Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2020

01-08-2020 | Opioids | KNEE

Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block

Authors: Huan Min, Yulong Ouyang, Gang Chen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2020

Login to get access

Abstract

Purpose

Moderate-to-severe postoperative pain remains a challenge for both patients and surgeons after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to systematically review the current evidence in the literature to compare adductor canal block (ACB) with femoral nerve block (FNB) in the treatment of ACLR.

Methods

A comprehensive search of the published literature in PubMed, Scopus, EMBASE, and Cochrane Library databases was performed. Only English randomized clinical trials (RCTs) were included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse events, patient satisfaction, and quadriceps strength.

Results

Eight RCTs with a total of 587 patients were included. No statistically
significant difference was observed between the ACB and FNB groups in pain scores at 6 h, 12 h, 24 h, or 48 h; cumulative opioid consumption at 24 h or 48 h; patient satisfaction at 24 or 48 h; and postoperative adverse event. However, ACB showed superior quadriceps strength in the early postoperative period.

Conclusions

Both treatments provided similar overall pain relief after ACLR. The
potential benefits of quadriceps preservation with ACB are worthy of future study.
Therefore, ACB is recommended as an attractive alternative to FNB as the peripheral nerve block of choice for ACLR.

Level of evidence

Meta-analysis of Level 1 was performed in this study.
Literature
1.
go back to reference Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J et al (2016) Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 124(5):1053–1064CrossRef Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J et al (2016) Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 124(5):1053–1064CrossRef
2.
go back to reference Akkaya T, Ersan O, Ozkan D, Sahiner Y, Akin M, Gümüş H et al (2008) Saphenous nerve block is an effective regional technique for post-meniscectomy pain. Knee Surg Sports Traumatol Arthrosc 16(9):855–858CrossRef Akkaya T, Ersan O, Ozkan D, Sahiner Y, Akin M, Gümüş H et al (2008) Saphenous nerve block is an effective regional technique for post-meniscectomy pain. Knee Surg Sports Traumatol Arthrosc 16(9):855–858CrossRef
3.
go back to reference Bailey L, Griffin J, Elliott M, Wu J, Papavasiliou T, Harner C et al (2019) Adductor canal nerve versus femoral nerve blockade for pain control and quadriceps function following anterior cruciate ligament reconstruction with patellar tendon autograft: a prospective randomized trial. Arthroscopy 35(3):921–929CrossRef Bailey L, Griffin J, Elliott M, Wu J, Papavasiliou T, Harner C et al (2019) Adductor canal nerve versus femoral nerve blockade for pain control and quadriceps function following anterior cruciate ligament reconstruction with patellar tendon autograft: a prospective randomized trial. Arthroscopy 35(3):921–929CrossRef
4.
go back to reference Ballantyne BT, O'Hare SJ, Paschall JL, Pavia-Smith MM, Pitz AM, Gillon JF et al (1993) Electromyo-graphic activity of selected shoulder muscles in commonly used therapeutic exercises. Phys Ther 73(10):668–682CrossRef Ballantyne BT, O'Hare SJ, Paschall JL, Pavia-Smith MM, Pitz AM, Gillon JF et al (1993) Electromyo-graphic activity of selected shoulder muscles in commonly used therapeutic exercises. Phys Ther 73(10):668–682CrossRef
5.
go back to reference Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL (2011) Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med 12(4):657–667CrossRef Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL (2011) Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med 12(4):657–667CrossRef
6.
go back to reference Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R et al (2001) Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 16(4):436–445CrossRef Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R et al (2001) Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 16(4):436–445CrossRef
7.
go back to reference Chisholm MF, Bang H, Maalouf DB, Marcello D, Lotano MA, Marx RG et al (2014) Postoperative analgesia with saphenous block appears equivalent to femoral nerve block in ACL reconstruction. HSS J 10(3):245–251CrossRef Chisholm MF, Bang H, Maalouf DB, Marcello D, Lotano MA, Marx RG et al (2014) Postoperative analgesia with saphenous block appears equivalent to femoral nerve block in ACL reconstruction. HSS J 10(3):245–251CrossRef
8.
go back to reference El Ahl MS (2015) 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(3):279–282CrossRef El Ahl MS (2015) 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(3):279–282CrossRef
9.
go back to reference Ghodki PS, Shalu PS, Sardesai SP (2018) Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol 34(2):242–246PubMedPubMedCentral Ghodki PS, Shalu PS, Sardesai SP (2018) Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol 34(2):242–246PubMedPubMedCentral
10.
go back to reference Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRef Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRef
11.
go back to reference Jaeger P, Grevstad U, Henningsen MH, Gottschau B, Mathiesen O, Dahl JB (1993) Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 56(8):1013–1019CrossRef Jaeger P, Grevstad U, Henningsen MH, Gottschau B, Mathiesen O, Dahl JB (1993) Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 56(8):1013–1019CrossRef
12.
go back to reference Jæger 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(2):409–415CrossRef Jæger 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(2):409–415CrossRef
13.
go back to reference Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J et al (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38(6):526–532CrossRef Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J et al (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38(6):526–532CrossRef
14.
go back to reference Jenstrup MT, Jæger 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(3):357–364CrossRef Jenstrup MT, Jæger 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(3):357–364CrossRef
15.
go back to reference 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 Arthroplasty 32(10):3238–3248CrossRef 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 Arthroplasty 32(10):3238–3248CrossRef
16.
go back to reference Kuang MJ, Xu LY, Ma JX, Wang Y, Zhao J, Lu B et al (2016) Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: a meta-analysis. Int J Surg 31:17–24CrossRef Kuang MJ, Xu LY, Ma JX, Wang Y, Zhao J, Lu B et al (2016) Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: a meta-analysis. Int J Surg 31:17–24CrossRef
17.
go back to reference Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM (1993) Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 50(3):303–312CrossRef Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM (1993) Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 50(3):303–312CrossRef
18.
go back to reference 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(4):321–325CrossRef 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(4):321–325CrossRef
19.
go back to reference Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40(5):925–933CrossRef Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40(5):925–933CrossRef
20.
go back to reference Lynch JR, Okoroha KR, Lizzio V, Yu CC, Jildeh TR, Moutzouros V (2019) Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med 47(2):355–363CrossRef Lynch JR, Okoroha KR, Lizzio V, Yu CC, Jildeh TR, Moutzouros V (2019) Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med 47(2):355–363CrossRef
21.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef
22.
go back to reference Myers H, Christopherson Z, Butler RJ (2018) Relationship between the lower quarter Y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. Int J Sports Phys Ther 13(2):152–159CrossRef Myers H, Christopherson Z, Butler RJ (2018) Relationship between the lower quarter Y-balance test scores and isokinetic strength testing in patients status post ACL reconstruction. Int J Sports Phys Ther 13(2):152–159CrossRef
23.
go back to reference Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM (2018) Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: a cross-sectional study. J Athl Train 53(5):475–485CrossRef Norte GE, Hertel J, Saliba SA, Diduch DR, Hart JM (2018) Quadriceps neuromuscular function in patients with anterior cruciate ligament reconstruction with or without knee osteoarthritis: a cross-sectional study. J Athl Train 53(5):475–485CrossRef
24.
go back to reference Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113(5):1144–1162CrossRef Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113(5):1144–1162CrossRef
25.
go back to reference Petersen W, Taheri P, Forkel P, Zantop T (2011) Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 134(10):1417–1428CrossRef Petersen W, Taheri P, Forkel P, Zantop T (2011) Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg 134(10):1417–1428CrossRef
26.
go back to reference Runner RP, Boden SA, Godfrey WS, Premkumar A, Samady H, Gottschalk MB et al (2018) Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded. Randomized Trial Orthop J Sports Med 6(9):2325967118797990PubMed Runner RP, Boden SA, Godfrey WS, Premkumar A, Samady H, Gottschalk MB et al (2018) Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded. Randomized Trial Orthop J Sports Med 6(9):2325967118797990PubMed
27.
go back to reference Seangleulur A, Manuwong S, Chernchujit B, Worathongchai S, Sorin T (2019) Comparison of post-operative analgesia between adductor canal block and femoral nerve block after arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial. J Med Assoc Thai 102(3):335–342 Seangleulur A, Manuwong S, Chernchujit B, Worathongchai S, Sorin T (2019) Comparison of post-operative analgesia between adductor canal block and femoral nerve block after arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial. J Med Assoc Thai 102(3):335–342
28.
go back to reference Secrist ES, Freedman KB, Ciccotti MG, Mazur DW, Hammoud S (2015) Pain management after outpatient anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Am J Sports Med 44(9):2435–2447CrossRef Secrist ES, Freedman KB, Ciccotti MG, Mazur DW, Hammoud S (2015) Pain management after outpatient anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Am J Sports Med 44(9):2435–2447CrossRef
29.
go back to reference Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL (2010) Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 468(1):135–140CrossRef Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL (2010) Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 468(1):135–140CrossRef
Metadata
Title
Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block
Authors
Huan Min
Yulong Ouyang
Gang Chen
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05933-6

Other articles of this Issue 8/2020

Knee Surgery, Sports Traumatology, Arthroscopy 8/2020 Go to the issue