2023, Vol. 27 ›› Issue (4): 640-645

A meta-analysis of the effects of continuous adductor canal block and continuous femoral nerve block on early activity after knee arthroplasty

Xu Yangyang1, He Peiliang2, Meng Qingqi2, Li Siming1, 2   

Abstract: OBJECTIVE: To systematically evaluate the effects of continuous adductor canal block versus continuous femoral nerve block on pain relief and functional recovery after total knee arthroplasty.
METHODS: The free words “arthroplasty, replacement, knee; continuous adductor canal block; adductor canal block; continuous femoral nerve block; femoral nerve block” were added according to the subject word. The main databases were searched, including CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, etc., for randomized controlled trials of continuous adductor canal block and continuous femoral nerve block after total knee arthroplasty published from inception to August 31, 2021. Two researchers independently screened the literature, performed quality assessment and offset risk assessment with Cochrane. Relevant outcome indicators, containing analgesic effect (resting pain and post-activity pain score, use of weak opioids), functional recovery (quadriceps muscle strength, timed up & go test, and hospital stay), and complications (nausea, vomiting, and falls), were collected and meta-analyzed by Revman 5.3 software.
RESULTS: (1) A total of 617 patients were included in 9 articles, all of which were randomized controlled trials. The evaluation of literature quality indicated that the overall quality was good. (2) Compared with continuous femoral nerve block, continuous adductor canal block had significant differences in quadriceps strength (MD=1.42; 95%CI, 0.32-2.52; P=0.01) and timed up & go test (MD=-1.23; 95%CI, -2.03 to -0.42; P=0.003). (3) There was no significant difference in pain score after rest and activity (P > 0.05), postoperative opioid consumption (MD =0.51; 95%CI, 0.20 to 1.30; P=0.16), and hospital stay (MD =-0.42; 95%CI, -1.24 to 0.40; P=0.32) between continuous femoral nerve block and continuous adductor canal block. (4) In addition, there was no significant difference in the incidence of complications between the two block methods, including nausea and vomiting (MD=1.04; 95%CI, 0.06-17.15; P=0.98) and falls (MD=0.45; 95%CI, 0.10-2.08; P=0.31).
CONCLUSION: The analgesic effect of continuous adductor canal block after total knee arthroplasty is similar to that of continuous femoral nerve block, but continuous adductor canal block reduces the effect on quadriceps muscle strength and is beneficial to early activity after total knee arthroplasty.
Key words: continuous adductor canal block, continuous femoral nerve block, total knee arthroplasty, meta-analysis, pain