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

Affiliations
  • 1Department of Rehabilitation Medicine, Taiping Hospital, Perak, Malaysia
  • 2Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

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

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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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Reference

1. Neogi T. 2013; The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 21:1145–53. DOI: 10.1016/j.joca.2013.03.018. PMID: 23973124. PMCID: PMC3753584.
Article
2. Palazzo C, Ravaud JF, Papelard A, Ravaud P, Poiraudeau S. 2014; The burden of musculoskeletal conditions. PLoS One. 9:e90633. DOI: 10.1371/journal.pone.0090633. PMID: 24595187. PMCID: PMC3942474. PMID: ae38f17194cc4717ba7bc65d55f76b47.
Article
3. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. 2012; American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 64:465–74. DOI: 10.1002/acr.21596. PMID: 22563589.
Article
4. Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. 2011; "Beating osteoARThritis": development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol. 30:1623–9. DOI: 10.1007/s10067-011-1835-x. PMID: 21887488.
Article
5. Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, et al. 2012; Knee replacement. Lancet. 379:1331–40. DOI: 10.1016/S0140-6736(11)60752-6. PMID: 30496082.
Article
6. Liddle AD, Pegg EC, Pandit H. 2013; Knee replacement for osteoarthritis. Maturitas. 75:131–6. DOI: 10.1016/j.maturitas.2013.03.005. PMID: 23582106.
Article
7. Veerapen K, Wigley RD, Valkenburg H. 2007; Musculoskeletal pain in Malaysia: a COPCORD survey. J Rheumatol. 34:207–13. PMID: 17216688.
8. Silva AG, Alvarelhão J, Queirós A, Rocha NP. 2013; Pain intensity is associated with self-reported disability for several domains of life in a sample of patients with musculoskeletal pain aged 50 or more. Disabil Health J. 6:369–76. DOI: 10.1016/j.dhjo.2013.04.007. PMID: 24060260.
Article
9. Petursdottir U, Arnadottir SA, Halldorsdottir S. 2010; Facilitators and barriers to exercising among people with osteoarthritis: a phenomenological study. Phys Ther. 90:1014–25. DOI: 10.2522/ptj.20090217. PMID: 20466741.
Article
10. Stone RC, Baker J. 2017; Painful choices: a qualitative exploration of facilitators and barriers to active lifestyles among adults with osteoarthritis. J Appl Gerontol. 36:1091–116. DOI: 10.1177/0733464815602114. PMID: 26316267.
Article
11. Foo CN, Arumugam M, Lekhraj R, Lye MS, Mohd-Sidik S, Jamil Osman Z. 2020; Effectiveness of health-led cognitive behavioral-based group therapy on pain, functional disability and psychological outcomes among knee osteoarthritis patients in Malaysia. Int J Environ Res Public Health. 17:6179. DOI: 10.3390/ijerph17176179. PMID: 32858791. PMCID: PMC7503685. PMID: 220a0eb6d0854b05912a8b72bb0862f3.
Article
12. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. 2019; OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 27:1578–89. DOI: 10.1016/j.joca.2019.06.011. PMID: 31278997.
Article
13. Koh IJ, Choi YJ, Kim MS, Koh HJ, Kang MS, In Y. 2017; Femoral nerve block versus adductor canal block for analgesia after total knee arthroplasty. Knee Surg Relat Res. 29:87–95. DOI: 10.5792/ksrr.16.039. PMID: 28545172. PMCID: PMC5450580.
Article
14. Sardana V, Burzynski JM, Scuderi GR. 2019; Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 34:183–9. DOI: 10.1016/j.arth.2018.09.083. PMID: 30360981.
Article
15. Lee DH, Lee MY, Kwack KS, Yoon SH. 2017; Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: retrospective comparative study. Medicine (Baltimore). 96:e6374. DOI: 10.1097/MD.0000000000006374. PMID: 28328826. PMCID: PMC5371463.
16. Arcila Lotero MA, Rivera Díaz R, Mejía Aguilar MA, Jaramillo Jaramillo S. 2014; Efficacy and safety of ultrasound-guided saphenous nerve block in patients with chronic knee pain. Colomb J Anesthesiol. 42:166–71. https://doi.org/10.1016/j.rca.2014.03.005. DOI: 10.1016/j.rca.2014.03.005.
Article
17. Shah NA, Jain NP, Panchal KA. 2015; Adductor canal blockade following total knee arthroplasty-continuous or single shot technique? Role in postoperative analgesia, ambulation ability and early functional recovery: a randomized controlled trial. J Arthroplasty. 30:1476–81. DOI: 10.1016/j.arth.2015.03.006. PMID: 25824025.
Article
18. Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. 2011; Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand. 55:14–9. DOI: 10.1111/j.1399-6576.2010.02333.x. PMID: 21039357.
Article
19. van der Wal M, Lang SA, Yip RW. 1993; Transsartorial approach for saphenous nerve block. Can J Anaesth. 40:542–6. DOI: 10.1007/BF03009739. PMID: 8403121.
Article
20. Jenstrup MT, Jæger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, et al. 2012; Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand. 56:357–64. DOI: 10.1111/j.1399-6576.2011.02621.x. PMID: 22221014.
Article
21. Jæger P, Koscielniak-Nielsen ZJ, Schrøder HM, Mathiesen O, Henningsen MH, Lund J, et al. 2014; Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One. 9:e111951. DOI: 10.1371/journal.pone.0111951. PMID: 25386752. PMCID: PMC4227669.
Article
22. Ludwigson JL, Tillmans SD, Galgon RE, Chambers TA, Heiner JP, Schroeder KM. 2015; A comparison of single shot adductor canal block versus femoral nerve catheter for total knee arthroplasty. J Arthroplasty. 30(9 Suppl):68–71. DOI: 10.1016/j.arth.2015.03.044. PMID: 26129851.
Article
23. Hadzic A. 2007. Textbook of regional anesthesia and acute pain management. McGraw-Hill Medical Pub Division;New York: https://www.worldcat.org/title/textbook-of-regional-anesthesia-and-acute-pain-management/oclc/1261740526?referer=br&ht=edition. DOI: 10.1016/j.jpain.2015.01.289.
24. Herman DC, Vincent KR. 2018; Saphenous nerve block for the assessment of knee pain refractory to conservative treatment. Curr Sports Med Rep. 17:146–7. DOI: 10.1249/JSR.0000000000000480. PMID: 29738318.
Article
25. Kirkpatrick JD, Sites BD, Antonakakis JG. 2010; Preliminary experience with a new approach to performing an ultrasound-guided saphenous nerve block in the mid to proximal femur. Reg Anesth Pain Med. 35:222–3. DOI: 10.1097/AAP.0b013e3181d24589. PMID: 20216039.
Article
26. Horner G, Dellon AL. 1994; Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res. 301:221–6. DOI: 10.1097/00003086-199404000-00034. PMID: 8156678.
Article
27. Childs JD, Piva SR, Fritz JM. 2005; Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 30:1331–4. DOI: 10.1097/01.brs.0000164099.92112.29. PMID: 15928561.
Article
28. Jensen MP, McFarland CA. 1993; Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 55:195–203. DOI: 10.1016/0304-3959(93)90148-I. PMID: 8309709.
Article
29. Roos EM, Lohmander LS. 2003; The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 1:64. DOI: 10.1186/1477-7525-1-64. PMID: 14613558. PMCID: PMC280702.
30. Zulkifli MM, Kadir AA, Elias A, Bea KC, Sadagatullah AN. 2017; Psychometric properties of the Malay language version of Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire among knee osteoarthritis patients: a confirmatory factor analysis. Malays Orthop J. 11:7–14. DOI: 10.5704/MOJ.1707.003. PMID: 29021872. PMCID: PMC5630044.
31. Arroll B, Goodyear-Smith F. 2004; Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 328:869. DOI: 10.1136/bmj.38039.573970.7C. PMID: 15039276. PMCID: PMC387479.
Article
32. Eker HE, Cok OY, Aribogan A, Arslan G. 2017; The efficacy of intra-articular lidocaine administration in chronic knee pain due to osteoarthritis: a randomized, double-blind, controlled study. Anaesth Crit Care Pain Med. 36:109–14. DOI: 10.1016/j.accpm.2016.05.003. PMID: 27485803.
Article
33. Ayhan E, Kesmezacar H, Akgun I. 2014; Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 5:351–61. DOI: 10.5312/wjo.v5.i3.351. PMID: 25035839. PMCID: PMC4095029.
Article
34. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. 2019; Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 293:656–63. DOI: 10.1148/radiol.2019190341. PMID: 31617798.
Article
35. Park MR, Kim D, Rhyu IJ, Yu JH, Hong J, Yoon S, et al. 2020; An anatomical neurovascular study for procedures targeting peri-articular nerves in patients with anterior knee pain. Knee. 27:1577–84. DOI: 10.1016/j.knee.2020.08.006. PMID: 33010776.
Article
36. Hunter DJ, McDougall JJ, Keefe FJ. 2008; The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 34:623–43. DOI: 10.1016/j.rdc.2008.05.004. PMID: 18687276. PMCID: PMC2597216.
Article
37. Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. 2015; Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med. 40:3–10. DOI: 10.1097/AAP.0000000000000169. PMID: 25376972.
Article
38. Shah NA, Jain NP. 2014; Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty. 29:2224–9. DOI: 10.1016/j.arth.2014.06.010. PMID: 25041873.
Article
39. Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, et al. 2014; Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology. 120:540–50. DOI: 10.1097/ALN.0000000000000119. PMID: 24401769.
40. Burckett-St Laurant D, Peng P, Girón Arango L, Niazi AU, Chan VW, Agur A, et al. 2016; The nerves of the adductor canal and the innervation of the knee: an anatomic study. Reg Anesth Pain Med. 41:321–7. DOI: 10.1097/AAP.0000000000000389. PMID: 27015545.
41. Akkaya T, Ersan O, Ozkan D, Sahiner Y, Akin M, Gümüş H, et al. 2008; Saphenous nerve block is an effective regional technique for post-menisectomy pain. Knee Surg Sports Traumatol Arthrosc. 16:855–8. DOI: 10.1007/s00167-008-0572-4. PMID: 18574578.
Article
42. Hanson NA, Derby RE, Auyong DB, Salinas FV, Delucca C, Nagy R, et al. 2013; Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial. Can J Anaesth. 60:874–80. DOI: 10.1007/s12630-013-9992-9. PMID: 23820968.
Article
43. Hsu LP, Oh S, Nuber GW, Doty R Jr, Kendall MC, Gryzlo S, et al. 2013; Nerve block of the infrapatellar branch of the saphenous nerve in knee arthroscopy: a prospective, double-blinded, randomized, placebo-controlled trial. J Bone Joint Surg Am. 95:1465–72. DOI: 10.2106/JBJS.L.01534. PMID: 23965696.
44. Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. 2015; Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 10:CD005328. DOI: 10.1002/14651858.CD005328.pub3. PMID: 26490760. PMCID: PMC8884338.
Article
45. Goto F, Ishizaki K, Yoshikawa D, Obata H, Arii H, Terada M. 1999; The long lasting effects of peripheral nerve blocks for trigeminal neuralgia using high concentration of tetracaine dissolved in bupivacaine. Pain. 79:101–3. DOI: 10.1016/S0304-3959(98)00156-0. PMID: 9928782.
46. Gracely RH, Lynch SA, Bennett GJ. 1992; Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain. 51:175–94. Erratum in: Pain 1993; 52: 251-3. DOI: 10.1016/0304-3959(93)90141-B. PMID: 1484715.
Article
47. Arnér S, Lindblom U, Meyerson BA, Molander C. 1990; Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clinical studies. Pain. 43:287–97. DOI: 10.1016/0304-3959(90)90026-A. PMID: 1705693.
Article
48. Naredo E, Cabero F, Palop MJ, Collado P, Cruz A, Crespo M. 2005; Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment. Osteoarthritis Cartilage. 13:568–74. DOI: 10.1016/j.joca.2005.02.008. PMID: 15979008.
Article
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