Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-10-09

AUTHORS

Stavros G. Memtsoudis, Daniel Yoo, Ottokar Stundner, Thomas Danninger, Yan Ma, Lazaros Poultsides, David Kim, Mary Chisholm, Kethy Jules-Elysee, Alejandro Gonzalez Della Valle, Thomas P. Sculco

ABSTRACT

PurposeProviding effective analgesia for total knee arthroplasty (TKA) patients remains challenging. Femoral nerve block (FNB) offers targeted pain control; however, its effect on motor function, related fall risk and impact on rehabilitation has been the source of controversy. Adductor canal block (ACB) potentially spares motor fibres of the femoral nerve, but the comparative effect of the two approaches has not yet been well defined due to considerable variability in pain perception. Our study compares both single-shot FNB and ACB, side to side, in the same patients undergoing bilateral TKA.MethodsSixty patients scheduled for bilateral TKA were randomised to receive ultrasound-guided FNB on one leg and ACB on the other, in addition to combined spinal epidural anaesthesia. The primary outcome was comparative postoperative pain in either extremity at six to eight, 24 and 48 hours postoperatively. Secondary comparative outcomes included motor strength (manually and via dynamometer), physical therapy milestones and patient satisfaction.ResultsWhile pain levels were lowest at six to eight hours postoperatively and increased thereafter (P < 0.001), no significant differences were seen between extremities at any time point with regard to pain in the quantitative comparison using visual analogue scale (VAS) scores (P = 0.4154), motor strength (P = 0.7548), physical therapy milestones or patient satisfaction. However, in the qualitative comparison, a significant proportion of patients reported the leg receiving ACB to be more painful than that receiving FNB at 24 h [50.9 % (n = 30) vs 25.42 % (n = 15), P = 0.0168)].ConclusionsAlthough we could not confirm a benefit in motor function between ACB and FNB, given the equivalent analgesic potency combined with its potentially lower overall impact if neuropraxia should occur, ACB may represent an attractive alternative to FNB. More... »

PAGES

673-680

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00264-014-2527-3

DOI

http://dx.doi.org/10.1007/s00264-014-2527-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1046948810

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25297681


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30 schema:description PurposeProviding effective analgesia for total knee arthroplasty (TKA) patients remains challenging. Femoral nerve block (FNB) offers targeted pain control; however, its effect on motor function, related fall risk and impact on rehabilitation has been the source of controversy. Adductor canal block (ACB) potentially spares motor fibres of the femoral nerve, but the comparative effect of the two approaches has not yet been well defined due to considerable variability in pain perception. Our study compares both single-shot FNB and ACB, side to side, in the same patients undergoing bilateral TKA.MethodsSixty patients scheduled for bilateral TKA were randomised to receive ultrasound-guided FNB on one leg and ACB on the other, in addition to combined spinal epidural anaesthesia. The primary outcome was comparative postoperative pain in either extremity at six to eight, 24 and 48 hours postoperatively. Secondary comparative outcomes included motor strength (manually and via dynamometer), physical therapy milestones and patient satisfaction.ResultsWhile pain levels were lowest at six to eight hours postoperatively and increased thereafter (P < 0.001), no significant differences were seen between extremities at any time point with regard to pain in the quantitative comparison using visual analogue scale (VAS) scores (P = 0.4154), motor strength (P = 0.7548), physical therapy milestones or patient satisfaction. However, in the qualitative comparison, a significant proportion of patients reported the leg receiving ACB to be more painful than that receiving FNB at 24 h [50.9 % (n = 30) vs 25.42 % (n = 15), P = 0.0168)].ConclusionsAlthough we could not confirm a benefit in motor function between ACB and FNB, given the equivalent analgesic potency combined with its potentially lower overall impact if neuropraxia should occur, ACB may represent an attractive alternative to FNB.
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37 schema:keywords Comparative effects
38 ConclusionsAlthough
39 MethodsSixty patients
40 ResultsWhile pain levels
41 Scale score
42 Secondary comparative outcomes
43 Subsartorial adductor canal
44 TKA
45 addition
46 adductor canal
47 adductor canal block
48 alternative
49 analgesia
50 analgesic potency
51 analog scale score
52 anesthesia
53 approach
54 arthroplasty patients
55 attractive alternative
56 benefits
57 bilateral TKA
58 block
59 canal
60 canal block
61 comparative outcomes
62 comparative postoperative pain
63 comparison
64 considerable variability
65 control
66 controversy
67 differences
68 effect
69 effective analgesia
70 epidural anesthesia
71 equivalent analgesic potency
72 extremities
73 fall risk
74 femoral nerve
75 femoral nerve block
76 fibers
77 function
78 hours
79 impact
80 knee arthroplasty patients
81 knee replacement
82 leg
83 levels
84 lower overall impact
85 milestones
86 motor fibers
87 motor function
88 motor strength
89 nerve
90 nerve block
91 neuropraxia
92 outcomes
93 overall impact
94 pain
95 pain control
96 pain levels
97 pain perception
98 patient satisfaction
99 patients
100 perception
101 physical therapy milestones
102 point
103 postoperative pain
104 potency
105 primary outcome
106 proportion
107 qualitative comparison
108 quantitative comparison
109 regard
110 rehabilitation
111 replacement
112 risk
113 same patient
114 satisfaction
115 scores
116 side
117 significant differences
118 significant proportion
119 single shot femoral nerve block
120 source
121 source of controversy
122 spinal-epidural anesthesia
123 strength
124 study
125 therapy milestones
126 time points
127 total knee arthroplasty patients
128 total knee replacement
129 ultrasound-guided femoral nerve block
130 variability
131 visual analog scale score
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