Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.017
Brazilian Journal of Anesthesiology
Original Investigation

Analgesic effect of continuous adductor canal block versus continuous femoral nerve block for knee arthroscopic surgery: a randomized trial

Efeito analgésico do bloqueio contínuo do canal adutor versus bloqueio contínuo do nervo femoral para cirurgia artroscópica do joelho: um estudo randomizado

Chandni Sinha, Akhilesh Kumar Singh, Amarjeet Kumar, Ajeet Kumar, Sudeep Kumar, Poonam Kumari

Downloads: 0
Views: 816

Abstract

Background and objectives
Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR.

Method
In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion).

Results
The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p < 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p < 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p < 0.001).

Conclusion
The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.

Keywords

Nerve block,  Femoral nerve,  Analgesia,  Arthroscopy,  Anterior cruciate ligament reconstruction

Resumo

Justificativa e objetivos: A reconstrução do ligamento cruzado anterior (RLCA) é um dos procedimentos ortopédicos mais realizados. A capacidade de realizar RLCA ambulatorialmente depende em grande parte de um regime analgésico eficaz. O objetivo do estudo foi comparar o efeito analgésico entre o bloqueio contínuo do canal adutor (cACB) e o bloqueio do nervo femoral (cFNB) durante o RLCA guiado por artroscopia. Método: Neste ensaio clínico prospectivo, randomizado e controlado, foram recrutados 60 pacientes ASA I/II para RLCA artroscópico. Os pacientes do Grupo I receberam cACB e os do Grupo II cFNB. Uma dose em bolus de 20 cc de levobupivacaína 0,5% seguida de 0,125% 5 ml/h-1 foi iniciada por 24 horas. Analgesia de resgate na forma de paracetamol 1 g por via intravenosa (IV) foi administrada. Parâmetros avaliados como tempo da primeira analgesia de resgate, necessidade total de analgésico em 24 horas e amplitude de movimento indolor do joelho (15 graus de flexão para flexão posterior indolor). Resultados: O tempo até a primeira solicitação de analgésico pós-operatório (horas) foi mais precoce no Grupo II (14,40 ± 4,32) do que no Grupo I (16,90 ± 3,37) e essa diferença foi estatisticamente significativa (p < 0,05). O consumo cumulativo de analgésico em 24 horas (paracetamol em g) foi de 0,70 ± 0,47 no Grupo I e 1,70 ± 0,65 no Grupo II (p < 0,001). A amplitude de movimento indolor (grau) foi de 55,67 ± 10,40 no Grupo I e 40,00 ± 11,37 no Grupo II (p < 0,001). Conclusão: Os achados deste estudo sugerem que o bloqueio contínuo do canal adutor proporciona analgesia superior em pacientes submetidos ao RLCA artroscópico quando comparado ao bloqueio contínuo do nervo femoral.

Palavras-chave

Bloqueio do nervo; Nervo femoral; Analgesia; Artroscopia; Reconstrução do ligamento cruzado anterior

References

1 B.R. Bach Jr Revision anterior cruciate ligament surgery Arthroscopy., 19 (2003), pp. 14-29

2 G.S. Tierney, R.W. Wright, J.P. Smith, et al. Anterior cruciate ligament reconstruction as an outpatient procedure Am J Sports Med., 23 (1995), pp. 755-756

3 T.L. Chmielewski, D. Jones, T. Day, et al. The association of pain and fear of movement/ reinjury with function during anterior cruciate ligament reconstruction rehabilitation J Orthop Sports Phys Ther., 38 (2008), pp. 746-753

4 L.T. Buller, M.J. Best, M.G. Baraga, et al. Trends in anterior cruciate ligament reconstruction in the United States Orthop J Sports Med., 3 (2014), Article 2325967114563664

5 R.P.A. Janssen, N. van Melick, J.B.A. van Mourik, et al. ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: A systematic review of clinical outcomes BMJ Open Sport Exerc Med., 4 (2018), Article e000301

6 B.A. Williams, M.T. Bottegal, M.L. Kentor, et al. Rebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: Retrospective analysis of a prospective, randomized clinical trial Reg Anesth Pain Med., 32 (2007), pp. 186-192

7 J.E. Christensen, N.E. Taylor, S.J. Hetzel, et al. Isokinetic strength deficit 6 months after adductor canal blockade for anterior cruciate ligament reconstruction Orthop J Sports Med., 5 (2017), Article 2325967117736249

8 M.S. El Ahl Femoral nerve block versus adductor canal block for postoperative pain control after anterior cruciate ligament reconstruction: A randomized controlled double blind study Saudi J Anaesth., 9 (2015), pp. 279-282

9 M.T. Charous, S.J. Madison, P.J. Suresh, et al. Continuous femoral nerve blocks: Varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block Anesthesiology., 115 (2011), Article e000301

10 Bm Ilfeld, Kb Duke, Mc. Donohue The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty Anesth Analg., 111 (2010), pp. 1552-1554

11 F. Gao, J. Ma, W. Sun, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: A systematic review and metaanalysis Clin J Pain., 33 (2017), pp. 356-368

12 H.D. Atkinson, I. Hamid, C.M. Gupte, et al. Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery: A report of four cases J Orthop Surg (Hong Kong)., 16 (2008), pp. 381-384

13 B.P. McKeon, J.V. Bono, J.C. Richmond Knee Arthroscopy (1st ed.), Springer, New York (2009), pp. 1-25

14 P.R. Williams, R. Warwick, M. Dyson, et al. Gray’s Anatomy International Student Edition (37th ed.), Churchill Livingstone, London (1989), pp. 1142-1148

15 A. Hadzic, P.E. Karaca, P. Hobeika, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy Anesth Analg., 100 (2005), pp. 976-981

16 M. Espelund, J.S. Fomsgaard, J. Haraszuk, et al. Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction: A randomised controlled trial Eur J Anaesthesiol., 30 (2013), pp. 422-428

17 M.S. El Ahl Femoral nerve block versus adductor canal block for postoperative pain control after anterior cruciate ligament reconstruction: A randomized controlled double blind study Saudi J Anaesth., 9 (2015), pp. 279-282

18 M. Espelund, U. Grevstad, P. Jaeger, et al. Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery: A randomized controlled trial Acta Anaesthesiol Scand., 58 (2014), pp. 1220-1227

19 F.W. Abdallah, D.B. Whelan, V.W. Chan, et al. Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction Anesthesiology., 124 (2016), pp. 1053-1064

20 F. Gao, J. Ma, W. Sun, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: A systematic review and metaanalysis Clin J Pain., 33 (2017), pp. 356-368

21 W. Zhang, Y. Hu, Y. Tao, et al. Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement Chin Med J (Engl)., 127 (2014), pp. 4077-4081

22 R. Patel, J. Lynch, K.R. Okoroha, et al. Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: A prospective randomized trial Arthroscopy., 34 (2018), p. e35

23 E.L. Holland, R.E. Robbins, D.K. Low, et al. Comparison of Continuous Adductor Canal and Femoral Nerve Blocks for Analgesia and Return of Quadriceps Function After Anterior Cruciate Ligament Reconstruction in Adolescent Patients Arthroscopy, Sports Medicine, and Rehabilitation., 2 (2020), pp. e121-e128
 

60982c0ba9539566e741f383 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections