Comparison of Postoperative Analgesia between Ultrasound Guided Adductor Canal Block and Femoral Nerve Block in Patients after Total Knee Arthroplasty_West China Medical Journal

Authors：

 LIUYue ¹ , ZHANGYan-zi ¹ , TANZhen ² , LIAORen ¹ , ZHAOTao-yan ¹ , PANYan ¹ , ZHOUZong-ke ² , YANGJing ² , PEIFu-xing ² , KANGPeng-de ² , SHENBin ² , WANGXiao ¹ ,  YANGJing ¹

1. Department of Anesthesiology;West China Hospital, Chengdu, Sichuan 610041, P. R. China;
2. Department of Orthopedics;West China Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YANGJing, Email: weiweiyang@163.com

Keywords：

Total knee arthroplasty; Adductor canal block; Femoral nerve block; Postoperative analgesia; Motor function recovery

DOI：

10.7507/1002-0179.20140675

Video：

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Objective To compare postoperative analgesic efficacy and motor function recovery between ultrasound guided adductor canal block (ACB) and Femoral nerve block (FNB) in patients after total knee arthroplasty (TKA). Methods From March to April 2014, 40 patients chosen to receive TKA under general anesthesia were randomly allocated to FNB group and ACB group with 20 in each group. Opioids consumption during and after operation, pain score in rest and movement, the force of quadriceps femoris, activity of knee and complications after surgery were recorded. Results No differences were found in opioids consumption during and after operation, pain score in rest and movement after operation. Patients of ACB group were superior to those of FNB group in motor function recovery. At hour 2, 4, 8, 12, 24, and 48 after operation, the force of quadriceps femoris was higher in patients of ACB group than those of FNB group (P<0.05). Activity of knee was higher in patients of ACB group than those of FNB group postoperatively. Conclusion ACB and FNB have equal postoperative analgesic effect for TKA patients. But ACB has less influence on the force of quadriceps femoris than FNB. Therefore, patients of ACB group are superior to those of FNB group in motor function recovery, showing better activity of knee and early time of first straight leg raising.

Citation： LIUYue, ZHANGYan-zi, TANZhen, LIAORen, ZHAOTao-yan, PANYan, ZHOUZong-ke, YANGJing, PEIFu-xing, KANGPeng-de, SHENBin, WANGXiao, YANGJing. Comparison of Postoperative Analgesia between Ultrasound Guided Adductor Canal Block and Femoral Nerve Block in Patients after Total Knee Arthroplasty. West China Medical Journal, 2014, 29(12): 2231-2235. doi: 10.7507/1002-0179.20140675 Copy

1.	Singelyn FJ, Deyaert M, Joris D, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty[J]. Anesth Analg, 1998, 87(1):88-92.
2.	Capdevila X, Barthelet Y, Biboulet P, et al. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery[J]. Anesthesiology, 1999, 91(1):8-15.
3.	Hogan MV, Grant RE, Lee L Jr. Analgesia for total hip and knee arthroplasty:a review of lumbar plexus, femoral, and sciatic nerve blocks[J]. Am J Orthop (Belle Mead NJ), 2009, 38(8):E129-E133.
4.	Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery[J]. Anesth Analg, 1998, 87(1):93-97.
5.	Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement[J]. Reg Anesth Pain Med, 2002, 27(2):139-144.
6.	Atkinson HD, Hamid I, Gupte CM, et al. Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery:a report of four cases[J]. J Orthop Surg (Hong Kong), 2008, 16(3):381-384.
7.	Kent ML, Hackworth RJ, Riffenburgh RH, et al. A comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade:a prospective, controlled, blinded, crossover trial[J]. Anesth Analg, 2013, 117(1):265-270.
8.	Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty:a prospective, randomized, controlled trial[J]. Anesthesiology, 2014, 120(3):540-550.
9.	Jaeger P, Grevstad U, Henningsen MH, et al. Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty:a randomised study[J]. Acta Anaesthesiol Scand, 2012, 56(8):1013-1019.
10.	Jenstrup MT, Jaeger P, Lund J, et al. Effects of Adductor-Canal-Blockade on pain and ambulation after total knee arthroplasty:a randomized study[J]. Acta Anaesthesiol Scand, 2012, 56(3):357-364.
11.	Davis JJ, Bond TS, Swenson JD. Adductor canal block:more than just the saphenous nerve?[J]. Reg Anesth Pain Med, 2009, 34(6):618-619.
12.	Kapoor R, Adhikary SD, Siefring C, et al. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal:an anatomical study[J]. Acta Anaesthesiol Scand, 2012, 56(3):365-367.
13.	Krombach J, Gray AT. Sonography for saphenous nerve block near the adductor canal[J]. Reg Anesth Pain Med, 2007, 32(4):369-370.
14.	Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength:a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers[J]. Anesthesiology, 2013, 118(2):409-415.
15.	Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty a randomized, double-blind study[J]. Reg Anesth Pain Med, 2013, 38(6):526-532.
16.	Mariano ER, Perlas A. Adductor canal block for total knee arthroplasty the perfect recipe or just one ingredient?[J]. Anesthesiology, 2014, 120(3):530-532.
17.	Thomas K, Burton D, Withrow L, et al. Impact of a preoperative education program via interactive telehealth network for rural patients having total joint replacement[J]. Orthop Nurs, 2004, 23(1):39-44.

1. Singelyn FJ, Deyaert M, Joris D, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty[J]. Anesth Analg, 1998, 87(1):88-92.
2. Capdevila X, Barthelet Y, Biboulet P, et al. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery[J]. Anesthesiology, 1999, 91(1):8-15.
3. Hogan MV, Grant RE, Lee L Jr. Analgesia for total hip and knee arthroplasty:a review of lumbar plexus, femoral, and sciatic nerve blocks[J]. Am J Orthop (Belle Mead NJ), 2009, 38(8):E129-E133.
4. Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery[J]. Anesth Analg, 1998, 87(1):93-97.
5. Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement[J]. Reg Anesth Pain Med, 2002, 27(2):139-144.
6. Atkinson HD, Hamid I, Gupte CM, et al. Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery:a report of four cases[J]. J Orthop Surg (Hong Kong), 2008, 16(3):381-384.
7. Kent ML, Hackworth RJ, Riffenburgh RH, et al. A comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade:a prospective, controlled, blinded, crossover trial[J]. Anesth Analg, 2013, 117(1):265-270.
8. Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty:a prospective, randomized, controlled trial[J]. Anesthesiology, 2014, 120(3):540-550.
9. Jaeger P, Grevstad U, Henningsen MH, et al. Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty:a randomised study[J]. Acta Anaesthesiol Scand, 2012, 56(8):1013-1019.
10. Jenstrup MT, Jaeger P, Lund J, et al. Effects of Adductor-Canal-Blockade on pain and ambulation after total knee arthroplasty:a randomized study[J]. Acta Anaesthesiol Scand, 2012, 56(3):357-364.
11. Davis JJ, Bond TS, Swenson JD. Adductor canal block:more than just the saphenous nerve?[J]. Reg Anesth Pain Med, 2009, 34(6):618-619.
12. Kapoor R, Adhikary SD, Siefring C, et al. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal:an anatomical study[J]. Acta Anaesthesiol Scand, 2012, 56(3):365-367.
13. Krombach J, Gray AT. Sonography for saphenous nerve block near the adductor canal[J]. Reg Anesth Pain Med, 2007, 32(4):369-370.
14. Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength:a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers[J]. Anesthesiology, 2013, 118(2):409-415.
15. Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty a randomized, double-blind study[J]. Reg Anesth Pain Med, 2013, 38(6):526-532.
16. Mariano ER, Perlas A. Adductor canal block for total knee arthroplasty the perfect recipe or just one ingredient?[J]. Anesthesiology, 2014, 120(3):530-532.
17. Thomas K, Burton D, Withrow L, et al. Impact of a preoperative education program via interactive telehealth network for rural patients having total joint replacement[J]. Orthop Nurs, 2004, 23(1):39-44.

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Comparison of Postoperative Analgesia between Ultrasound Guided Adductor Canal Block and Femoral Nerve Block in Patients after Total Knee Arthroplasty

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