than ACB which requires experienced anaesthesiologist.