Efficacy of Adductor Canal Blocks in Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m² and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS (p < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; p < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.

Keywords

arthroplasty - adductor canal block - regional anesthesia - hunters canal - total knee replacement

Publikationsverlauf

Eingereicht: 18. Juni 2020

Angenommen: 12. Februar 2021

Artikel online veröffentlicht:
14. April 2021

• References

• 1 Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66 (04) 433-439
• 2 Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med 2015; 49 (24) 1554-1557
• 3 Wall C, Johnson T, de Steiger R. Symptom management for patients awaiting joint replacement surgery. Aust J Gen Pract 2020; 49 (07) 444-446
• 4 Skou ST, Roos EM, Laursen MB. et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis Cartilage 2018; 26 (09) 1170-1180
• 5 Daigle ME, Weinstein AM, Katz JN, Losina E. The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract Res Clin Rheumatol 2012; 26 (05) 649-658
• 6 Wu CL, Richman JM. Postoperative pain and quality of recovery. Curr Opin Anaesthesiol 2004; 17 (05) 455-460
• 7 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2019 Annual Report. Accessed March 1, 2021 at: https://aoanjrr.sahmri.com/documents/10180/668596/Lay+Summary+of+Hip+and+Knee+Replacement/9a0ce4fc-c157-0c7f-8850-a43027d2e044
• 8 Ackerman IN, Bohensky MA, Zomer E. et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 2019; 20 (01) 90
• 9 Leyland KM, Judge A, Javaid MK. et al. Obesity and the relative risk of knee replacement surgery in patients with knee osteoarthritis: a prospective cohort study. Arthritis Rheumatol 2016; 68 (04) 817-825
• 10 Australian Bureau of Statistics. National health survey: first results, 2017–18. Accessed April 18, 2020 at: https://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/4364.0.55.001?OpenDocument
• 11 Jenstrup MT, Jæger 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 (03) 357-364
• 12 Faculty of Pain Medicine Australian and New Zealand College of Anaesthetists. Opioid dose equivalence. Accessed March 1, 2021 at: https://www.anzca.edu.au/resources/professional-documents/standards-(1)/pm01-appendix-2-opioid-dose-equivalence
• 13 Cohen J. Statistical power analysis. Curr Dir Psychol Sci 1992; 1 (03) 98-101
• 14 Wang Y, Wluka AE, Simpson JA. et al. Body weight at early and middle adulthood, weight gain and persistent overweight from early adulthood are predictors of the risk of total knee and hip replacement for osteoarthritis. Rheumatology (Oxford) 2013; 52 (06) 1033-1041
• 15 Sarpong NO, Boddapati V, Herndon CL, Shah RP, Cooper HJ, Geller JA. Trends in length of stay and 30-day complications after total knee arthroplasty: an analysis from 2006 to 2016. J Arthroplasty 2019; 34 (08) 1575-1580
• 16 Christelis N, Wallace S, Sage CE. et al. An enhanced recovery after surgery program for hip and knee arthroplasty. Med J Aust 2015; 202 (07) 363-368
• 17 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 (05) 1144-1162
• 18 Koh IJ, Choi YJ, Kim MS, Koh HJ, Kang MS, In Y. Femoral nerve block versus adductor canal block for analgesia after total knee arthroplasty. Knee Surg Relat Res 2017; 29 (02) 87-95
• 19 Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 2011; 55 (01) 14-19
• 20 Sah AP, Liang K, Sclafani JA. Optimal multimodal analgesia treatment recommendations for total joint arthroplasty: a critical analysis review. JBJS Rev 2018; 6 (06) e7
• 21 Sardana V, Burzynski JM, Scuderi GR. Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2019; 34 (01) 183-189