Adductor canal block catheters and post-TKA outcomes: Weighing pain management against complication risks

BackgroundAdductor canal block (ACB) catheters are an effective method of pain control for patients undergoing total knee arthroplasty (TKA). Despite their widespread use, there is limited research analyzing their impact on postoperative outcomes. Thus, this study compares 30 and 90 days postoperative outcomes in TKA patients stratified by the use of an ACB catheter.MethodsThis retrospective, propensity-matched cohort study utilized the TriNetX Research Network. The first cohort included patients who had an indwelling ACB catheter (continuous infusion) on the same day as their TKA (+ACB). The second cohort consisted of patients who did not have an ACB catheter on the same day as their TKA (-ACB). The study analyzed data collected between January 1, 2003, and January 1, 2023. To control for confounding variables, propensity score matching was employed based on common comorbidities. P < 0.01 was considered significant.ResultsA total of 27,813 patients were successfully matched in each cohort. Within 30 days following TKA, patients in the +ACB cohort exhibited a significantly increased rate of several complications including: transfusion (1.5% vs 0.5%; RR: 3.2), deep vein thrombosis (lower extremity) (2.5% vs 1.9%; RR: 1.3), periprosthetic joint infection (0.9% vs 0.6%; RR: 1.6), acute renal failure (2.1% vs 1.2%; RR: 1.8), acute posthemorrhagic anemia (8.1% vs 3.9%; RR: 2.1), and opioid use (98.6% vs 94.2%; RR: 1.046 [95% CI: 1.043-1.050]). The increased risk profile remained at 90-days follow-up. Notably, we found no significant difference in the risk of manipulation under anesthesia between the cohorts at 90-days follow-up (RR: 1.0).ConclusionOur study raises concern that the use of ACB catheters in TKA may increase morbidity following TKA. While ACB catheters may help with pain management, these results suggest an increased risk of many postoperative complications within 30- and 90-days post-TKA.