Korean J Pain.  2022 Apr;35(2):191-201. 10.3344/kjp.2022.35.2.191.

Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study

• Ming LH
• Chin CS
• Yang CT
• Suhaimi A

• KMID: 2527770
• DOI: http://doi.org/10.3344/kjp.2022.35.2.191

Abstract

Background
This study aimed to assess the efficacy of the adductor canal block (ACB) in comparison to intra-articular steroid-lidocaine injection (IASLI) to control chronic knee osteoarthritis (KOA) pain.
Methods
A randomized, single-blinded trial in an outpatient rehabilitation clinic re- cruiting chronic KOA with pain ≥ 6 months over one year. Following randomization, subjects received either a single ACB or IASLI under ultrasound guidance. Numerical rating scale (NRS) scores for pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were recorded at baseline, 1 hour, 1 month, and 3 months postinjection.
Results
Sixty-six knees were recruited; 2 were lost to follow-up. Age was normally distributed (P = 0.463), with more female subjects in both arms (P = 0.564). NRS scores improved significantly for both arms at 1 hour, with better pain scores for the IASLI arm (P = 0.416) at 1st month and ACB arm at 3rd month (P = 0.077) with larger effect size (Cohen’s d = 1.085). Lower limb function improved significantly in the IASLI arm at 1 month; the ACB subjects showed greater functional improvement at 3 months (Cohen’s d = 0.3, P = 0.346). Quality of life (QoL) improvement mirrored the functional scores whereby the IASLI group fared better at the 1st month (P = 0.071) but at the 3rd month the ACB group scored better (Cohen’s d = 0.08, P = 0.710).
Conclusions
ACB provides longer lasting analgesia which improves function and QoL in chronic KOA patients up to 3 months without any significant side effects.

Keyword

Analgesia; Injections; Intra-Articular; Lidocaine; Nerve Block; Osteoarthritis; Knee; Pain; Randomized Controlled Trial; Steroids

Figure

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  Fig. 1 Ultrasound image of the adductor canal at the level of mid-thigh. Sar: sartorius, SN: saphenous nerve, VM: vastus medialis, AL: adductor longus, FA: femoral artery.

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  Fig. 2 Insertion of needle and advancement under sonographic guidance. White arrowheads indicating the acoustic shadow of spinal needle. SN: saphenous nerve, VM: vastus medialis, FA: femoral artery. *Injectate.

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  Fig. 3 Subject flow through the study. KOA: knee osteoarthritis, VAS: visual analogue scale, ACB: adductor canal block, IASLI: intra-articular steroid and lidocaine injection, NRS: numerical rating scale.

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  Fig. 4 Analgesia use in IASLI versus ACB group at assessment time points (%). IASLI: intra-articular steroid and lidocaine injection, ACB: adductor canal block, Pre: baseline, 1M: 1-month post intervention, 3M: 3-months post intervention.

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  Fig. 5 KOOS functional scores for IASLI versus ACB at assessment time points. Lower line: minimum value, Upper line: maximum value, (Box) Lower line: Q1 lower quartile, Middle line: median, X: mean, Upper line: Q3 upper quartile, KOOS: Knee Injury and Osteoarthritis Outcome Scores, IASLI: intra-articular steroid and lidocaine injection, ACB: adductor canal block, Pre: baseline, 1M: 1-month post intervention, 3M: 3-months post intervention.

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  Fig. 6 KOOS QoL scores for IASLI versus ACB at assessment time points. Lower line: minimum value, Upper line: maximum value, (Box) Lower line: Q1 lower quartile, Middle line: median, X: mean, Upper line: Q3 upper quartile, KOOS: Knee Injury and Osteoarthritis Outcome Scores, QoL: quality of life, IASLI: intra-articular steroid and lidocaine injection, ACB: adductor canal block, Pre: baseline, 1M: 1-month post intervention, 3M: 3-months post intervention.

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  Fig. 7 NRS scores for pain of IASLI versus ACB at assessment time points. Lower line: minimum value, Upper line: maximum value, (Box) Lower line: Q1 lower quartile, Middle line: median, X: mean, Upper line: Q3 upper quartile, NRS: numerical rating scale, IASLI: intra-articular steroid and lidocaine injection, ACB: adductor canal block, Pre: baseline, 1M: 1-month post intervention, 3M: 3-months post intervention.

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  Fig. 8 Correlation between NRS pain score (%) and KOOS functional and QoL scores for IASLI and ACB subjects at assessment time points. IASLI: intra-articular steroid and lidocaine injection, ACB: adductor canal block, NRS: numerical rating scale, KOOS: Knee Injury and Osteoarthritis Outcome Scores, QoL: quality of life, Pre: baseline, 1M: 1-month post intervention, 3M: 3-months post intervention.

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