Dataset Information

Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis.

ABSTRACT:

Background

This study aimed to evaluate the effectiveness of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in postoperative analgesia and early rehabilitation of patients with total knee arthroplasty (TKA).

Methods

The Cochrane Library, PubMed, and EMbase were systematically searched to retrieve literature comparing efficacy of CACB versus CFNB on pain relief and functional recovery in knee replacement patients until December 2018, without language limitation. Meta-analysis was performed using RevMan 5.3 software.

Results

A total of 7 clinical randomized controlled trials and 4 retrospective studies were included, involving 484 cases in the CACB group and 491 in the CFNB group. The results of the meta-analysis showed that the visual analogue scores (VAS) at rest were similar between the CACB group and the CFNB group at 8?hours (standard mean difference(SMD)?=?-0.26, 95% confidence interval(CI): -0.62, 0.11), 12?hours (SMD?=?-0.02, 95%CI: -0.50, 0.47), 24?hours (SMD?=?0.05, 95%CI: -0.22, 0.33), and 48?hours (SMD?=?-0.10, 95%CI: -0.29, 0.09) after TKA (P?>?.05 for all). The muscle strength of patients in the CACB group post-operation was significantly improved than those of the CFNB group (SMD?=?0.81; 95% CI: 0.35, 1.26; P?=?.0005). There were no significant differences in the amount of opioids consumption and the incidence of postoperative fall between CACB and CFNB (P?>?.05).

Conclusion

The analgesic effects of CACB versus CFNB are equivalent after TKA. CACB has less effect on the quadriceps muscle strength, which is beneficial to the early postoperative activities and functional rehabilitation.

SUBMITTER: Zhang Z

PROVIDER: S-EPMC6890367 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis.

Zhang Zhen Z Wang Yu Y Liu Yuanyuan Y

Medicine 20191101 48

<h4>Background</h4>This study aimed to evaluate the effectiveness of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in postoperative analgesia and early rehabilitation of patients with total knee arthroplasty (TKA).<h4>Methods</h4>The Cochrane Library, PubMed, and EMbase were systematically searched to retrieve literature comparing efficacy of CACB versus CFNB on pain relief and functional recovery in knee replacement patients until December 2018, without lan ...[more]

PMID: 31770220

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Project description:The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined.We compared two volumes and concentrations of a fixed dose of ropivacaine for continuous femoral nerve block after TKA to a single injection femoral nerve block with ropivacaine to determine (1) time to discharge readiness; (2) early pain scores and analgesic consumption; and (3) functional outcomes, including range of motion and WOMAC scores at the time of recovery.Ninety-nine patients were allocated to one of three continuous femoral nerve block groups for this randomized, placebo-controlled, double-blind trial: a high concentration group (ropivacaine 0.2% infusion), a low concentration group (ropivacaine 0.1% infusion), or a placebo infusion group (saline 0.9% infusion). Infusions were discontinued on postoperative Day (POD) 2. The primary outcome was time to discharge readiness. Secondary outcomes included opioid consumption, pain, and functional outcomes. Ninety-three patients completed the study protocol; the study was halted early because of unanticipated changes to pain protocols at the host institution, by which time only 61% of the required number of patients had been enrolled.With the numbers available, the mean time to discharge readiness was not different between groups (high concentration group, 62 hours [95% confidence interval [CI], 51-72 hours]; low concentration group, 73 hours [95% CI, 63-83 hours]; placebo infusion group 65 hours [95% CI, 56-75 hours]; p = 0.27). Patients in the low concentration group consumed significantly less morphine during the period of infusion (POD 1, high concentration group, 56 mg [95% CI, 42-70 mg]; low concentration group, 35 mg [95% CI, 27-43 mg]; placebo infusion group, 48 mg [95% CI, 38-59 mg], p = 0.02; POD 2, high concentration group, 50 mg [95% CI, 41-60 mg]; low concentration group, 33 mg [95% CI, 24-42 mg]; placebo infusion group, 39 mg [95% CI, 30-48 mg], p = 0.04); however, there were no important differences in pain scores or opioid-related side effects with the numbers available. Likewise, there were no important differences in functional outcomes between groups.Based on this study, which was terminated prematurely before the desired sample size could be achieved, we were unable to demonstrate that varying the concentration and volume of a fixed-dose ropivacaine infusion for continuous femoral nerve block influences time to discharge readiness when compared with a conventional single-injection femoral nerve block after TKA. A low concentration of ropivacaine infusion can reduce postoperative opioid consumption but without any important differences in pain scores, side effects, or functional outcomes. These pilot data may be used to inform the statistical power of future randomized trials.Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Project description:BACKGROUND:Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24?h compared with end-hole catheter. METHODS:Eighty adult patients (aged ?18?years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400?mm) or an end-hole (Silverstim VYGON®, 20G - 500?mm) catheter. Once the femoral catheter was sited, a bolus of 20?mL lidocaine 1% was injected. An electronic pump then delivered an automated 5?mL bolus of ropivacaine 0.2% hourly, with 10?mL self-administered patient controlled analgesia boluses. RESULTS:There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24?h (4(2-7) vs. 4(2-8) in six-hole and end-hole groups, respectively; P?=?0.832) or median ropivacaine consumption at 48?h (365(295-418) vs. 387(323-466); P?=?0.452). No significant differences were recorded between the groups at 24?h regarding median average verbal rate pain scale (2(0-3) vs. 2(0-4); P?=?0.486) or morphine consumption (0(0-20) vs. 0(0-20); P?=?0.749). Quadriceps muscle strength declined to 7% (0-20) and 10% (0-28) in the six-hole and end-hole groups, respectively, at 24?h after surgery (P?=?0.733). CONCLUSIONS:In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness. TRIAL REGISTRATION:Retrospectively registered at ( NCT03376178 ). Date: 21 November 2017.

Dataset Information

Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis.

Background

Methods

Results

Conclusion

Publications

Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis.

Similar Datasets

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