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The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study.

Publication ,  Journal Article
Gadsden, JC; Sata, S; Bullock, WM; Kumar, AH; Grant, SA; Dooley, JR
Published in: Korean J Anesthesiol
October 2020

BACKGROUND: Multiple comparative studies report that adductor canal blocks provide similar pain relief to femoral nerve blocks following total knee arthroplasty. However, adductor canal blockade fails to anesthetize several important femoral nerve branches that contribute to knee innervation. We sought to clarify this anatomic discrepancy by performing both blocks in sequence, using patients as their own controls. We hypothesized that patients would experience additional pain relief following a superimposed femoral nerve block, demonstrating that these techniques are not equivalent. METHODS: Sixteen patients received continuous adductor canal block before undergoing knee arthroplasty under general anesthesia. In the recovery room, patients reported their pain score on a numeric scale of 0-10. Once a patient reached a score of five or greater, he/she was randomized to receive an additional femoral nerve block using 2% chloroprocaine or saline sham, and pain scores recorded every 5 min for 30 min. Patients received opioid rescue as needed. Anesthesiologists performing and assessing block efficacy were blinded to group allocation. RESULTS: Patients randomized to chloroprocaine versus saline reported significantly improved median pain scores 30 min after the femoral block (2.0 vs. 5.5, P = 0.0001). Patients receiving chloroprocaine also required significantly fewer morphine equivalents during the 30 min post-femoral block (1.0 vs. 4.5 mg, P = 0.03). CONCLUSIONS: Adductor canal block is a useful technique for postoperative pain following total knee arthroplasty, but it does not provide equivalent analgesic efficacy to femoral nerve block. Future studies comparing efficacy between various block sites along the thigh are warranted.

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Published In

Korean J Anesthesiol

DOI

EISSN

2005-7563

Publication Date

October 2020

Volume

73

Issue

5

Start / End Page

417 / 424

Location

Korea (South)

Related Subject Headings

  • Thigh
  • Prospective Studies
  • Procaine
  • Pain, Postoperative
  • Pain Measurement
  • Middle Aged
  • Male
  • Humans
  • Femoral Nerve
  • Female
 

Citation

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Gadsden, J. C., Sata, S., Bullock, W. M., Kumar, A. H., Grant, S. A., & Dooley, J. R. (2020). The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study. Korean J Anesthesiol, 73(5), 417–424. https://doi.org/10.4097/kja.20269
Gadsden, Jeff C., Siddharth Sata, W Michael Bullock, Amanda H. Kumar, Stuart A. Grant, and Joshua R. Dooley. “The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study.Korean J Anesthesiol 73, no. 5 (October 2020): 417–24. https://doi.org/10.4097/kja.20269.
Gadsden JC, Sata S, Bullock WM, Kumar AH, Grant SA, Dooley JR. The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study. Korean J Anesthesiol. 2020 Oct;73(5):417–24.
Gadsden, Jeff C., et al. “The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study.Korean J Anesthesiol, vol. 73, no. 5, Oct. 2020, pp. 417–24. Pubmed, doi:10.4097/kja.20269.
Gadsden JC, Sata S, Bullock WM, Kumar AH, Grant SA, Dooley JR. The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study. Korean J Anesthesiol. 2020 Oct;73(5):417–424.

Published In

Korean J Anesthesiol

DOI

EISSN

2005-7563

Publication Date

October 2020

Volume

73

Issue

5

Start / End Page

417 / 424

Location

Korea (South)

Related Subject Headings

  • Thigh
  • Prospective Studies
  • Procaine
  • Pain, Postoperative
  • Pain Measurement
  • Middle Aged
  • Male
  • Humans
  • Femoral Nerve
  • Female