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

Authors：

LI Canfeng ¹ ,  XU Hongwei ² ,  SHEN Bin ¹ , YANG Jing ¹ , ZHOU Zongke ¹ , KANG Pengde ¹ , PEI Fuxing ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Anesthesia, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XU Hongwei, Email: xhwzxyqq@163.com; SHEN Bin, Email: shenbin_1971@163.com

Keywords：

Total knee arthroplasty; nerve block; adductor canal; analgesia; rehabilitation

DOI：

10.7507/1002-1892.201704056

Video：

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Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.

Citation： LI Canfeng, XU Hongwei, SHEN Bin, YANG Jing, ZHOU Zongke, KANG Pengde, PEI Fuxing. 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(9): 1049-1054. doi: 10.7507/1002-1892.201704056 Copy

1.	Singelyn FJ, Deyaert M, Joris D, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg, 1998, 87(1): 88-92.
2.	赵旻暐, 田华, 王宁, 等. 连续收肌管阻滞在全膝关节置换术后镇痛方面的应用. 中国微创外科杂志, 2016, 16(12): 1146-1149.
3.	Webb CA, Mariano ER. Best multimodal analgesic protocol for total knee arthroplasty. Pain Manag, 2015, 5(3): 185-196.
4.	McDonald LT, Corbiere NC, DeLisle JA, et al. Pain Management After Total Joint Arthroplasty. AORN J, 2016, 103(6): 605-616.
5.	Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg, 1998, 87(1): 93-97.
6.	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.
7.	Sakai N, Inoue T, Kunugiza Y, et al. Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2013, 28(5): 807-814.
8.	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(5): 1144-1162.
9.	程晓燕, 王梅玲, 纪凡层, 等. 膝关节置换术后两种股神经阻滞镇痛比较. 中国矫形外科杂志, 2016, 24(21): 1968-1971.
10.	Pelt CE, Anderson AW, Anderson MB, et al. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplasty, 2014, 29(6): 1154-1157.
11.	Sharma S, Iorio R, Specht LM, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 135-140.
12.	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(1): 3-10.
13.	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(3): 357-364.
14.	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(6): 526-532.
15.	赵旻暐, 王宁, 曾琳, 等. 膝关节置换术后连续收肌管阻滞与股神经阻滞的疗效比较. 北京大学学报(医学版), 2017, 49(1): 142-147.
16.	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(6): 720-725.
17.	Murphy GS, Szokol JW, Marymont JH, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg, 2008, 107(1): 130-137.
18.	Burckett-St Laurant D, Peng P, Giron Arango L, et al. The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study. Reg Anesth Pain Med, 2016, 41(3): 321-327.
19.	Bendtsen TF, Moriggl B, Chan V, et al. Defining adductor canal block. Reg Anesth Pain Med, 2014, 39(3): 253-254.
20.	Kapoor R, Adhikary SD, Siefring C, et al. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal: an anatomical study. Acta Anaesthesiol Scand, 2012, 56(3): 365-367.
21.	Lavie LG, Fox MP, Dasa V. Overview of Total Knee Arthroplasty and Modern Pain Control Strategies. Curr Pain Headache Rep, 2016, 20(11): 59.
22.	Gao F, Ma J, Sun W, Guo 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, 2016, 33(4): 356-368.
23.	Ilfeld BM. Single-injection and continuous femoral nerve blocks are associated with different risks of falling. Anesthesiology, 2014, 121(3): 668-669.
24.	Soto Mesa D, Del Valle Ruiz V, Fayad Fayad M, et al. Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block. Rev Esp Anestesiol Reanim, 2012, 59(4): 204-209.
25.	Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg, 2006, 102(4): 1234-1239.
26.	Albrecht E, Morfey D, Chan V, et al. Single-injection or continuous femoral nerve block for total knee arthroplasty? Clin Orthop Relat Res, 2014, 472(5): 1384-1393.
27.	Chan EY, Fransen M, Sathappan S, et al. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty, 2013, 28(4): 608-613.
28.	Chan EY, Blyth FM, Nairn L, et al. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage, 2013, 21(9): 1257-1263.
29.	Lisowska B, Maśliński W, Maldyk P, et al. The role of cytokines in inflammatory response after total knee arthroplasty in patients with rheumatoid arthritis. Rheumatol Int, 2008, 28(7): 667-671.
30.	Shah K, Mohammed A, Patil S, et al. Circulating cytokines after hip and knee arthroplasty: a preliminary study. Clin Orthop Relat Res, 2009, 467(4):946-951.
31.	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(3): 540-550.
32.	Macrinici G, Drescher M, Ascan J, et al. Poster 391 Prospective, Double-blind, Randomized Clinical Trial to Compare Single Shot Adductor Canal Nerve Block Versus Femoral Nerve Block Combined with Local Infiltration Analgesia: Postoperative Functional Outcomes After Total Knee Arthroplasty. PM R, 2016, 8(9S): S288-S289.
33.	Watson MW, Mitra D, McLintock TC, et al. Continuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty. Reg Anesth Pain Med, 2005, 30(6): 541-547.

1. Singelyn FJ, Deyaert M, Joris D, et al. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg, 1998, 87(1): 88-92.
2. 赵旻暐, 田华, 王宁, 等. 连续收肌管阻滞在全膝关节置换术后镇痛方面的应用. 中国微创外科杂志, 2016, 16(12): 1146-1149.
3. Webb CA, Mariano ER. Best multimodal analgesic protocol for total knee arthroplasty. Pain Manag, 2015, 5(3): 185-196.
4. McDonald LT, Corbiere NC, DeLisle JA, et al. Pain Management After Total Joint Arthroplasty. AORN J, 2016, 103(6): 605-616.
5. Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg, 1998, 87(1): 93-97.
6. 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.
7. Sakai N, Inoue T, Kunugiza Y, et al. Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2013, 28(5): 807-814.
8. 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(5): 1144-1162.
9. 程晓燕, 王梅玲, 纪凡层, 等. 膝关节置换术后两种股神经阻滞镇痛比较. 中国矫形外科杂志, 2016, 24(21): 1968-1971.
10. Pelt CE, Anderson AW, Anderson MB, et al. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplasty, 2014, 29(6): 1154-1157.
11. Sharma S, Iorio R, Specht LM, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res, 2010, 468(1): 135-140.
12. 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(1): 3-10.
13. 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(3): 357-364.
14. 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(6): 526-532.
15. 赵旻暐, 王宁, 曾琳, 等. 膝关节置换术后连续收肌管阻滞与股神经阻滞的疗效比较. 北京大学学报(医学版), 2017, 49(1): 142-147.
16. 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(6): 720-725.
17. Murphy GS, Szokol JW, Marymont JH, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg, 2008, 107(1): 130-137.
18. Burckett-St Laurant D, Peng P, Giron Arango L, et al. The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study. Reg Anesth Pain Med, 2016, 41(3): 321-327.
19. Bendtsen TF, Moriggl B, Chan V, et al. Defining adductor canal block. Reg Anesth Pain Med, 2014, 39(3): 253-254.
20. Kapoor R, Adhikary SD, Siefring C, et al. The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal: an anatomical study. Acta Anaesthesiol Scand, 2012, 56(3): 365-367.
21. Lavie LG, Fox MP, Dasa V. Overview of Total Knee Arthroplasty and Modern Pain Control Strategies. Curr Pain Headache Rep, 2016, 20(11): 59.
22. Gao F, Ma J, Sun W, Guo 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, 2016, 33(4): 356-368.
23. Ilfeld BM. Single-injection and continuous femoral nerve blocks are associated with different risks of falling. Anesthesiology, 2014, 121(3): 668-669.
24. Soto Mesa D, Del Valle Ruiz V, Fayad Fayad M, et al. Control of postoperative pain in knee arthroplasty: single dose femoral nerve block versus continuous femoral block. Rev Esp Anestesiol Reanim, 2012, 59(4): 204-209.
25. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg, 2006, 102(4): 1234-1239.
26. Albrecht E, Morfey D, Chan V, et al. Single-injection or continuous femoral nerve block for total knee arthroplasty? Clin Orthop Relat Res, 2014, 472(5): 1384-1393.
27. Chan EY, Fransen M, Sathappan S, et al. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty, 2013, 28(4): 608-613.
28. Chan EY, Blyth FM, Nairn L, et al. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage, 2013, 21(9): 1257-1263.
29. Lisowska B, Maśliński W, Maldyk P, et al. The role of cytokines in inflammatory response after total knee arthroplasty in patients with rheumatoid arthritis. Rheumatol Int, 2008, 28(7): 667-671.
30. Shah K, Mohammed A, Patil S, et al. Circulating cytokines after hip and knee arthroplasty: a preliminary study. Clin Orthop Relat Res, 2009, 467(4):946-951.
31. 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(3): 540-550.
32. Macrinici G, Drescher M, Ascan J, et al. Poster 391 Prospective, Double-blind, Randomized Clinical Trial to Compare Single Shot Adductor Canal Nerve Block Versus Femoral Nerve Block Combined with Local Infiltration Analgesia: Postoperative Functional Outcomes After Total Knee Arthroplasty. PM R, 2016, 8(9S): S288-S289.
33. Watson MW, Mitra D, McLintock TC, et al. Continuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty. Reg Anesth Pain Med, 2005, 30(6): 541-547.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of continuous and single shot adductor canal blocks for postoperative analgesia and early rehabilitation after total knee arthroplasty

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