Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Cui-Cui Dong, Shu-Ling Dong, Fu-Cheng He, Cui-Cui Dong, Shu-Ling Dong, Fu-Cheng He

Abstract

A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA.Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis.Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea.Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
The risk of bias graph.
FIGURE 2
FIGURE 2
The result of the risk of bias summary.
FIGURE 3
FIGURE 3
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of visual analogue scale score with rest at 4 h after total knee arthroplasty.
FIGURE 4
FIGURE 4
The meta-analysis of 4 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of visual analogue scale score with rest at 24 h after total knee arthroplasty.
FIGURE 5
FIGURE 5
Funnel plot of studies analysing the effect of visual analogue scale score on the final results.
FIGURE 6
FIGURE 6
The sensitivity analysis of the visual analogue scale score at 24 h with rest.
FIGURE 7
FIGURE 7
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of VAS score with rest at 48 h after total knee arthroplasty.
FIGURE 8
FIGURE 8
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of visual analogue scale score with mobilization at 4 h after total knee arthroplasty.
FIGURE 9
FIGURE 9
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of visual analogue scale score with mobilization at 24 h after total knee arthroplasty.
FIGURE 10
FIGURE 10
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of visual analogue scale score with mobilization at 48 h after total knee arthroplasty.
FIGURE 11
FIGURE 11
The meta-analysis of 3 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of opioid rescue.
FIGURE 12
FIGURE 12
The meta-analysis of 2 trials included showed that there was no statistical significance between adductor canal block (ACB) and femoral nerve block (FNB) in terms of length of hospital stay.
FIGURE 13
FIGURE 13
Forest plot diagram showing maximum voluntary isometric contraction of quadriceps of adductor canal block (ACB) and femoral nerve block (FNB) groups.
FIGURE 14
FIGURE 14
Forest plot diagram showing maximum voluntary isometric contraction of adductor of adductor canal block (ACB) and femoral nerve block (FNB) groups.
FIGURE 15
FIGURE 15
Forest plot diagram showing complication of adductor canal block (ACB) and femoral nerve block (FNB) on transfusion vomiting and nausea.

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