The Analgesic Effect of Continuous Adductor Canal Block Combined with Popliteal Plexus Block for Total Knee Arthroplasty: a Randomized Controlled Trial

Overview

Journal Sci Rep

Specialty Science

Date 2024 Nov 12

PMID 39533094

Authors

Bo-Wei Jiang

Ying Guo

Ming-Yu Yang

Qian Zhang

Jin-Ning Liu

Mei-Na Gao

Hao-Jun Zhang

Xu-Wei Wang

Fang-Yu Ren

Chun-Guang Wang

Affiliations

Soon will be listed here.

Abstract

This study aimed to confirm the hypothesis that continuous ACB (CACB) combined with a popliteal plexus block (PPB) can improve posterior knee pain, reduce nalbuphine consumption, and shorten the length of hospital stay. Patients who underwent TKA were allocated to the CACB + sham block (SHAM) or CACB + PPB groups. The primary outcome was the maximum pain score originating from the posterior knee within 4 h after TKA. Secondary outcomes included the maximum pain score originating from the posterior and anterior knees within 72 h after TKA, range of motion on postoperative day (POD) 1-3, postoperative nalbuphine consumption within 72 h of surgery, length of hospital stay, and complications. The maximum pain score of the posterior knee was lower in the CACB + PPB group than in the CACB + SHAM group within 0-12 h after surgery. Nalbuphine consumption within 24 h after surgery was lower in the CACB + PPB group than in the CACB + SHAM group. The range of motion was better in the CACB + PPB group than in the CACB + SHAM group on POD1 and 2. The length of hospital stay was shorter in the CACB + PPB group than in the CACB + SHAM group. The incidence of clinical significant nausea and vomiting was lower in the CACB + PPB group than in the CACB + SHAM group. This study found that PPB combined with CACB could relieve pain in the posterior knee within at least 12 h after TKA, reduce nalbuphine consumption within 24 h after TKA, improve the range of motion on POD1 and 2, and shorten the length of hospital stay for patients who underwent TKA.

References

Goffin P, Lecoq J, Ninane V, Brichant J, Sala-Blanch X, Gautier P . Interfascial Spread of Injectate After Adductor Canal Injection in Fresh Human Cadavers. Anesth Analg. 2016; 123(2):501-3. DOI: 10.1213/ANE.0000000000001441. View

Grevstad U, Mathiesen O, Valentiner L, Jaeger P, Hilsted K, Dahl J . 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. 2014; 40(1):3-10. DOI: 10.1097/AAP.0000000000000169. View

Cappelleri G, Ambrosoli A, Gemma M, Cedrati V, Bizzarri F, Danelli G . Intraneural Ultrasound-guided Sciatic Nerve Block: Minimum Effective Volume and Electrophysiologic Effects. Anesthesiology. 2018; 129(2):241-248. DOI: 10.1097/ALN.0000000000002254. View

Zhao X, Jiang N, Yuan F, Wang L, Yu B . The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis. J Anesth. 2016; 30(5):745-54. DOI: 10.1007/s00540-016-2194-1. View

Gardner E . The innervation of the knee joint. Anat Rec. 1948; 101(1):109-30. DOI: 10.1002/ar.1091010111. View

ONeill A, Lirk P . Multimodal Analgesia. Anesthesiol Clin. 2022; 40(3):455-468. DOI: 10.1016/j.anclin.2022.04.002. View

Kennedy J, Alexander I, Hayes K . Nerve supply of the human knee and its functional importance. Am J Sports Med. 1982; 10(6):329-35. DOI: 10.1177/036354658201000601. View

Ochroch J, Qi V, Badiola I, Grosh T, Cai L, Graff V . Analgesic efficacy of adding the IPACK block to a multimodal analgesia protocol for primary total knee arthroplasty. Reg Anesth Pain Med. 2020; 45(10):799-804. DOI: 10.1136/rapm-2020-101558. View

Jaeger P, Jenstrup M, Lund J, Siersma V, Brondum V, Hilsted K . Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95. Br J Anaesth. 2015; 115(6):920-6. DOI: 10.1093/bja/aev362. View

10.

Mou P, Wang D, Tang X, Zeng W, Zeng Y, Yang J . Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. J Arthroplasty. 2021; 37(2):259-266. DOI: 10.1016/j.arth.2021.10.004. View

11.

Yee E, Gapinski Z, Ziemba-Davis M, Nielson M, Meneghini R . Quadriceps Weakness After Single-Shot Adductor Canal Block: A Multivariate Analysis of 1,083 Primary Total Knee Arthroplasties. J Bone Joint Surg Am. 2020; 103(1):30-36. DOI: 10.2106/JBJS.19.01425. View

12.

Sinha S, Abrams J, Arumugam S, DAlessio J, Freitas D, Barnett J . Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg. 2012; 115(1):202-6. DOI: 10.1213/ANE.0b013e3182536193. View

13.

Kandarian B, Elkassabany N, Tamboli M, Mariano E . Updates on multimodal analgesia and regional anesthesia for total knee arthroplasty patients. Best Pract Res Clin Anaesthesiol. 2019; 33(1):111-123. DOI: 10.1016/j.bpa.2019.02.004. View

14.

Myles P, Wengritzky R . Simplified postoperative nausea and vomiting impact scale for audit and post-discharge review. Br J Anaesth. 2012; 108(3):423-9. DOI: 10.1093/bja/aer505. View

15.

Ardon A, Clendenen S, Porter S, Robards C, Greengrass R . Opioid consumption in total knee arthroplasty patients: a retrospective comparison of adductor canal and femoral nerve continuous infusions in the presence of a sciatic nerve catheter. J Clin Anesth. 2016; 31:19-26. DOI: 10.1016/j.jclinane.2015.12.014. View

16.

Abdullah M, Abu Elyazed M, Mostafa S . The Interspace Between Popliteal Artery and Posterior Capsule of the Knee (IPACK) Block in Knee Arthroplasty: A Prospective Randomized Trial. Pain Physician. 2022; 25(3):E427-E433. View

17.

Weinstein A, Rome B, Reichmann W, Collins J, Burbine S, Thornhill T . Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am. 2013; 95(5):385-92. PMC: 3748969. DOI: 10.2106/JBJS.L.00206. View

18.

Sorensen J, Grevstad U, Jaeger P, Nikolajsen L, Runge C . Effects of popliteal plexus block after total knee arthroplasty: a randomized clinical trial. Reg Anesth Pain Med. 2024; . DOI: 10.1136/rapm-2024-105747. View

19.

Abdallah F, Chan V, Gandhi R, Koshkin A, Abbas S, Brull R . The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology. 2014; 121(6):1302-10. DOI: 10.1097/ALN.0000000000000406. View

20.

Bendtsen T, Moriggl B, Chan V, Borglum J . The Optimal Analgesic Block for Total Knee Arthroplasty. Reg Anesth Pain Med. 2016; 41(6):711-719. DOI: 10.1097/AAP.0000000000000485. View