Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?: An updated meta-analysis of randomized controlled trials

Rongguo Yu, Haiyang Wang, Youguang Zhuo, Dongxin Liu, Chunling Wu, Yiyuan Zhang, Rongguo Yu, Haiyang Wang, Youguang Zhuo, Dongxin Liu, Chunling Wu, Yiyuan Zhang

Abstract

Background: Adductor canal block (ACB) has emerged as an attractive alternative for femoral nerve blocks (FNB) as the peripheral nerve block of choice for total knee arthroplasty (TKA), preserving quadriceps motor function while providing analgesia comparable to FNB. However, its optimal application for TKA remains controversial. The objective of this meta-analysis was to compare continuous-injection ACB (CACB) vs single-injection ACB (SACB) for postoperative pain control in patients undergoing TKA.

Methods: This study attempts to identify the available and relevant randomized controlled trials (RCTs) regarding the analgesic effects of CACB compared to SACB in patients undergoing TKA according to electronic databases, including PubMed, Medline, Web of Science, EMbase, and the Cochrane Library, up to September 2019. Primary outcomes in this regard included the use of a visual analogue scale (VAS) pain score with rest or activity, while secondary outcomes were cumulative opioid consumption, length of hospital stay (LOS), complications of vomiting and nausea, and rescue analgesia. The corresponding data were analyzed using RevMan v5.3.

Ethical review: Because all of the data used in this systematic review and meta-analysis has been published, the ethical approval was not necessary RESULTS:: This research included 9 studies comprised of 739 patients. The analyzed outcomes demonstrated that patients who received CACB had a better at rest-VAS scores at 4 hours (P = .007), 8 hors (P < .0001), 12 hours (P < .0001), 24 hours (P = .02), mobilization-VAS score at 48 hours (P < .0001), and rescue analgesia (P = .03) than those who underwent SACB. Nevertheless, no significant differences were present between the 2 strategies in terms of pain VAS scores 48 hours at rest (P = .23) and 24 hours at mobilization (P = .10), complications of vomiting and nausea (P = .42), and length of hospital stay (P = .09).

Conclusion: This meta-analysis indicated that CACB is superior to SACB in regard to analgesic effect following TKA. However, due to the variation of the included studies, no firm conclusions can be drawn. Further investigations into RCT are required for verification.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The PRISMA flow diagram detailing our literature search.
Figure 2
Figure 2
The risk of bias summary of the included studies. (+ represents yes; – represents no?; represents not clear).
Figure 3
Figure 3
The risk of bias graph of the included studies.
Figure 4
Figure 4
Forest plots of the pain VAS score with rest between CACB group and SACB group after TKA.
Figure 5
Figure 5
Forest plots of the pain VAS score with movement between the CACB group and SACB group after TKA.
Figure 6
Figure 6
Forest plots of the complications of vomiting and nausea between CACB group and SACB group after TKA.
Figure 7
Figure 7
Forest plots of the cumulative opioid consumption within 48 hours between CACB group and SACB group after TKA.
Figure 8
Figure 8
Forest plots of the length of hospital stay between the CACB group and SACB group after TKA.
Figure 9
Figure 9
Forest plots of the rescue analgesia between the CACB group and SACB group after TKA.
Figure 10
Figure 10
A. Funnel plot of publication bias for the pain score with rest between CACB group and SACB group after TKA. There was symmetry, suggesting that there was not a significant publication bias. B. Funnel plot of publication bias for the pain score with movement between the CACB group and SACB group after TKA. There was symmetry, suggesting that there was not a significant publication bias. C. Funnel plot of publication bias for the cumulative opioid consumption within 48 hours between CACB group and SACB group after TKA. There was symmetry, suggesting that there was not a significant publication bias. D. Funnel plot of publication bias for the length of hospital stay between CACB group and SACB group after TKA. There was symmetry, suggesting that there was not a significant publication bias. E. Funnel plot of publication bias for nausea or vomiting between the CACB group and the SACB group after TKA. There was symmetry, suggesting that there was not a significant publication bias.

References

    1. Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet (London, England) 2018;392:1672–82.
    1. Popescu R, Haritinian EG, Cristea S. Relevance of finite element in total knee arthroplasty - literature review. Chirurgia (Bucharest, Romania: 1990) 2019;114:437–42.
    1. Inacio MCS, Paxton EW, Graves SE, et al. Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthritis and cartilage 2017;25:1797–803.
    1. Culliford D, Maskell J, Judge A, et al. Future projections of total hip and knee arthroplasty in the UK. Results from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage 2015;23:594–600.
    1. Shafaghi R, Rodriguez O, Schemitsch EH, et al. A review of materials for managing bone loss in revision total knee arthroplasty. Mater Sci Eng C Mater Biol Appl 2019;104:109941.
    1. Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg 2019;11:755–61.
    1. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011;93:1075–84.
    1. Husted H, Lunn TH, Troelsen A, et al. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 2011;82:679–84.
    1. Sardana V, Burzynski JM, Scuderi GR. Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2019;34:183–9.
    1. Wu CL, Richman JM. Postoperative pain and quality of recovery. Curr Opin Anaesthesiol 2004;17:455–60.
    1. Cyriac J, Garson L, Schwarzkopf R, et al. Total joint replacement perioperative surgical home program: 2-year follow-up. Anesth Analg 2016;123:51–62.
    1. Singh PM, Borle A, Trikha A, et al. Role of Periarticular Liposomal Bupivacaine Infiltration in Patients Undergoing Total Knee Arthroplasty-A Meta-analysis of Comparative Trials. J Arthroplasty 2017;32:675–88. e671.
    1. Gwam CU, Mistry JB, Jha P, et al. Efficacy of Adductor Canal Blockade Compared to Multimodal Peri-Articular Analgesia Following Total Knee Arthroplasty. Surg Technol Int 2017;30:300–5.
    1. Essving P, Axelsson K, Aberg E, et al. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 2011;113:926–33.
    1. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 2010;113:1144–62.
    1. Sato K, Adachi T, Shirai N, et al. Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty: a prospective, randomized, double-blind study. Reg Anesth Pain Med 2014;39:225–9.
    1. Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 2008;100:154–64.
    1. Chan MH, Chen WH, Tung YW, et al. Single-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol Taiwan 2012;50:54–8.
    1. Atkinson HD, Hamid I, Gupte CM, et al. Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery: a report of 4 cases. J Orthop Surg (Hong Kong) 2008;16:381–4.
    1. Hebl JR, Kopp SL, Ali MH, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 2005;87: Suppl 2: 63–70.
    1. Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998;87:93–7.
    1. Thacher RR, Hickernell TR, Grosso MJ, et al. Decreased risk of knee buckling with adductor canal block versus femoral nerve block in total knee arthroplasty: a retrospective cohort study. Arthroplast Today 2017;3:281–5.
    1. Charous MT, Madison SJ, Suresh PJ, et al. Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block. Anesthesiology 2011;115:774–81.
    1. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 2010;111:1552–4.
    1. Andersen HL, Zaric D. Adductor canal block or midthigh saphenous nerve block: same same but different name!. Reg Anesth Pain Med 2014;39:256–7.
    1. Jin SQ, Ding XB, Tong Y, et al. Effect of saphenous nerve block for postoperative pain on knee surgery: a meta-analysis. Int J Clin Exp Med 2015;8:368–76.
    1. Hanson NA, Allen CJ, Hostetter LS, et al. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg 2014;118:1370–7.
    1. Gao F, Ma J, Sun W, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a systematic review and meta-analysis. Clin J Pain 2017;33:356–68.
    1. Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 2013;38:526–32.
    1. Grevstad U, Mathiesen O, Valentiner LS, et al. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med 2015;40:3–10.
    1. Elkassabany NM, Antosh S, Ahmed M, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg 2016;122:1696–703.
    1. Zhao XQ, Jiang N, Yuan FF, et al. The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis. J Anesth 2016;30:745–54.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed) 2009;339:b2535.
    1. Wang D, Xie T, Xu J, et al. Genetic association between NFKB1-94 ins/del ATTG Promoter Polymorphism and cancer risk: a meta-analysis of 42 case-control studies. Scientific Rep 2016;6:30220.
    1. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    1. Zhang Y, Yang J, Wang X, et al. Long-term analgesic efficacy of an ultrasound guided single-shot adductor canal block in patients undergoing total knee arthroplasty. Anesthesia Analgesia 2016;123:656.
    1. Boublik J, Dorman S, Van Bergen Granelli A, et al. Comparison of single-injection and continuous infusion adductor canal block initial ambulation times and distance after total knee arthroplasty (TKA). Regional Anesthesia Pain Med 2014;39:e151–2.
    1. Lyngeraa TS, Jaeger P, Gottschau B, et al. Comparison of the analgesic effect of an adductor canal block using a new suture-method catheter vs. standard perineural catheter vs. single-injection: a randomised, blinded, controlled study. Anaesthesia 2019;74:1397–405.
    1. Elkassabany NM, Cai LF, Badiola I, et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J 2019;101-b:340–7.
    1. Canbek U, Akgun U, Aydogan NH, et al. Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: A prospective randomized controlled trial. Acta Orthop Traumatol Turc 2019;53:334–9.
    1. Zhang Y, Tan Z, Liao R, et al. The prolonged analgesic efficacy of an ultrasound-guided single-shot adductor canal block in patients undergoing total knee arthroplasty. Orthopedics 2018;41:e607–14.
    1. Turner JD, Dobson SW, Henshaw DS, et al. Single-Injection Adductor Canal Block With Multiple Adjuvants Provides Equivalent Analgesia When Compared With Continuous Adductor Canal Blockade for Primary Total Knee Arthroplasty: A Double-Blinded, Randomized, Controlled, Equivalency Trial. J Arthroplasty 2018;33:3160–6. e3161.
    1. Lee S, Rooban N, Vaghadia H, et al. A Randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. J Arthroplasty 2018;33:1045–51.
    1. Li C, Xu H, Shen B, et al. Effect of continuous and single shot adductor canal blocks for postoperative analgesia and early rehabilitation after total knee arthroplasty. Chinese journal of reparative and reconstructive surgery 2017;31:1049–54.
    1. Shah NA, Jain NP, Panchal KA. Adductor canal blockade following total knee arthroplasty-continuous or single shot technique? Role in postoperative analgesia, ambulation ability and early functional recovery: a randomized controlled trial. J Arthroplasty 2015;30:1476–81.
    1. Kyoung KM, Yong MH, Gun RC, et al. The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial. Korean J Pain 2019;32:30–8.
    1. Kwofie MK, Shastri UD, Gadsden JC, et al. 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 2013;38:321–5.
    1. Koh IJ, Choi YJ, Kim MS, et al. Femoral nerve block versus adductor canal block for analgesia after total knee arthroplasty. Knee Surg Relat Res 2017;29:87–95.
    1. Vora MU, Nicholas TA, Kassel CA. Grant SA: Adductor canal block for knee surgical procedures: review article. J Clin Anesth 2016;35:295–303.
    1. Jaeger P, Nielsen ZJ, Henningsen MH, et al. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology 2013;118:409–15.
    1. Zhang LK, Zhang BY, Quan RF, et al. Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty: a PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019;98:e15539.
    1. Mudumbai SC, Kim TE, Howard SK, et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res 2014;472:1377–83.
    1. Grevstad U, Mathiesen O, Lind T, et al. 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 2014;112:912–9.
    1. Jenstrup MT, Jaeger P, Lund J, et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 2012;56:357–64.
    1. Jaeger P, Grevstad U, Henningsen MH, et al. Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 2012;56:1013–9.
    1. Lund J, Jenstrup MT, Jaeger P, et al. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 2011;55:14–9.
    1. Hanson NA, Derby RE, Auyong DB, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial. Can J Anaesth 2013;60:874–80.
    1. Strassels SA, Chen C, Carr DB. Postoperative analgesia: economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg 2002;94:130–7.
    1. Ng HP, Cheong KF, Lim A, et al. Intraoperative single-shot “3-in-1” femoral nerve block with ropivacaine 0.25%, ropivacaine 0.5% or bupivacaine 0. 25% provides comparable 48-hr analgesia after unilateral total knee replacement. Can J Anaesth 2001;48:1102–8.
    1. Szczukowski MJ, Jr, Hines JA, Snell JA, et al. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplasty 2004;19:720–5.
    1. Ares WJ, Jankowitz BT, Tonetti DA, et al. A comparison of digital subtraction angiography and computed tomography angiography for the diagnosis of penetrating cerebrovascular injury. Neurosurg Focus 2019;47:E16.
    1. Memtsoudis SG, Yoo D, Stundner O, et al. Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop 2015;39:673–80.
    1. Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology 2014;120:540–50.
    1. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty 2014;29:2224–9.
    1. Zhang W, Hu Y, Tao Y, et al. Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement. Chin Med J (Engl) 2014;127:4077–81.
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
    1. Dillon JP, Brennan L, Mitchell D. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta orthopaedica Belgica 2012;78:158–63.
    1. Edwards JL, Pandit H, Popat MT. Perioperative analgesia: a factor in the development of heel pressure ulcers? Br J Nurs 2006;15:S20–25.
    1. Wang D, Yang Y, Li Q, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Sci Rep 2017;7:40721.
    1. Wang C, Chen Z, Ma X. Continuous adductor canal block is a better choice compared to single shot after primary total knee arthroplasty. A meta-analysis of randomized controlled trials. Int J Surg 2019;72:16–24.

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