Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-07-2020 | Arthroscopic Partial Meniscectomy | KNEE

Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy

Authors: Juan Xin, Yabing Zhang, Qian Li, Xu Cheng, YanJun Lin, Bin Liu, Leng Zhou

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2020

Abstract

Purpose

Adductor canal block (ACB) provides postoperative pain relief as effectively as femoral nerve block (FNB) does, and it preserves the strength of the quadriceps femoris. However, its effect on rehabilitation after arthroscopic partial meniscectomy has not been reported. The purpose of this study was to determine the effect of pre-operative ACB and FNB on the quality of rehabilitation after arthroscopic partial meniscectomy.

Methods

A total of 150 patients undergoing arthroscopic partial meniscectomy were randomly allocated to the FNB group (receiving 0.3% ropivacaine 30 ml at the thighroot-femoral nerve), the ACB group (receiving 0.3% ropivacaine 30 ml at mid-thigh adductor canal), or the control group. The primary outcome was the Hospital for Special Surgery (HSS) knee score on the 30th postoperative day.

Results

The HSS knee score of the ACB group on the 30th day after the operation was significantly higher than those of the FNB and control groups (88.6 ± 5.3 vs. 85.3 ± 6.9 and 81.2 ± 5.9, respectively; P < 0.05). Both the ACB and FNB groups showed excellent rehabilitation, indicating similar rehabilitation quality for both treatments.

Conclusion

ACB is similar to FNB concerning the quality of rehabilitation and pain relief after arthroscopic partial meniscectomy, while ACB has little effect on the strength of the quadriceps femoris.

Level of evidence

Trial registrataion

This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INC-16008346).

Alford JW, Lewis P, Kang RW, Cole BJ (2005) Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy. Arthroscopy 21:1505–1509CrossRef

Anagnostopoulou S, Anagnostis G, Saranteas T, Mavrogenis AF, Paraskeuopoulos T (2016) Saphenous and infrapatellar nerves at the adductor canal: anatomy and implications in regional anesthesia. Orthopedics 39:e259–262CrossRef

Casati A, Cappelleri G, Fanelli G, Borghi B, Anelati D, Berti M et al (2000) Regional anaesthesia for outpatient knee arthroscopy: a randomized clinical comparison of two different anaesthetic techniques. Acta Anaesthesiol Scand 44:543–547CrossRef

Espelund M, Fomsgaard JS, Haraszuk J, Mathiesen O, Dahl JB (2013) Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction: a randomised controlled trial. Eur J Anaesthesiol 30:422–428CrossRef

Everhart JS, Hughes L, Abouljoud MM, Swank K, Lewis C, Flanigan DC (2019) Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury. Knee Surg Sports Traumatol Arthrosc 17:019–05628

Gatewood CT, Tran AA, Dragoo JL (2017) The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc 25:501–516CrossRef

Goranson BD, Lang S, Cassidy JD, Dust WN, McKerrell J (1997) A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy. Can J Anaesth 44:371–376CrossRef

Grevstad U, Mathiesen O, Lind T, Dahl JB (2014) Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth 112:912–919CrossRef

Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B (2003) Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med 28:29–32CrossRef

10.

Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB (2013) Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 118:409–415CrossRef

11.

Jenstrup MT, Jaeger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O et al (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56:357–364CrossRef

12.

Kessler S, Kafer W (2007) Comparative assessment of outcome in osteoarthritis of the knee: the utility of knee scores. Acta Chir Orthop Traumatol Cech 74:332–335PubMed

13.

Kuang MJ, Ma JX, Fu L, He WW, Zhao J, Ma XL (2017) Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplast 32:3238–3248CrossRef

14.

Kwofie MK, Shastri UD, Gadsden JC, Sinha SK, Abrams JH, Xu D et al (2013) The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 38:321–325CrossRef

15.

Lee SJ, Lee BS, Kim JM, Bin SI (2015) Clinical results of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty: minimum 3-year follow-up. Knee Surg Relat Res 27:76–81CrossRef

16.

Li D, Ma GG (2016) Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2614–2619CrossRef

17.

Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R (2009) Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med 34:578–580CrossRef

18.

Marshall SI, Chung F (1999) Discharge criteria and complications after ambulatory surgery. Anesth Analg 88:508–517CrossRef

19.

McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S (2004) Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5703 patients. Can J Anaesth 51:886–891CrossRef

20.

Memtsoudis SG, Yoo D, Stundner O, Danninger T, Ma Y, Poultsides L et al (2015) Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop 39:673–680CrossRef

21.

Molony SL, Kobayashi M, Holleran EA, Mezey M (2005) Assessing pain as a fifth vital sign in long-term care facilities: recommendations from the field. J Gerontol Nurs 31:16–24CrossRef

22.

Muraskin SI, Conrad B, Zheng N, Morey TE, Enneking FK (2007) Falls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms. Reg Anesth Pain Med 32:67–72PubMed

23.

Narin S, Unver B, Bakirhan S, Bozan O, Karatosun V (2014) Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score. Acta Orthop Traumatol Turc 48:241–248CrossRef

24.

Pfister U, Gareis V, Keller E, Weller S (1986) Late results after meniscectomy. Aktuelle Traumatol 16:90–93PubMed

25.

Rosseland LA, Solheim N, Stubhaug A (2008) Pain and disability 1 year after knee arthroscopic procedures. Acta Anaesthesiol Scand 52:332–337CrossRef

26.

Slupik A, Bialoszewski D (2009) A comparative analysis of the clinical utility of the Staffelstein-score and the hospital for special surgery knee score (HSS) in monitoring physiotherapy of total knee replacement patients–preliminary study. Ortop Traumatol Rehabil 11:37–45PubMed

27.

Starke C, Kopf S, Petersen W, Becker R (2009) Meniscal repair. Arthroscopy 25:1033–1044CrossRef

28.

Westergaard B, Jensen K, Lenz K, Bendtsen TF, Vazin M, Tanggaard K et al (2014) A randomised controlled trial of ultrasound-guided blockade of the saphenous nerve and the posterior branch of the obturator nerve for postoperative analgesia after day-case knee arthroscopy. Anaesthesia 69:1337–1344CrossRef

Title: Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy
Authors: Juan Xin
Yabing Zhang
Qian Li
Xu Cheng
YanJun Lin
Bin Liu
Leng Zhou
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Arthroscopic Partial Meniscectomy
Sufentanil
Nerve Block
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05796-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Trial registrataion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Trial registrataion

Please log in to get access to this content

Other articles of this Issue 7/2020

The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury

Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally

Quadriceps tendon autograft for anterior cruciate ligament reconstruction is associated with high revision rates: results from the Danish Knee Ligament Registry

Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

Usability of the AAOS Appropriate Use Criteria (AUC) for the surgical management of knee osteoarthritis in clinical practice

Healthy knee KT1000 measurements of anterior tibial translation have significant variation