Clin Orthop Surg.  2017 Sep;9(3):303-309. 10.4055/cios.2017.9.3.303.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

• Seo SS
• Kim OG
• Seo JH
• Kim DH
• Kim YG
• Park BY

• KMID: 2412266
• DOI: http://doi.org/10.4055/cios.2017.9.3.303

Abstract

BACKGROUND
This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty.
METHODS
Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block.
RESULTS
No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption.
CONCLUSIONS
The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Keyword

Total knee arthroplasty; Postoperative pain; Femoral nerve block; Adductor canal block

MeSH Terms

Aged
Amides/administration & dosage
Anesthetics, Local/administration & dosage
*Arthroplasty, Replacement, Knee
Female
*Femoral Nerve
Humans
Male
Muscle Strength
Nerve Block/*methods
Pain, Postoperative/prevention & control
Retrospective Studies
Thigh/innervation
Amides
Anesthetics, Local

Figure

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  Fig. 1 Mean numerical rating scale (NRS) pain score at rest. A p-value less than 0.05 was considered to be statistically significant. FNB: femoral nerve block, ACB: adductor canal block, POD: postoperative day. *p < 0.05 in independent samples t-test.

• 

  Fig. 2 Mean numerical rating scale (NRS) pain score during 45° flexion of knee. A p-value less than 0.05 was considered to be statistically significant. FNB: femoral nerve block, ACB: adductor canal block, POD: postoperative day. *p < 0.05 in independent samples t-test.

• 

  Fig. 3 Quadriceps muscle strength was assessed by manual muscle test (MMT). A p-value less than 0.05 was considered to be statistically significant. FNB: femoral nerve block, ACB: adductor canal block, POD: postoperative day. *p < 0.05 in independent samples t-test.

• 

  Fig. 4 Walking ability was assessed by Timed Up and Go (TUG) test. A p-value less than 0.05 was considered to be statistically significant. FNB: femoral nerve block, ACB: adductor canal block, POD: postoperative day. *p < 0.05 in independent samples t-test.

• 

  Fig. 5 Comparison of total analgesic consumption between groups. FNB: femoral nerve block, ACB: adductor canal block.

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