Research progress on analgesic effect of adductor canal block after knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Dianqi ¹ , WEN Xiaohui ² ,  LU Weijie ¹

1. Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China;
2. Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

LU Weijie, Email: 13902280296@139.com

Keywords：

Knee arthroplasty; adductor canal block; analgesia; quadriceps muscle

DOI：

10.7507/1002-1892.202210066

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. Methods The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. Results In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once “gold standard” femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. Conclusion ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.

Citation： LIU Dianqi, WEN Xiaohui, LU Weijie. Research progress on analgesic effect of adductor canal block after knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 106-114. doi: 10.7507/1002-1892.202210066 Copy

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1. Lakra A, Murtaugh T, Shah RP, et al. Early postoperative pain predicts 2-year functional outcomes following knee arthroplasty. J Knee Surg, 2020, 33(11): 1132-1139.
2. 郑晓静, 疏树华. 多模式镇痛在术后快速康复中的临床研究进展. 医学综述, 2019, 25(4): 800-804.
3. Choy WS, Lee SK, Kim KJ, et al. Two continuous femoral nerve block strategies after TKA. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1901-1908.
4. 牟童, 刘丹彦. 收肌管阻滞在全膝关节置换术术后镇痛中的应用研究进展. 山东医药, 2021, 61(21): 91-95.
5. 王波, 董补怀. 全膝关节置换术后镇痛应用外周神经阻滞的进展. 中华关节外科杂志 (电子版), 2020, 14(4): 486-490.
6. Vora MU, Nicholas TA, Kassel CA, et al. Adductor canal block for knee surgical procedures: review article. J Clin Anesth, 2016, 35: 295-303.
7. Ilfeld BM. Continuous peripheral nerve blocks: An update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg, 2017, 124(1): 308-335.
8. 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(6): 1370-1377.
9. Jæger P, Koscielniak-Nielsen ZJ, Schrøder HM, et al. Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One, 2014, 9(11): e111951. doi: 10.1371/journal.pone.0111951.
10. 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(2): 409-415.
11. Thiayagarajan MK, Kumar SV, Venkatesh S. An exact localization of adductor canal and its clinical significance: A cadaveric study. Anesth Essays Res, 2019, 13(2): 284-286.
12. Burckett-St Laurant D, Peng P, Girón 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.
13. Kerver AL, Leliveld MS, den Hartog D, et al. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery. J Bone Joint Surg (Am), 2013, 95(23): 2119-2125.
14. Tran J, Chan VWS, Peng PWH, et al. Evaluation of the proximal adductor canal block injectate spread: a cadaveric study. Reg Anesth Pain Med, 2019. doi: 10.1136/rapm-2019-101091.
15. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med, 1982, 10(6): 329-335.
16. Bendtsen TF, Moriggl B, Chan V, et al. Defining adductor canal block. Reg Anesth Pain Med, 2014, 39(3): 253-254.
17. Kendir S, Torun Bİ, Akkaya T, et al. Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study. Surg Radiol Anat, 2018, 40(11): 1267-1274.
18. Wong WY, Bjørn S, Strid JM, et al. Defining the location of the adductor canal using ultrasound. Reg Anesth Pain Med, 2017, 42(2): 241-245.
19. 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.
20. Chen J, Lesser JB, Hadzic A, et al. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med, 2014, 39(2): 170-171.
21. Veal C, Auyong DB, Hanson NA, et al. Delayed quadriceps weakness after continuous adductor canal block for total knee arthroplasty: a case report. Acta Anaesthesiol Scand, 2014, 58(3): 362-364.
22. Gautier PE, Lecoq JP, Vandepitte C, et al. Impairment of sciatic nerve function during adductor canal block. Reg Anesth Pain Med, 2015, 40(1): 85-89.
23. Goffin P, Lecoq JP, Ninane V, et al. Interfascial spread of injectate after adductor canal injection in fresh human cadavers. Anesth Analg, 2016, 123(2): 501-503.
24. Nair A, Dolan J, Tanner KE, et al. Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet. Br J Anaesth, 2018, 121(4): 890-898.
25. Raddaoui K, Radhouani M, Bargaoui A, et al. Adductor canal block: Effect of volume of injectate on sciatic extension. Saudi J Anaesth, 2020, 14(1): 33-37.
26. Johnston DF, Sondekoppam RV, Giffin R, et al. Determination of ED50 and ED95 of 0.5% ropivacaine in adductor canal block to produce quadriceps weakness: A dose-finding study. Reg Anesth Pain Med, 2017, 42(6): 731-736.
27. Yee EJ, Gapinski ZA, Ziemba-Davis M, et al. Quadriceps weakness after single-shot adductor canal block: A multivariate analysis of 1, 083 primary total knee arthroplasties. J Bone Joint Surg (Am), 2021, 103(1): 30-36.
28. Jaeger P, Jenstrup MT, Lund J, et al. Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95. Br J Anaesth, 2015, 115(6): 920-926.
29. Grevstad U, Jæger P, Sørensen JK, et al. The effect of local anesthetic volume within the adductor canal on quadriceps femoris function evaluated by electromyography: A randomized, observer- and subject-blinded, placebo-controlled study in volunteers. Anesth Analg, 2016, 123(2): 493-500.
30. 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(4): 321-325.
31. Taboada Muñiz M, Rodríguez J, Bermúdez M, et al. Low volume and high concentration of local anesthetic is more efficacious than high volume and low concentration in Labat’s sciatic nerve block: a prospective, randomized comparison. Anesth Analg, 2008, 107(6): 2085-2088.
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