Primary Arthroplasty
Effect of Adductor Canal Block on Acute Perioperative Pain and Function in Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2019.02.049Get rights and content

Abstract

Background

Multimodal pain management strategies are commonplace in perioperative management of total knee arthroplasty (TKA), although controversy remains regarding the role of adductor canal blocks (ACB) in this algorithm. The purpose of this study is to independently evaluate the effect of ACB on short-term postoperative outcomes including (1) length of stay (LOS), (2) postoperative narcotic utilization, and (3) function with physical therapy in the era of modern TKA.

Methods

We retrospectively identified a cohort of consecutive patients from January 2014 to January 2018 who had undergone unilateral primary TKA using a single-shot ACB in addition to a standardized multimodal pain regimen vs those who only received a multimodal pain regimen. These 2 groups were compared using independent sample t-tests with primary end points of interest being LOS, distance ambulated with therapy, and inpatient narcotic use.

Results

There were 624 patients in the ACB group, with a mean age of 64.5 years. The group without ACB consisted of 69 patients, with a mean age of 67.2 years. We observed no significant difference in narcotic utilization postoperatively (2.361 vs 2.097, P = .088). The ACB group ambulated significantly further with therapy (75.8 vs 59.9 ft, P = .008) and had a shorter LOS in both total hours and percentage of postoperative day 1 (%POD1) discharges (34.8 vs 40.6 hours, P = .01, 83% vs 66.6%, P = .01).

Conclusion

ACB did not decrease postoperative pain medication utilization. The modest improvement in distance ambulated with therapy on POD1 (16 ft) and LOS (16% greater POD1 discharges) may not support the cost-effectiveness of this intervention.

Level of Evidence

III, Retrospective Cohort.

Section snippets

Methods

After institutional review board approval was obtained, our institutional database was used to retrospectively identify 2 cohorts of consecutive patients who had undergone unilateral TKA with a single surgeon. Patients who underwent surgery from January 2014 through January 2018 were included, as this time frame captures patients treated with our current TKA perioperative protocol, including use of tranexamic acid (1 g at incision and 1 g at closure), pericapsular injection (0.5% Marcaine with

Results

The ACB + PAI group consisted of 624 patients with a mean age of 64.5 years. There were 237 males (38%) and 387 females (62%) with a mean BMI of 32.6. The percentage of these patients requiring narcotics preoperatively was 29.7%. The PAI-alone group consisted of 69 patients with a mean age of 67.2 years. There were 28 males (41%) and 41 females (59%) with a mean BMI of 31.7. The percentage of these patients requiring narcotics preoperatively for pain control was 31.9%. The PAI group was

Discussion

Poorly controlled pain following TKA can result in diminished function with physical therapy, decreased mobilization, prolonged hospitalization, and reduced patient satisfaction. PAI and ACB have both been implicated as important components in multimodal pain management regimens but the role of ACB remains controversial. To our knowledge, this is the largest retrospective study exploring the role of ACB. We demonstrated improved function with physical therapy and decreased length of

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  • Cited by (7)

    • Intraoperative Surgeon Administered Adductor Canal Blockade Is Not Inferior to Anesthesiologist Administered Adductor Canal Blockade: A Prospective Randomized Trial

      2020, Journal of Arthroplasty
      Citation Excerpt :

      In the anesthesiologist performed group, 2 subjects underwent manipulation under anesthesia, and 1 subject had an unrelated hematoma. ACB has proven effective in reducing pain without providing motor blockade after TKA, either in isolation or as part of multimodal anesthesia with pericapsular injections [4–10]. Grevstad et al and Kuang et al demonstrated that ACB was equivalent in pain control to femoral nerve block without the motor blockade that is associated with femoral nerve blocks [6,7].

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.02.049.

    Source of funding: No outside sources of funding were used for this study.

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