Comparative evaluation of the use of femoral nerve block and adductor canal as a component of early patient activation after knee arthroplasty

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Abstract

BACKGROUND: The number of surgical interventions for the knee joint increases annually due the increase in the total number of patients and the improvement of operation techniques. The provision of modern anesthesiology and intensive care is associated with a positive treatment outcome, which is based on adequate pain relief in the perioperative period, suppressed complications, and reduction in hospital stay. Regional analgesia is a modern and effective method of pain relief after knee surgery. However, the location of peripheral blockade may affect the timing of activation and rehabilitation in these patients.

AIM: This study aimed to evaluate the use of femoral nerve and adductor canal blockade in the framework of the accelerated recovery program after knee arthroplasty.

MATERIALS AND METHODS: A prospective, randomized, single-center study included 80 patients who underwent primary knee arthroplasty and were randomly assigned to two clinical groups. Group 1 (n=40) included patients who underwent femoral nerve blockade in the postoperative period, and group 2 (n=40) included patients who underwent adductor canal blockade in the postoperative period. In the postoperative period, the level of pain at rest and during movement was analyzed using a visual analog pain level scale after 6, 12, 24, and 48 hours. The amount of prescribed narcotic analgesic in the postoperative period was recorded, and the total distance that patients were able to walk after 6, 12, 24, and 48 hours was measured.

RESULTS: For the level of pain at rest and during movement, no significant differences at all time intervals were observed for both groups (p >0.05). No additional prescription of narcotic analgesics was required. Compared with group 1, group 2 covered a significantly greater distance in the first 24 after the operation. After 48 hours, no significant differences were found between the two groups (p >0.05).

CONCLUSIONS: Femoral nerve and adductor canal blockades provide an adequate level of analgesia after knee arthroplasty. In particular, adductor canal blockade significantly increase the distance of movement by patients in the first 24 hours after surgery.

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About the authors

Sergey V. Krylov

National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorova; Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Author for correspondence.
Email: doc087@inbox.ru
ORCID iD: 0000-0001-7755-7163
SPIN-code: 4067-1787

MD, Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Igor N. Pasechnik

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Email: pasigor@yandex.ru
ORCID iD: 0000-0002-8121-4160
SPIN-code: 4433-1418

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

References

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Supplementary files

Supplementary Files
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2. Fig. 1. The neurovascular bundle at the level of the inguinal fold (1 – femoral artery, 2 – femoral nerve, 3 – iliopsoas muscle)

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3. Fig. 2. Femoral nerve after blockade (1 – femoral artery, 2 – femoral nerve, 3 – local anesthetic solution)

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4. Fig. 3. The neurovascular bundle at the level of the adductor canal (1 – external femoral artery, 2 – external femoral vein, 3 – femoral nerve in the adductor canal, 4 – sartorius muscle)

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5. Fig. 4. Femoral nerve in the adductor canal after blockade (1 – external femoral artery, 2 – femoral nerve in the adductor canal, 3 – local anesthetic)

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6. Fig. 5. Average distance traveled by patients (* p <0.05)

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