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Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Femoral nerve blocks (FNBs) provide effective analgesia after total knee arthroplasty, but have been associated with quadriceps weakness. Adductor canal block (ACB) is a promising alternative option that delivers a primarily sensory blockade. The aim of this study was to determine whether ACB provides superior quadriceps strength and similar pain control than FNB.

Methods

A systematic search of PubMed, the Cochrane Library, EMBASE and Web of Science was conducted without publication data or language restriction. Comparative studies comparing ACB with FNB were included. Two authors independently assessed data extraction and quality of the studies.

Results

Nine studies with 639 patients were identified. Results of meta-analysis showed that compared with FNB, ACB preserved quadriceps muscle strength better than FNB [MD24h = 1.14, 95 % CI (0.38, 1.91), p < 0.01; MD48h = 0.40, 95 % CI (0.16, 0.64), p < 0.01], while there were no significant differences in pain score during rest at 24 h [SMD = − 0.04, 95 % CI (−0.17, 0.26); n.s] or 48 h [SMD = − 0.10, 95 % CI (−0.27, 0.08); n.s], pain score during activity at 24 h [SMD = 0.13, 95 % CI (−0.36, 0.62); n.s] or 48 h [SMD = − 0.13, 95 % CI (−0.37, 0.12); n.s], opioid consumption at 24 h [SMD = − 0.01, 95 % CI (−1.68, 1.66); n.s] or 48 h [SMD = − 0.92, 95 % CI (−6.86, 5.01); n.s], length of hospital stay [MD = 0.05, 95 % CI (−0.91, 1.00); n.s] and nausea or vomiting [RR = 1.17, 95 % CI (0.62, 2.20); n.s] between ACB and FNB.

Conclusions

ACB preserved the strength of quadriceps more than FNB and achieves similar analgesic effects in post-operative pain.

Level of evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedics, Linzi District People’s Hospital of Shandong Province, No. 139 Henggong Road, Linzi District, Zibo, Shandong, China

    Dong Li

  2. Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Guo-guang Ma

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  1. Dong Li
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Correspondence to Guo-guang Ma.

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Li, D., Ma, Gg. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 2614–2619 (2016). https://doi.org/10.1007/s00167-015-3874-3

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  • DOI: https://doi.org/10.1007/s00167-015-3874-3

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