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  • Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty: A Randomized, Blinded Study

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Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty: A Randomized, Blinded Study
  1. Ulrik Grevstad, MD*,
  2. Ole Mathiesen, MD, PhD†,
  3. Laura Staun Valentiner, PT‡,
  4. Pia Jaeger, MD§,
  5. Karen Lisa Hilsted, RN§ and
  6. Jørgen B. Dahl, MD, DMSci, MBA§
  1. *Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte
  2. †Section of Acute Pain Management, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen
  3. ‡Department of Orthopaedic Surgery, Copenhagen University Hospital, Gentofte Hospital, Gentofte
  4. §Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  1. Address correspondence to: Ulrik Grevstad, MD, Department of Anaesthesia and Intensive Care Medicine, Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark (e-mail: ulrik.grevstad{at}hotmail.com).

Abstract

Background and Objectives Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the adductor canal block (ACB) could increase functional muscle strength.

Methods We included 50 TKA patients with severe movement-related pain; defined as having visual analog scale pain score of greater than 60 mm during active flexion of the knee. The ACB group received an ACB with ropivacaine 0.2% 30 mL and a femoral nerve block (FNB) with 30 mL saline. The FNB group received an ACB with 30 mL saline and an FNB with ropivacaine 0.2% 30 mL. We compared the effect of the ACB versus FNB on maximum voluntary isometric contraction of the quadriceps muscle relative to a postoperative baseline value. Secondary end points were differences between groups in ability to ambulate and changes in pain scores (Clinicaltrials.gov identifier NCT01922596).

Results After block, the quadriceps maximum voluntary isometric contraction increased to 193% (95% confidence interval [CI], 143–288) of the baseline value in the ACB group and decreased to 16% (95% CI, 3–33) in the FNB group with an estimated difference of 178% (95% CI, 136–226), P < 0.0001. Pain scores were similar between groups. Before block, 2 of 25 patients in each group were unable to perform the Timed-Up-and-Go test; after block, this number increased to 7 of 25 in the FNB group and decreased to 0 of 25 in the ACB group.

Conclusion Adductor canal block provides a clinically relevant and statistically significant increase in quadriceps muscle strength for patients in severe pain after TKA.

https://doi.org/10.1097/AAP.0000000000000169

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    Footnotes

    • Attribution: Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte, and Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark.

      All expenses were covered by departmental sources.

      The authors declare no conflict of interest.

      Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.rapm.org).