A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Dianqi ¹ , HUANG Wenbin ¹ , ZHAI Wenrun ¹ , LI Yingfen ² , CHEN Dongfeng ¹ , ZHENG Shicong ¹ , WU Yingbin ³ ,  LU Weijie ¹ , LIU Dianqi ¹ , HUANG Wenbin ¹ , ZHAI Wenrun ¹ , LI Yingfen ² , CHEN Dongfeng ¹ , ZHENG Shicong ¹ , WU Yingbin ³ ,  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;
3. Department of Joint Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, 528000, P. R. China;

Corresponding?author：

LU Weijie, Email: 13902280296@139.com; LU Weijie, Email: 13902280296@139.com

Keywords：

Single adductor canal block; continuous adductor canal block; local infiltration anesthesia; unicompartmental knee arthroplasty; analgesic; joint function

DOI：

10.7507/1002-1892.202312103

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.

Citation： LIU Dianqi, HUANG Wenbin, ZHAI Wenrun, LI Yingfen, CHEN Dongfeng, ZHENG Shicong, WU Yingbin, LU Weijie. A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 448-454. doi: 10.7507/1002-1892.202312103 Copy

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.	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.
3.	劉典琦, 溫曉暉, 盧偉杰. 收肌管阻滯應用于膝關節置換術后鎮痛效果的研究進展. 中國修復重建外科雜志, 2023, 37(1): 106-114.
4.	劉典琦, 溫曉暉, 盧偉杰. 收肌管阻滯應用于膝關節置換術后鎮痛效果的研究進展. 中國修復重建外科雜志, 2023, 37(1): 106-114.
5.	Vora MU, Nicholas TA, Kassel CA, et al. Adductor canal block for knee surgical procedures: review article. J Clin Anesth, 2016, 35: 295-303.
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.	牟童, 劉丹彥. 收肌管阻滯在全膝關節置換術術后鎮痛中的應用研究進展. 山東醫藥, 2021, 61(21): 91-95.
8.	牟童, 劉丹彥. 收肌管阻滯在全膝關節置換術術后鎮痛中的應用研究進展. 山東醫藥, 2021, 61(21): 91-95.
9.	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.
10.	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.
11.	Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials. Reg Anesth Pain Med, 2023, 48(2): 49-60.
12.	Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials. Reg Anesth Pain Med, 2023, 48(2): 49-60.
13.	Nielsen S, Degenhardt L, Hoban B, et al. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf, 2016, 25(6): 733-737.
14.	Nielsen S, Degenhardt L, Hoban B, et al. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf, 2016, 25(6): 733-737.
15.	Lee S, Rooban N, Vaghadia H, et al. A randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. J Arthroplasty, 2018, 33(4): 1045-1051.
16.	Lee S, Rooban N, Vaghadia H, et al. A randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. J Arthroplasty, 2018, 33(4): 1045-1051.
17.	Elkassabany NM, Cai LF, Badiola I, et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J, 2019, 101-B(3): 340-347.
18.	Elkassabany NM, Cai LF, Badiola I, et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J, 2019, 101-B(3): 340-347.
19.	Lam HYJ, Tang YHB, Wong HL, et al. Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial. J Orthop Surg (Hong Kong), 2020, 28(2): 2309499020932037. doi: 10.1177/2309499020932037.
20.	Lam HYJ, Tang YHB, Wong HL, et al. Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial. J Orthop Surg (Hong Kong), 2020, 28(2): 2309499020932037. doi: 10.1177/2309499020932037.
21.	Xiong C, Han CP, Zhao D, et al. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(34): e27064. doi: 10.1097/MD.0000000000027064.
22.	Xiong C, Han CP, Zhao D, et al. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(34): e27064. doi: 10.1097/MD.0000000000027064.
23.	Ahuja V, Thapa D, Chander A, et al. Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. Korean J Pain, 2020, 33(2): 166-175.
24.	Ahuja V, Thapa D, Chander A, et al. Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. Korean J Pain, 2020, 33(2): 166-175.
25.	Wang C, Zhang Z, Ma W, et al. Perineural dexmedetomidine reduces the median effective concentration of ropivacaine for adductor canal block. Med Sci Monit, 2021, 27: e929857. doi: 10.12659/MSM.929857.
26.	Wang C, Zhang Z, Ma W, et al. Perineural dexmedetomidine reduces the median effective concentration of ropivacaine for adductor canal block. Med Sci Monit, 2021, 27: e929857. doi: 10.12659/MSM.929857.
27.	王春光, 劉蕊, 韓寶君, 等. 右美托咪定對羅哌卡因收肌管內隱神經阻滯半數有效濃度的影響. 臨床麻醉學雜志, 2020, 36(12): 1169-1172.
28.	王春光, 劉蕊, 韓寶君, 等. 右美托咪定對羅哌卡因收肌管內隱神經阻滯半數有效濃度的影響. 臨床麻醉學雜志, 2020, 36(12): 1169-1172.
29.	Ge J, Hernigou P, Guo W, et al. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. Int Orthop, 2023, 47(11): 2717-2725.
30.	Ge J, Hernigou P, Guo W, et al. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. Int Orthop, 2023, 47(11): 2717-2725.
31.	Price AJ, Webb J, Topf H, et al. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty, 2001, 16(8): 970-976.
32.	Price AJ, Webb J, Topf H, et al. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty, 2001, 16(8): 970-976.
33.	Thijssen M, Timmerman L, Koning NJ, et al. Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry. PLoS One, 2022, 17(12): e0279606. doi: 10.1371/journal.pone.0279606.
34.	Thijssen M, Timmerman L, Koning NJ, et al. Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry. PLoS One, 2022, 17(12): e0279606. doi: 10.1371/journal.pone.0279606.
35.	李燦鋒, 徐宏偉, 沈彬, 等. 置管持續收肌管阻滯與單次注射收肌管阻滯對人工全膝關節置換術后鎮痛及早期康復的影響研究. 中國修復重建外科雜志, 2017, 31(9): 1049-1054.
36.	李燦鋒, 徐宏偉, 沈彬, 等. 置管持續收肌管阻滯與單次注射收肌管阻滯對人工全膝關節置換術后鎮痛及早期康復的影響研究. 中國修復重建外科雜志, 2017, 31(9): 1049-1054.
37.	Seo SS, Kim OG, Seo JH, et al. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg, 2017, 9(3): 303-309.
38.	Seo SS, Kim OG, Seo JH, et al. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg, 2017, 9(3): 303-309.
39.	魏學磊, 孫杰, 馬寶通. 全膝關節置換術后股骨假體周圍骨折的治療進展. 中華骨科雜志, 2023, 43(4): 269-276.
40.	魏學磊, 孫杰, 馬寶通. 全膝關節置換術后股骨假體周圍骨折的治療進展. 中華骨科雜志, 2023, 43(4): 269-276.
41.	焦麗媛, 井子夜, 閆華磊, 等. 低阿片聯合隱神經阻滯多模式鎮痛方案在老年人膝關節置換術中的應用. 中華老年醫學雜志, 2023, 42(1): 67-72.
42.	焦麗媛, 井子夜, 閆華磊, 等. 低阿片聯合隱神經阻滯多模式鎮痛方案在老年人膝關節置換術中的應用. 中華老年醫學雜志, 2023, 42(1): 67-72.

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. 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.
3. 劉典琦, 溫曉暉, 盧偉杰. 收肌管阻滯應用于膝關節置換術后鎮痛效果的研究進展. 中國修復重建外科雜志, 2023, 37(1): 106-114.
4. 劉典琦, 溫曉暉, 盧偉杰. 收肌管阻滯應用于膝關節置換術后鎮痛效果的研究進展. 中國修復重建外科雜志, 2023, 37(1): 106-114.
5. Vora MU, Nicholas TA, Kassel CA, et al. Adductor canal block for knee surgical procedures: review article. J Clin Anesth, 2016, 35: 295-303.
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. 牟童, 劉丹彥. 收肌管阻滯在全膝關節置換術術后鎮痛中的應用研究進展. 山東醫藥, 2021, 61(21): 91-95.
8. 牟童, 劉丹彥. 收肌管阻滯在全膝關節置換術術后鎮痛中的應用研究進展. 山東醫藥, 2021, 61(21): 91-95.
9. 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.
10. 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.
11. Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials. Reg Anesth Pain Med, 2023, 48(2): 49-60.
12. Hussain N, Brull R, Zhou S, et al. Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials. Reg Anesth Pain Med, 2023, 48(2): 49-60.
13. Nielsen S, Degenhardt L, Hoban B, et al. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf, 2016, 25(6): 733-737.
14. Nielsen S, Degenhardt L, Hoban B, et al. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf, 2016, 25(6): 733-737.
15. Lee S, Rooban N, Vaghadia H, et al. A randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. J Arthroplasty, 2018, 33(4): 1045-1051.
16. Lee S, Rooban N, Vaghadia H, et al. A randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. J Arthroplasty, 2018, 33(4): 1045-1051.
17. Elkassabany NM, Cai LF, Badiola I, et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J, 2019, 101-B(3): 340-347.
18. Elkassabany NM, Cai LF, Badiola I, et al. A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J, 2019, 101-B(3): 340-347.
19. Lam HYJ, Tang YHB, Wong HL, et al. Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial. J Orthop Surg (Hong Kong), 2020, 28(2): 2309499020932037. doi: 10.1177/2309499020932037.
20. Lam HYJ, Tang YHB, Wong HL, et al. Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial. J Orthop Surg (Hong Kong), 2020, 28(2): 2309499020932037. doi: 10.1177/2309499020932037.
21. Xiong C, Han CP, Zhao D, et al. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(34): e27064. doi: 10.1097/MD.0000000000027064.
22. Xiong C, Han CP, Zhao D, et al. Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore), 2021, 100(34): e27064. doi: 10.1097/MD.0000000000027064.
23. Ahuja V, Thapa D, Chander A, et al. Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. Korean J Pain, 2020, 33(2): 166-175.
24. Ahuja V, Thapa D, Chander A, et al. Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. Korean J Pain, 2020, 33(2): 166-175.
25. Wang C, Zhang Z, Ma W, et al. Perineural dexmedetomidine reduces the median effective concentration of ropivacaine for adductor canal block. Med Sci Monit, 2021, 27: e929857. doi: 10.12659/MSM.929857.
26. Wang C, Zhang Z, Ma W, et al. Perineural dexmedetomidine reduces the median effective concentration of ropivacaine for adductor canal block. Med Sci Monit, 2021, 27: e929857. doi: 10.12659/MSM.929857.
27. 王春光, 劉蕊, 韓寶君, 等. 右美托咪定對羅哌卡因收肌管內隱神經阻滯半數有效濃度的影響. 臨床麻醉學雜志, 2020, 36(12): 1169-1172.
28. 王春光, 劉蕊, 韓寶君, 等. 右美托咪定對羅哌卡因收肌管內隱神經阻滯半數有效濃度的影響. 臨床麻醉學雜志, 2020, 36(12): 1169-1172.
29. Ge J, Hernigou P, Guo W, et al. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. Int Orthop, 2023, 47(11): 2717-2725.
30. Ge J, Hernigou P, Guo W, et al. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. Int Orthop, 2023, 47(11): 2717-2725.
31. Price AJ, Webb J, Topf H, et al. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty, 2001, 16(8): 970-976.
32. Price AJ, Webb J, Topf H, et al. Rapid recovery after Oxford unicompartmental arthroplasty through a short incision. J Arthroplasty, 2001, 16(8): 970-976.
33. Thijssen M, Timmerman L, Koning NJ, et al. Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry. PLoS One, 2022, 17(12): e0279606. doi: 10.1371/journal.pone.0279606.
34. Thijssen M, Timmerman L, Koning NJ, et al. Multimodal analgesia practices for knee and hip arthroplasties in the Netherlands. A prospective observational study from the PAIN OUT registry. PLoS One, 2022, 17(12): e0279606. doi: 10.1371/journal.pone.0279606.
35. 李燦鋒, 徐宏偉, 沈彬, 等. 置管持續收肌管阻滯與單次注射收肌管阻滯對人工全膝關節置換術后鎮痛及早期康復的影響研究. 中國修復重建外科雜志, 2017, 31(9): 1049-1054.
36. 李燦鋒, 徐宏偉, 沈彬, 等. 置管持續收肌管阻滯與單次注射收肌管阻滯對人工全膝關節置換術后鎮痛及早期康復的影響研究. 中國修復重建外科雜志, 2017, 31(9): 1049-1054.
37. Seo SS, Kim OG, Seo JH, et al. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg, 2017, 9(3): 303-309.
38. Seo SS, Kim OG, Seo JH, et al. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg, 2017, 9(3): 303-309.
39. 魏學磊, 孫杰, 馬寶通. 全膝關節置換術后股骨假體周圍骨折的治療進展. 中華骨科雜志, 2023, 43(4): 269-276.
40. 魏學磊, 孫杰, 馬寶通. 全膝關節置換術后股骨假體周圍骨折的治療進展. 中華骨科雜志, 2023, 43(4): 269-276.
41. 焦麗媛, 井子夜, 閆華磊, 等. 低阿片聯合隱神經阻滯多模式鎮痛方案在老年人膝關節置換術中的應用. 中華老年醫學雜志, 2023, 42(1): 67-72.
42. 焦麗媛, 井子夜, 閆華磊, 等. 低阿片聯合隱神經阻滯多模式鎮痛方案在老年人膝關節置換術中的應用. 中華老年醫學雜志, 2023, 42(1): 67-72.

Chinese Journal of Reparative and Reconstructive Surgery

A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty

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