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Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty

View Article: PubMed Central - PubMed

ABSTRACT

A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA.

Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis.

Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea.

Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists.

No MeSH data available.


The result of the risk of bias summary.
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Figure 2: The result of the risk of bias summary.

Mentions: In the initial search, we identified 422 potentially relevant studies, of which 80 duplicates were removed by Endnote Software. According to the inclusion criteria, 335 studies were excluded after reading the titles and abstracts. Finally, we included 8 clinical trials with 751 patients (751 knees) in the meta-analysis.10–17 Since on study performed the trial in one patient with one leg in ACB and another is in FNB.11 The characteristics of the studies that were included are shown in Table 1. Of the included studies, a total of 751 TKAs are performed and the number of ACB and FNB is 360 and 391, respectively; all articles were in English and published from the year of 2013. All participants in the 8 studies were the elderly that prepared for TKA. The mean age of the patients in the studies ranged from 61.9 to 70 years. The male patients and female patients are 98 and 243, respectively. The included 8 studies contained 6 RCTs and 2 non-RCTs published within 2 years. Only 2 trials11,13 did not state the random sequence generation and only 1 RCT13 did not state the allocation concealment, blinding of participant and personnel, and blinding of outcome assessment. The details of Cochrane Handbook for Systematic Reviews of Interventions can be seen in Figure 1 and Figure 2. Minor quality scores can be seen in Table 2.


Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty
The result of the risk of bias summary.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998367&req=5

Figure 2: The result of the risk of bias summary.
Mentions: In the initial search, we identified 422 potentially relevant studies, of which 80 duplicates were removed by Endnote Software. According to the inclusion criteria, 335 studies were excluded after reading the titles and abstracts. Finally, we included 8 clinical trials with 751 patients (751 knees) in the meta-analysis.10–17 Since on study performed the trial in one patient with one leg in ACB and another is in FNB.11 The characteristics of the studies that were included are shown in Table 1. Of the included studies, a total of 751 TKAs are performed and the number of ACB and FNB is 360 and 391, respectively; all articles were in English and published from the year of 2013. All participants in the 8 studies were the elderly that prepared for TKA. The mean age of the patients in the studies ranged from 61.9 to 70 years. The male patients and female patients are 98 and 243, respectively. The included 8 studies contained 6 RCTs and 2 non-RCTs published within 2 years. Only 2 trials11,13 did not state the random sequence generation and only 1 RCT13 did not state the allocation concealment, blinding of participant and personnel, and blinding of outcome assessment. The details of Cochrane Handbook for Systematic Reviews of Interventions can be seen in Figure 1 and Figure 2. Minor quality scores can be seen in Table 2.

View Article: PubMed Central - PubMed

ABSTRACT

A total knee arthroplasty (TKA) has always been associated with moderate-to-severe pain. A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate the efficacy and safety of pain control of adductor canal block (ACB) and femoral nerve block (FNB) after TKA.

Relevant literatures about the ACB and FNB after TKA for reducing pain were searched from Medline (1996-January, 2015), Embase (1980-January, 2015), PubMed (1980-January, 2015), Web of Science (1980-January, 2015), and The Cochrane Central Register of Controlled Trials. High-quality RCTs and non-RCTs were picked to evaluate the visual analogue scale (VAS) and other outcome. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The software RevMan 5.30 was used for the meta-analysis.

Eight literatures fitted into the inclusion criteria. There were no significant differences in VAS score with rest or mobilization at 4, 24, and 48 h between ACB group and FNB group. There were also no significant differences in the strength of quadriceps and adductor, the length of hospital stay, and complications of vomiting and nausea.

Present meta-analysis indicated that ACB shows no superiority than FNB group. Both of them can reduce the pain score after TKA. As referred to which method to adopt, it is determined by the preference of the surgeons and anesthesiologists.

No MeSH data available.