Single-shot Adductor Canal Block Research Articles

Comparison of Analgesic Efficacy of Continuous Adductor Canal Block versus Single-shot Adductor Canal Block Using Ropivacaine for Unilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract Context: Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. Aims: The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. Settings and Design: It was a prospective randomized controlled trial carried out in a tertiary care hospital. Materials and Methods: Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Statistical Analysis: Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant. Results: In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. Conclusions: ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.

Adductor Canal Block Versus Femoral Nerve Block in Total Knee Arthroplasty: Network Meta-Analysis.

The quality of postoperative analgesia in total knee arthroplasty is crucial for patient recovery, rehabilitation, and hospital stay duration. In line with the above, а single-shot adductor canal block has been considered as an improved method over continuous femoral nerve block. However, continuous adductor canal block and single-shot femoral nerve block have been not adequately addressed in the discussion. This study aimed to compare the effectiveness of various types of adductor and femoral nerve blocks on clinically relevant outcomes in patients following total knee arthroplasty. A systematic review and network meta-analysis were conducted following "PRISMA-NMA" and Cochrane Handbook guidelines. The eligibility criteria included randomized trials and, where these were lacking for a comparison, nonrandomized studies involving adults undergoing primary total knee arthroplasty, comparing single-shot adductor canal block, continuous adductor canal block, single-shot femoral nerve block, and continuous femoral nerve block. A total of 36 studies involving 3308 patients were included. Single-shot adductor canal block showed higher pain scores and opioid consumption but better functional recovery at 24h compared with continuous femoral nerve block. However, this trend vanishes by the 48h assessment postsurgery. Continuous adductor canal block required higher opioid consumption but better functional recovery and shorter hospital stay compared with continuous femoral nerve block. Single-shot adductor canal block showed higher pain scores but comparable opioid consumption and functional recovery to continuous adductor canal block. The shift from continuous femoral nerve block to single-shot adductor canal block as the preferred method for pain relief after total knee arthroplasty may be premature. While the latter improves mobility, it falls short in pain control and does not shorten hospital stays. Continuous adductor canal block shows promise but is currently underappreciated, and single-shot femoral nerve block is often overshadowed by other techniques in regional anesthesia. Further high-quality, multicenter randomized controlled trials are needed to validate these findings.

Retracted: Early Postoperative Pain Control and Inflammation for Total Knee Arthroplasty: A Retrospective Comparison of Continuous Adductor Canal Block versus Single-Shot Adductor Canal Block Combined with Patient-Controlled Intravenous Analgesia.

[This retracts the article DOI: 10.1155/2022/1351480.].

Adductor Canal Block versus Intravenous Patient Controlled Analgesia for Postoperative Pain Control for Primary Total Knee Arthroplasty

Abstract Background Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response. Aim of the Work to compare efficacy, hemodynamic effects, opiate consumption and side effects of Adductor canal block and intravenous patient-controlled analgesia (PCA) in terms of postoperative primary total knee arthroplasty analgesia. Patients and Methods The study was performed upon 60 patients, randomly distributed into two equal groups: Group I: Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery and before extubation with 20 ml of bupivacaine 0.5% and Group II: Patients of this group received intravenous patientcontrolled analgesia (PCA) with Nalbuphine after the end of surgery and before extubation. For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, VAS, Nalbuphine extradoses consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension were recorded. Orthopedic rehabilitation indices were assessed by physiotherapy staff. Results ACB provided more effective analgesia for the first 6 hours but PCA with nalbuphine was superior after and for the rest of 24 postoperative hours. Conclusions Adductor canal block had good control of pain for the first 6 postoperative hours. However, the conventional use of intravenous PCA containing opioids was more effective for the rest of the first 24 postoperative hours.

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.

The Efficacy and Safety of Regional Nerve Blocks in Total Knee Arthroplasty: Systematic Review and Direct Meta-Analysis

BackgroundRegional nerve blocks are widely used in primary total knee arthroplasty (TKA) to reduce postoperative pain and opioid consumption. The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after TKA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published before March 24, 2020 on femoral nerve block, adductor canal block, and infiltration between Popliteal Artery and Capsule of Knee in primary TKA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks compared to a control, local peri-articular anesthetic infiltration (PAI), or between regional nerve blocks. ResultsCritical appraisal of 1,673 publications yielded 56 publications representing the best available evidence for analysis. Femoral nerve and adductor canal blocks are effective at reducing postoperative pain and opioid consumption, but femoral nerve blocks are associated with quadriceps weakness. Use of a continuous compared to single shot adductor canal block can improve postoperative analgesia. No difference was noted between an adductor canal block or PAI regarding postoperative pain and opioid consumption, but the combination of both may be more effective. ConclusionSingle shot adductor canal block or PAI should be used to reduce postoperative pain and opioid consumption following TKA. Use of a continuous adductor canal block or a combination of single shot adductor canal block and PAI may improve postoperative analgesia in patients with concern of poor postoperative pain control.

Efficacy of single-shot adductor canal block before Versus after primary total knee arthroplasty - Does timing make a difference? A randomized controlled trial.

Total knee arthroplasty (TKA) is associated with severe postoperative pain. Multimodal analgesia, including peripheral nerve block, is recommended for post-operative pain relief. Administration of some pain medications prior to surgery has shown to be more effective than after the operation. This is a prospective, randomized controlled trial designed to compare the analgesic efficacy of the adductor canal block (ACB) performed immediately before or immediately after primary total knee arthroplasty (TKA). We hypothesized that ACB before the surgery will reduce postoperative pain and improve knee function. A total of 50 patients were enrolled and randomized into 2 groups, with 26 patients receiving a preoperative ACB and 24 receiving a postoperative ACB. Treatment groups were similar in terms of gender (p = .83), age (p = 0.61) weight (p = .39) and ASA score. Average visual analogue scale (VAS) on arrival to the post-anesthesia care unit (PACU) were 4.9 ± 3.2 in the preoperative ACB versus 3.4 ± 2.8 for the postoperative ACB (p = .075). VAS scores at different time points as well as the mean, minimal and maximal reported VAS scores were not significantly different between the two groups. The cumulative quantities of Fentanyl administered by the anesthesia team was comparable between the groups. Similarly, the dosage of Morphine, Tramadol, Acetaminophen and Dipyrone showed only small variations. The Quality of Recovery Score, Knee Society Scores and knee range of motion did not differ between the groups. Our findings demonstrate no significant differences in patient total narcotics consumption, pain scores and functional scores, between preoperative and postoperative ACB in patients undergoing TKA. The trial was registered at www.clinicaltrials.gov and was assigned the registration number NCT02908711. level I randomized controlled trial.

Single shot adductor canal block combined with intravenous patient-controlled analgesia can be effective as continuous adductor canal block in reducing opioid consumption and breakthrough pain after total knee arthroplasty

PurposeThe aim of this study was to compare the following three analgesic methods after Total knee arthroplasty (TKA): intravenous patient-controlled analgesia (IV-PCA), continuous adductor canal block (C-ACB), and intravenous patient-controlled analgesia combined with single shot adductor canal block (PCA + sACB).MethodsRecords of 482 patients undergoing primary TKA from September 2019 to September 2020 were analyzed. Patients were divided into three pain control groups: IV-PCA (n = 180), C-ACB (n = 173) and PCA + sACB (n = 129). Single shot adductor canal block was performed 24 h after surgery in the PCA + sACB group. Rescue opioid consumption, breakthrough pain, pain numerical rating scale (NRS), and anti-emetics administration were measured from postoperative day (POD) 1 to POD 5.ResultsRescue opioid consumption was less in C-ACB or PCA + sACB group than in the IV-PCA group at POD1 (p < 0.001 and p = 0.002, respectively). Patients in C-ACB and PCA + sACB groups had less breakthrough pain (NRS > 5) than the IV-PCA group at POD1 (p = 0.007). On POD2, C-ACB was statistically superior to IV-PCA (p = 0.011) in terms of breakthrough pain. Postoperative pain NRS was lower in the C-ACB and PCA + sACB groups than in the IV-PCA group (p = 0.025 and p = 0.019, respectively). The total number of anti-emetics consumption was lower in C-ACB and PCA + sACB groups than in the IV-PCA group (p = 0.003 and p = 0.002, respectively).ConclusionPCA + sACB not only reduced patients’ need for rescue opioids, but also decreased the number of breakthrough pain and anti-emetics compared to IV-PCA in early postoperative days after TKA. However, C-ACB and PCA + sACB did not differ significantly in analgesic efficacy or opioid-related side effects. PCA + sACB can be as effective as C-ACB for patients undergoing TKA.Level of evidenceRetrospective cohort study, level III.

Effect of introduction of routine single shot adductor canal block in primary total knee arthroplasty in a rural Australian setting.

There is a growing demand for quality osteoarthritis management available in Australia. There has been increasing emphasis on post-total knee replacement pain relief as a significant issue, especially in the context of postoperative recovery protocols which focus on early mobility. The aim of this study was to assess if the addition of adductor canal blocks (ACB) reduced postoperative pain and affected mobility post primary total knee arthroplasty (TKR) at Armidale Rural Referral Hospital (ARRH). A retrospective cohort study was performed of unilateral TKR patients before and after the addition of adductor canal blocks to the TKR protocol at ARRH. Forty-seven patients were included in the study who are matched for age and radiographic disease severity. All patients were prescribed post-operative analgesia per the protocol. Patients who received an ACB had a significant difference in opioid consumption in the first 24 h post-operative compared with those who did not, 115.90 mg oral morphine compared to 66.07 mg (P= 0.0001). This was also supported by a significant difference in patient self-rated numerical pain score between groups, no ACB group 3.09/10 and ACB group 1.05/10 (P= 0.0001). The ACB group were able to mobilize further on post-op days 1 and 2 than those who did not receive an ACB with the ACB group (P= 0.0001 and 0.0008). This adds to the evidence supporting the use of Adductor Canal Blocks in patients undergoing total knee arthroplasty, of especial significance in a rural population.

No Benefits of Adding Dexmedetomidine, Ketamine, Dexamethasone, and Nerve Blocks to an Established Multimodal Analgesic Regimen after Total Knee Arthroplasty.

An optimal opioid-sparing multimodal analgesic regimen to treat severe pain can enhance recovery after total knee arthroplasty. The hypothesis was that adding five recently described intravenous and regional interventions to multimodal analgesic regimen can further reduce opioid consumption. In a double-blinded fashion, 78 patients undergoing elective total knee arthroplasty were randomized to either (1) a control group (n = 39) that received spinal anesthesia with intrathecal morphine, periarticular local anesthesia infiltration, intravenous dexamethasone, and a single injection adductor canal block or (2) a study group (n = 39) that received the same set of analgesic treatments plus five additional interventions: local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intraoperative intravenous dexmedetomidine and ketamine, and postoperatively, one additional intravenous dexamethasone bolus and two additional adductor canal block injections. The primary outcome measure was 24-h cumulative opioid consumption after surgery and secondary outcomes were other analgesics, patient recovery, functional outcomes, and adverse events. Opioid consumption was not different between groups at 24 h (oral morphine equivalents, mean ± SD; study: 23.7 ± 18.0 mg vs. control: 29.3 ± 18.7 mg; mean difference [95% CI], -5.6 mg [-2.7 to 13.9]; P = 0.189) and all other time points after surgery. There were no major differences in pain scores, quality of recovery, or time to reach rehabilitation milestones. Hypotensive episodes occurred more frequently in the study group (25 of 39 [64.1%] vs. 13 of 39 [33.3%]; P = 0.010). In the presence of periarticular local anesthesia infiltration, intrathecal morphine, single-shot adductor canal block and dexamethasone, the addition of five analgesic interventions-local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intravenous dexmedetomidine, intravenous ketamine, an additional intravenous dexamethasone dose, and repeated adductor canal block injections-failed to further reduce opioid consumption or pain scores or to improve functional outcomes after total knee arthroplasty.

Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations.

The PROSPECT (PROcedure SPEcific Postoperative Pain ManagemenT) Working Group is a global collaboration of surgeons and anaesthesiologists formulating procedure-specific recommendations for pain management after common operations. Total knee arthroplasty (TKA) is associated with significant postoperative pain that is difficult to treat. Nevertheless, pain control is essential for rehabilitation and to enhance recovery. To evaluate the available literature and develop recommendations for optimal pain management after unilateral primary TKA. A narrative review based on published systematic reviews, using modified PROSPECT methodology. A literature search was performed in EMBASE, MEDLINE, PubMed and Cochrane Databases, between January 2014 and December 2020, for systematic reviews and meta-analyses evaluating analgesic interventions for pain management in patients undergoing TKA. Each randomised controlled trial (RCT) included in the selected systematic reviews was critically evaluated and included only if met the PROSPECT requirements. Included studies were evaluated for clinically relevant differences in pain scores, use of nonopioid analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs and current clinical relevance. A total of 151 systematic reviews were analysed, 106 RCTs met PROSPECT criteria. Paracetamol and nonsteroidal anti-inflammatory or cyclo-oxygenase-2-specific inhibitors are recommended. This should be combined with a single shot adductor canal block and peri-articular local infiltration analgesia together with a single intra-operative dose of intravenous dexamethasone. Intrathecal morphine (100 μg) may be considered in hospitalised patients only in rare situations when both adductor canal block and local infiltration analgesia are not possible. Opioids should be reserved as rescue analgesics in the postoperative period. Analgesic interventions that could not be recommended were also identified. The present review identified an optimal analgesic regimen for unilateral primary TKA. Future studies to evaluate enhanced recovery programs and specific challenging patient groups are needed.

Early Postoperative Pain Control and Inflammation for Total Knee Arthroplasty: A Retrospective Comparison of Continuous Adductor Canal Block versus Single-Shot Adductor Canal Block Combined with Patient-Controlled Intravenous Analgesia.

Objective The aim of this study was to compare pain control and inflammation among patients who received a continuous adductor canal block (CACB) versus single-shot adductor canal block (SACB) combined with patient-controlled intravenous analgesia (PCIA) for total knee arthroplasty (TKA) analgesia in the first two days after surgery. Design Matched cohort retrospective study. Setting. University hospital. Patients. One hundred fifty-six patient charts were included in this study: 78 patients with CACB in Group A and 78 patients with SACB combined with PCIA in Group B. Patients were matched according to age, body mass index, and American Society of Anesthesiologists class. Measurements. The primary outcome of the study was Visual Analogue Scale (VAS) pain scores before operation (Pre) and at postoperative 6 (POH6), 12 (POH12), 24 (POH24), 30 (POH30), 36 (POH36), and 48 hours (POH48). Secondary outcomes included patient-controlled bolus, time of first postoperative ambulation, range of knee flexion and extension, inflammation cytokines on Pre and POH48, percentage of remedial analgesics treatment, incidence of adverse events and complications, hospital stay and cost, and Numerical Rating Scale (NRS) satisfaction scores at discharge. Main Results. Mean VAS scores at rest and with motion were lower in Group B than in Group A on all postoperative hours. At POH30, compared with Group A (1.1 ± 0.6), mean VAS scores at rest in Group B (0.9 ± 0.4) were lower (P=0.048), and compared with Group A (2.6 ± 0.7), mean VAS scores with motion in Group B (2.2 ± 0.8) were lower (P=0.001). The number of patient-controlled bolus was 4.3 ± 1.6 (95% CI 3.9–4.6) in Group A and 3.1 ± 1.3 (95% CI 2.8–3.4) in Group B, respectively (P < 0.001). Patients in Group B displayed better functional recovery and inflammation results at POH48 than Group A with respect to range of knee flexion and extension (117.8 ± 10.9° vs. 125.2 ± 9.4°, P < 0.001) and inflammation cytokines, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) ((43.8 ± 16.1) vs. (36.8 ± 13.2), P=0.003; (34.9 ± 9.4 mg/L) vs. (29.6 ± 10.6 mg/L), P=0.001; (21.3 ± 8.7 pg/ml) vs. (14.0 ± 7.0 pg/ml), P < 0.001)). Conclusion SACB combined with PCIA in the first two days of patients undergoing TKA has better analgesic and beneficial effects on functional recovery and inflammation.

Popliteal Nerve Catheters for Perioperative Pain Control in Charcot-Marie-Tooth Patients

Category:Hindfoot; OtherIntroduction/Purpose:The underlying neuropathy of Charcot-Marie-Tooth (CMT) disease often makes postoperative pain control difficult. Previous institutional regimens for outpatient foot and ankle surgery in this population included preoperative single-shot regional nerve blocks and oral narcotic analgesics, but still resulted in unplanned visits for uncontrolled pain, especially after block effects abated. Longer duration of regional anesthesia effects were desired to manage pain and reduce opioid intake. We aimed to investigate the safety and efficacy of ultrasound-guided placement of popliteal nerve catheters in CMT patients undergoing foot deformity correction surgery.Methods:Twelve CMT patients, average 28 (range 13-53) years old, undergoing reconstructive surgery by a single foot and ankle attending surgeon were consented for preoperative ultrasound-guided popliteal catheters and single-shot adductor canal blocks. Patients were separately consented for enrollment in this study and follow-up questionnaires as per Institutional Review Board protocol. Seven patients underwent joint sparing reconstruction and 5 patients had subtalar fusion. Patients were discharged on postoperative day (POD) 0. Popliteal catheters were maintained, providing continuous infusion and patient-controlled bolus doses until POD3, and then self-discontinued. Oral oxycodone 5 mg (#60-80 pills) was prescribed as needed for breakthrough pain.Daily visual analog scale (VAS) pain scores were collected by phone. Patient satisfaction (0-10) was surveyed on POD5. A pill count for opioid consumption occurred at the surgeon's office on POD14. Five-point sensory testing using a 10g Semmes- Weinstein monofilament was performed preoperatively and on POD14.Results:All patients tolerated the catheters well. There were no complications related to infection or catheter malfunction requiring replacement. Four of the twelve patients had pre-existing sensory deficits involving at least two areas on the five-point monofilament test (Table 1). Postoperative testing showed these deficits were unchanged and there were no instances of new sensory deficits. Postoperative VAS pain scores were typically low with the median value (interquartile range IQR) 3.7 (1.5 - 5.75) on POD1, 3.2 (1.75 - 4.25) on POD2, and 2.5 (1 - 3.5) on POD3 (Figure 1). At POD14, VAS pain was 1 (0.75-1). Patients consumed an average total of 25 oxycodone pills (IQR 9-42) over 2 weeks, less than half the prescribed number. Patient satisfaction was high with the mean (standard deviation) score of 9.1 (1.6). All patients reported they would choose to have a nerve catheter again for a similar surgery.Conclusion:Regional anesthesia using ultrasound-guided popliteal catheters was effective for pain control in this series of CMT patients undergoing deformity correction. Opioid consumption was reduced from historical levels and no patients required emergency treatment for uncontrolled pain. These catheters provided three days of local anesthetic infusion. No new sensory deficits were detected and patients with underlying preoperative sensory deficits remained unchanged. Patients were highly satisfied. This small study group provides preliminary evidence supporting nerve catheter usage in CMT patients. Utilizing ultrasound guidance to minimize nerve injury, nerve catheters may allow safe and successful outpatient correction of CMT foot deformity.

Adductor canal block in outpatient clinic for pain control after knee arthroplasty: A randomized controlled, clinical trial.

Successful total knee replacement surgery is influenced by surgery and rehabilitation program. We hypothesized the adductor canal block (ACB) in the outpatient clinic is safe, effective for pain relief and decreases analgesic consumption compared with controls. a paired, randomized controlled trial. The intervention group received ACB with 15mL mixture of ropivacaine 0.2% with isotonic saline and steroids on post-operative day 14 (POD-14) at the outpatient clinic, the control group received daily consumption of analgesic. We evaluated Visual Analog Score (VAS) pain score, and analgesic consumption. 35 subjects for each group. In the ACB group, mean of age was 66.42 years old, mean of BMI was 25.87. The control group, mean of age was 64.11years old, mean of BMI was 25.95. There were significantly different mean VAS scores of both groups and analgesic consumption of both groups on POD 15th, 17th and 19th (p = 0.00, 0.000 and 0.001, respectively). Two patients complained about hematoma in their thigh (insertion needle) and recovered. Single-shot ACB in the outpatient clinic is safe, significantly decreased pain and analgesic consumption and may enhance the rehabilitation program.

Analgesic efficacy of single-shot adductor canal block versus adductor canal block combined with intra-articular ropivacaine infusion after total knee arthroplasty.

AimsSingle-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone.MethodsThis study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain.ResultsThe study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014).ConclusionCombined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA.Cite this article: Bone Jt Open 2021;2(12):1082–1088.

Adductor Canal Block vs Liposomal Bupivacaine Periarticular Injection in Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundThis study compares postoperative pain scores and functional outcomes between liposomal bupivacaine peri-articular injection (LB-PAI) vs a single-shot adductor canal block (ACB) using bupivacaine HCl in patients undergoing primary total knee arthroplasty (TKA). MethodsThis is a randomized controlled trial of 56 patients who were treated with TKA for arthritis. Patients were randomized to receive an intraoperative LB-PAI (n = 27) or preoperative ACB using bupivacaine HCl (n = 29). Both groups were otherwise given our institutional standard multimodal pain protocol. Data on Visual Analog Scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, knee range of motion, postoperative ambulation distance, hospital length of stay, and opioid use were collected. The total cost of each intervention was compared at the conclusion of the study. ResultsAge, gender, or body mass index was similar between groups. Compared to the ACB group, the LB-PAI group trended to lower average VAS pain scores on postoperative days 0, 1, and 2 (average difference [95% confidence interval] = −0.5 [−0.7, 1.7], −1.0 [−0.1, 2.0], −0.2 [−0.8, 1.3]), and identical average VAS pain scores on postoperative days 4 and 7. These differences and all postoperative outcome measures were not statistically significant at any time point. A single 266-milligram vial of liposomal bupivacaine costs $351, and a single-shot ACB costs $893 at our institution. ConclusionsThis randomized controlled trial shows similar postoperative pain control, functional outcomes, and opioid use between LB-PAI and a single-shot ACB in patients undergoing primary TKA. However, the single-shot ACB costs $542 more than the LB-PAI at our institution.

Adductor Canal Block in the Outpatient Clinic for Pain Control Following Knee Surgery.

BackgroundEffective postoperative pain control is an important factor for the success of rehabilitation programs. Adductor canal block (ACB) is a recently developed technique.ObjectivesThis study aimed to evaluate the application of ACB in patients who underwent knee surgery.MethodsWe performed ACB guided with ultrasonography for patients who underwent knee surgery. ACB was performed 14 days after surgery in the outpatient clinic with a ropivacaine mixture. The pain was evaluated using the visual analogue scale (VAS) every two days.ResultsIn this study, 115 patients were included. The mean score of VAS before ACB on the fifth, seventh, and ninth days was 7.4, 7.2, and 6.2, respectively. Mean VAS was significantly decreased after providing the intervention. However, the VAS score was increased gradually until the 23rd day and then flattened. Analgesic (etoricoxib) consumption was 102 mg, 98 mg, and 98 mg in postoperative days (POD), 5th, 7th, and 9th, respectively. Analgesic consumption was significantly decreased (16 mg) after ACB (POD 15th) and gradually increased in PODs 17th, 19th, and 21st. Only one patient complained of thigh hematoma after the ACB procedure.ConclusionsSingle-shot ACB, provided in outpatient clinics, is a safe intervention that could significantly decrease both pain and analgesic consumption. It may enhance the postoperative rehabilitation program.

Clinical efficacy of adductor canal block in medial open wedge high tibial osteotomy

BackgroundTo evaluate the effect of adductor canal block (ACB) on short-term postoperative outcomes in patients who underwent medial open-wedge high tibial osteotomy (MOWHTO) compared to that of a placebo. Methods35 patients who underwent unilateral MOWHTO between 2017 and 2019 were prospectively reviewed and randomly divided into two groups: 19 patients who received a single-shot ACB and 16 patients who received a saline injection (a placebo group). Primary outcomes were (1) pain measured using the visual analog scale and range of motion, (2) patient satisfaction, (3) postoperative need for additional opioids, (3) quadriceps strength (the time to straight leg raising [SLR]), (4) clinical outcomes, and (5) complications. ResultsThe pain score was lower in the ACB group than in the placebo group in the first 12 h (p = 0.04). ACB did not exhibit significantly less quadriceps strength weakness postoperatively. There was no statistical difference in the time to SLR (23.5 ± 17.7 h in ACB vs. 27.6 ± 11.4 in placebo, p = 0.520). The opioid consumption rate within postoperative 12 h was significantly decreased after ACB (16.7% in ACB, 70% in placebo, p = 0.017). The proportion of patients with more than 5 opioid injections within 72 h postoperatively was lower in the ACB group (8.3% in ACB, 50% in placebo, p = 0.043). Both groups did not show any localized and systemic complications. ConclusionACB following MOWHTO exhibited better outcomes than a placebo with respect to opioid consumption with no changes in the quadriceps strength and complications. Level of EvidenceII, Prospectively comparative study

Analgesic efficacy of single- shot adductor canal block with levobupivacaine and dexmedetomidine in total knee arthroplasty: A randomized clinical trial

ABSTRACT Background The goal of this study was to compare the analgesic efficacy of dexmedetomidine and levobupivacaine in adductor canal block (ACB) in total knee arthroplasty (TKA) patients, as well as the ambulation ability and adverse effects. Methods Sixty patients, ranging in age from 18 to 60 years old and with an ASA status of I to II, had unilateral TKA under spinal anesthesia. They were randomized into two groups; Group L received 20 mL of 0.25% levobupivacaine and Group LD received 20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine for ACB. The time it took for the first analgesic to be requested, the amount of morphine used in a 24-hour period, the postoperative pain score, and the range of motion (ROM), a 100-foot walking test data, sedation, patient satisfaction, and adverse outcomes were measured. Results LD group had lower scores of VAS either at rest or on movement at nearly all-time intervals. The mean time to first analgesic request in group L (406.77 ± 10.64 min) and group LD (515.10 ± 27.98 min, P-value <0.001). The mean total dose of morphine consumed in first 24 h postoperative was significantly lower in LD group (6.47 ± 2.01 mg) when compared to L group (10.93 ± 2.35 mg, P value <0.001). There were significant differences in ROM test, 100 foot test, and patient satisfaction between groups but no major adverse effects in both groups. Conclusion The addition of 0.5 µg/kg dexmedetomidine to 20 mL of 0.25% levobupivacaine in single-shot ACB is better than 20 mL of 0.25% levobupivacaine alone regarding postoperative analgesia, patient satisfaction and ambulation ability following TKA but, with low rate of adverse events in both groups.

Quadriceps Weakness After Single-Shot Adductor Canal Block: A Multivariate Analysis of 1,083 Primary Total Knee Arthroplasties.

Adductor canal blocks (ACBs) are commonly employed in multimodal pain control for total knee arthroplasty (TKA) and minimize motor blockade compared with femoral nerve blocks. Quadriceps weakness may be associated with ACBs. The purpose of this study was to quantify the prevalence of clinically relevant quadriceps weakness after a single-shot ACB and to identify the factors that are associated with its diagnosis. The study group consisted of 1,083 retrospectively reviewed consecutive TKAs that were performed with ACBs at an academic hip and knee center. Quadriceps weakness was quantified with a standardized rating system during the initial physical therapy evaluation, and 23 potential covariates were analyzed. The prevalence of quadriceps weakness was 9%. Increasing the dose of the ACB anesthetic per unit of body mass index (BMI) increased the probability of quadriceps weakness by 5.0 times (95% confidence interval [CI], 1.9 to 13.3; p = 0.001). The highest probability of quadriceps weakness (52.9%) was associated with women who received the highest anesthetic dose per unit of BMI and an epinephrine extender but no corticosteroid extender. The optimal volume of local anesthetic in ACBs to maintain pain control while minimizing quadriceps weakness has not yet been defined. Our observation that quadriceps weakness was associated with increasing doses of ACB anesthetic per unit of BMI suggests that more than traditional structural canal-fill parameters (i.e., filling the distal aspect of the adductor canal without spreading to the femoral triangle) should be considered when choosing injectates and injectate volumes for ACBs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.