Keywords
adductor canal block
ultrasound
postoperative analgesia
opioids
How to Cite
Abstract
Introduction: Knee arthroscopy is a minimally invasive procedure with the potential to cause postoperative pain, affecting early recovery. To effectively manage this pain, the adductor canal block (ACB) is positioned as a viable option within a multimodal analgesia regimen, offering advantages over conventional femoral nerve block and prolonged opioid use. Objective: The aim of this study was to review the efficacy and safety of ultrasound-guided ACB in patients over 65 years old undergoing knee arthroscopy. Methodology: A systematic review of studies was conducted on PubMed, considering specific inclusion criteria, resulting in 14 studies selected for detailed analysis. Results: The results indicate that ACB provides effective analgesia, and its combination with techniques such as IPACK and periarticular infiltration improves pain management and reduces opioid consumption, promoting early mobilization. No significant differences were found when comparing proximal and distal blocks, although opioid use is lower in the proximal group. Conclusion: Ultrasound-guided ACB is effective and safe for managing postoperative pain in knee arthroscopy for older patients. Its use in combination with other techniques can optimize results, highlight the importance of the professional performing the block, and consider the impact of additional pharmacology.
References
Chen B, Tan M, Li Q, Wang S, Chen D, Zhao M, et al. Application of ultrasound-guided single femoral triangle and adductor canal block in arthroscopic knee surgery: a prospective, double-blind, randomized clinical study. BMC Anesthesiol [Internet]. 23 de mayo de 2024;24:182. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11112763/
Ekinci M, Ciftci B, Demiraran Y, Celik EC, Yayik M, Omur B, et al. A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: a randomized, blinded study. Korean J Anesthesiol [Internet]. diciembre de 2021;74(6):514-21. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648508/
Xie Y, Sun Y, Lu Y. Effect of Adductor Canal Block Combined with Local Infiltration Analgesia on Postoperative Pain of Knee Arthroscopy Under General Anesthesia: A Randomized Controlled Trial. Pain and Therapy [Internet]. 15 de febrero de 2023;12(2):543. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10036701/
Tamam A, Güven Köse S, Köse HC, Akkaya ÖT. Comparison of the Effectiveness of Ultrasound-Guided Proximal, Mid, or Distal Adductor Canal Block after Knee Arthroscopy. Turk J Anaesthesiol Reanim [Internet]. 1 de abril de 2023;51(2):135-42. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210929/
Rahimzadeh P, Faiz HR, Imani F, Hobika GG, Abbasi A, Nader ND. Relieving Pain After Arthroscopic Knee Surgery: Ultrasound-Guided Femoral Nerve Block or Adductor Canal Block? Turkish Journal of Anaesthesiology and Reanimation [Internet]. 1 de agosto de 2017;45(4):218. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5579215/
Zhang LK, Chen C, Du WB, Zhou HT, Quan RF, Liu JS. Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 23 de octubre de 2020;99(43):e22667.
Yin W, Luo D, Xu W, Yang W, Jia S, Lin J. Effect of adductor canal block combined with infiltration between the popliteal artery and posterior capsular of the knee on chronic pain after total knee arthroplasty: a prospective, randomized, double-blind, placebo-controlled trial. BMC Anesthesiol [Internet]. 10 de septiembre de 2024;24:320. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11385851/
Mu T, Yuan B, Wei K, Yang Q. Adductor canal block combined with genicular nerve block versus local infiltration analgesia for total knee arthroplasty: a randomized noninferiority trial. J Orthop Surg Res [Internet]. 6 de septiembre de 2024;19:546. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378376/
Wang CG, Ding YL, Wang YY, Liu JY, Zhang Q. Comparison of Adductor Canal Block and Femoral Triangle Block for Total Knee Arthroplasty. Clin J Pain. julio de 2020;36(7):558-61.
Lawrence KW, Konopka JA, Arraut J, Bieganowski T, Schwarzkopf R, Rozell JC. Tourniquet and/or Adductor Canal Block Use Confer No Additional Early Quadriceps Weakness Following Total Knee Arthroplasty: An Analysis of 203 Patients. Iowa Orthop J [Internet]. 2024;44(2):67-76. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726490/
Ren Y, Hou Z, Zhang Y, Li Y, Liu H. Analgesic Effect of Intermittent Multiple IPACK Block Combined with ACB in Patients with Flexion Contracture Knee Arthritis Undergoing Total Knee Arthroplasty. J Knee Surg [Internet]. 20 de enero de 2025;38(6):316-22. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020490/
Cakmak MF, Horoz L, Arslan FN, Demir OU, Basarir K. Comparison ultrasound-guided adductor canal block and surgeon-performed block for pain management after total knee arthroplasty: a prospective randomized controlled study. BMC Musculoskelet Disord [Internet]. 10 de agosto de 2024;25:637. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316281/
Tan M, Chen B, Li Q, Wang S, Chen D, Zhao M, et al. Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty. Clin J Pain [Internet]. 20 de marzo de 2024;40(6):373-82. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11081475/
Brown B, Cheok TS, Worsley D, Kroon HM, Davis N, Jaarsma RL, et al. Comparative efficacy of intrathecal morphine and adductor canal block in the knee arthroplasty population: a retrospective multi-centre cohort study. BMC Anesthesiol [Internet]. 10 de octubre de 2024;24:365. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465912/
Zhao D, Li P. Efficacy of adding infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) to adductor canal block and local infiltration analgesia in total knee arthroplasty: A retrospective cohort study. J Orthop Surg (Hong Kong). 2024;32(2):10225536241265445.
Jiang B wei, Guo Y, Yang M yu, Zhang Q, Liu J ning, Gao M na, et al. The analgesic effect of continuous adductor canal block combined with popliteal plexus block for total knee arthroplasty: a randomized controlled trial. Sci Rep [Internet]. 12 de noviembre de 2024;14:27757. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557969/
Salihovic M, Rijavec B, Muratagic A, Blagus R, Puh U. Effectiveness of Ultrasound-Guided Canal Adductor Blockade for Chronic Pain and Functioning in Knee Osteoarthritis: A Prospective Longitudinal Observational Study. Biomed Res Int [Internet]. 22 de enero de 2022;2022:5270662. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8800601/
Sirivanasandha B, Sutthivaiyakit K, Kerdchan T, Poolsuppasit S, Tangwiwat S, Halilamien P. Adding a low-concentration sciatic nerve block to total knee arthroplasty in patients susceptible to the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial. BMC Anesthesiol [Internet]. 13 de noviembre de 2021;21:282. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590368/
Jaremko I, Lukaševič K, Tarasevičius Š, Zeniauskas L, Macas A, Gelmanas A. Comparison of 2 Peripheral Nerve Blocks Techniques for Functional Recovery and Postoperative Pain Management After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Trial. Med Sci Monit [Internet]. 11 de octubre de 2021;27:e932848-1-e932848-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518512/
Fei Y, Cui X, Chen S, Peng H, Feng B, Qian W, et al. Continuous block at the proximal end of the adductor canal provides better analgesia compared to that at the middle of the canal after total knee arthroplasty: a randomized, double-blind, controlled trial. BMC Anesthesiol [Internet]. 9 de octubre de 2020;20:260. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545931/
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