Affiliation:
1. From the Department of Anesthesiology, Hospital for Special Surgery, New York, New York (D.H.K., Y.L., E.A.G., R.L.K., D.B.M., A.K.G., and J.T.Y.); Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland (A.M.); Department of Anesthesiology, Weill-Cornell Medical Center, New York, New York (M.L.P.); and Department of Epidemiology and Biostatistic
Abstract
Abstract
Background:
This prospective double-blinded, randomized controlled trial compared adductor canal block (ACB) with femoral nerve block (FNB) in patients undergoing total knee arthroplasty. The authors hypothesized that ACB, compared with FNB, would exhibit less quadriceps weakness and demonstrate noninferior pain score and opioid consumption at 6 to 8 h postanesthesia.
Methods:
Patients received an ACB or FNB as a component of a multimodal analgesic. Quadriceps strength, pain score, and opioid consumption were assessed on both legs preoperatively and at 6 to 8, 24, and 48 h postanesthesia administration. In a joint hypothesis test, noninferiority was first evaluated on the primary outcomes of strength, pain score, and opioid consumption at 6 to 8 h; superiority on each outcome at 6 to 8 h was then assessed only if noninferiority was established.
Results:
Forty-six patients received ACB; 47 patients received FNB. At 6 to 8 h postanesthesia, ACB patients had significantly higher median dynamometer readings versus FNB patients (median [interquartile range], 6.1 kgf [3.5, 10.9] (ACB) vs. 0 kgf [0.0, 3.9] (FNB); P < 0.0001), but was not inferior to FNB with regard to Numeric Rating Scale pain scores (1.0 [0.0, 3.5] ACB vs. 0.0 [0.0, 1.0] FNB; P = 0.019), or to opioid consumption (32.2 [22.4, 47.5] ACB vs. 26.6 [19.6, 49.0]; P = 0.0115). At 24 and 48 h postanesthesia, there was no significant statistical difference in dynamometer results, pain scores, or opioid use between the two groups.
Conclusion:
At 6 to 8 h postanesthesia, the ACB, compared with the FNB, exhibited early relative sparing of quadriceps strength and was not inferior in both providing analgesia or opioid intake.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Anesthesiology and Pain Medicine
Reference25 articles.
1. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery.;Anesthesiology,1999
2. Peripheral nerve blocks improve analgesia after total knee replacement surgery.;Anesth Analg,1998
3. Femoral nerve block for analgesia in patients having knee arthroplasty.;Anesthesiology,2010
4. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement.;Reg Anesth Pain Med,2002
5. 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.;Anesth Analg,1998