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

TY - JOUR

T1 - Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty

T2 - A Randomized, Blinded Study

AU - Grevstad, Jens Ulrik

AU - Mathiesen, Ole

AU - Valentiner, Laura Risted Staun

AU - Jaeger, Pia

AU - Hilsted, Karen Lisa

AU - Dahl, Jørgen B

PY - 2015/1

Y1 - 2015/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anesthetics, Local

KW - Arthroplasty, Replacement, Knee

KW - Autonomic Nerve Block

KW - Female

KW - Femoral Nerve

KW - Humans

KW - Male

KW - Middle Aged

KW - Mobility Limitation

KW - Muscle Strength

KW - Pain, Postoperative

KW - Prospective Studies

KW - Quadriceps Muscle

KW - Single-Blind Method

KW - Treatment Outcome

U2 - 10.1097/AAP.0000000000000169

DO - 10.1097/AAP.0000000000000169

M3 - Journal article

C2 - 25376972

SN - 1098-7339

VL - 40

SP - 3

EP - 10

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

IS - 1

ER -