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:ObjectiveAdductor canal block (ACB) is widely performed for postoperative analgesia for total knee arthroplasty (TKA). The aim of this study is to compare surgeon-assisted and anesthesiologist-assisted (ultrasound-guided) adductor blocks in terms of postoperative analgesic efficacy.MethodsThis study was designed as a double-blind, prospective and randomized trial. A total of 240 participants were randomly allocated to three groups: one where the surgeon performed the adductor canal block (ACBs), another where it was conducted by an anesthetist with ultrasound guidance (ACBa), and a third group without the adductor block. The follow-up management after the Total Knee Arthroplasty (TKA) procedure occurred on the first, third, and tenth days, as well as the twelfth week. Outcome measures comprised pain assessment using the Visual Analog Scale (VAS) and monitoring opioid analgesic consumption.ResultsNo significant differences in demographic profiles were observed between the groups. Groups ACBa and ACBs exhibited significantly lower VAS scores compared to the control group at both 3 and 12 h after surgery, with group ACBa showing the lowest VAS scores among all groups. However, at 1 day, 3 days, 10 days and 12 weeks after surgery, there was no significant difference in VAS scores between the ACBa and ACBs groups. On the first three days, the ACBa group had the lowest opioid consumption and the lowest total opioid consumption. The differences in VAS scores between the groups began to decrease on the first day after surgery.ConclusionThe adductor canal block (ACB) has been demonstrated to be an effective method of reducing pain in patients undergoing total knee replacement (TKR) in the postoperative period. Nevertheless, despite the pronounced impact that ACB performed by an anesthesiologist under ultrasound guidance has on VAS scores according to intraoperative ACB by surgeons, its effect on clinical outcomes has not been demonstrated.Trial registrationsThis study was retrospectively registered with the Clinical Trials Registry Platform on July 31, 2024 (NCT06533085).

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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