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Ultrasound-Guided Adductor Canal Block Versus Intraoperative Transarticular Saphenous Nerve Block: A Retrospective
Daniel S Sveom1, John V Horberg1, Donald A Allen1
1Department of Orthopaedic Surgery, Virginia Tech Carilion Clinic, Roanoke, VA.
The Journal of Arthroplasty
|February 22, 2022
Summary
The intraoperative adductor canal block (Low-ACB) offers comparable pain control and opioid use to the ultrasound-guided High-ACB for total knee arthroplasty (TKA). This safe, cost-effective Low-ACB is a viable alternative for TKA pain management.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- The ultrasound-guided adductor canal block (High-ACB) is effective for total knee arthroplasty (TKA) pain but incurs significant costs and preparation time.
- An intraoperative adductor canal block (Low-ACB) performed by the surgeon is a potential alternative.
- This study investigates if Low-ACB provides noninferior pain control and opioid use compared to High-ACB.
Purpose of the Study:
- To compare the efficacy of intraoperative Low-ACB versus ultrasound-guided High-ACB for postoperative pain management in TKA.
- To evaluate differences in opioid consumption, pain scores, functional outcomes, and complications between the two block techniques.
Main Methods:
- Retrospective analysis of a prospectively maintained database comparing High-ACB and Low-ACB in 139 TKA patients.
- Primary outcome: 24-hour postoperative morphine milligram equivalents (MME).
- Secondary outcomes: Visual Analog Scale (VAS) pain scores, Patient-Reported Outcome Measurement Information System (PROMIS), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, length of stay, mobilization speed, and complications.
Main Results:
- Opioid use in the first 24 hours was slightly lower in the Low-ACB group (26.3 MME) versus High-ACB (30 MME), but not statistically significant (P = .29).
- Postoperative day 1 VAS pain scores were significantly higher in the Low-ACB group (4.6) compared to High-ACB (3.7) (P = .02), but this difference lacked clinical significance.
- No significant differences were observed in PROMIS, KOOS, range of motion, or block-related complications between the groups.
Conclusions:
- The intraoperative Low-ACB is a safe and effective alternative for pain control in TKA.
- Low-ACB demonstrates cost-saving potential compared to the traditional High-ACB.
- The findings support the adoption of Low-ACB as a practical alternative in TKA procedures.
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