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Continuous Ultrasound-Guided Adductor Canal Block for Total Knee Arthroplasty: A Randomized, Double-Blind Trial

Hanson, Neil A. MD*; Allen, Cindy Jo RN*; Hostetter, Lucy S. MD; Nagy, Ryan MD*; Derby, Ryan E. MD, MPH*; Slee, April E. MS; Arslan, Alex BS; Auyong, David B. MD*

doi: 10.1213/ANE.0000000000000197
Regional Anesthesia: Research Report

BACKGROUND: Adductor canal blocks have shown promise in reducing postoperative pain in total knee arthroplasty patients. No randomized, controlled studies, however, evaluate the opioid-sparing benefits of a continuous 0.2% ropivacaine infusion at the adductor canal. We hypothesized that a continuous adductor canal block would decrease postoperative opioid consumption.

METHODS: Eighty subjects presenting for primary unilateral total knee arthroplasty were randomized to receive either a continuous ultrasound-guided adductor canal block with 0.2% ropivacaine or a sham catheter. All subjects received a preoperative single-injection femoral nerve block with spinal anesthesia as is standard of care at our institution. Cumulative IV morphine consumption 48 hours after surgery was evaluated with analysis of covariance, adjusted for baseline characteristics. Secondary outcomes included resting pain scores (numeric rating scale), peak pain scores during physical therapy on postoperative days 1 and 2, quadriceps maximum voluntary isometric contraction, distance ambulated during physical therapy, postoperative nausea and vomiting, and satisfaction with analgesia.

RESULTS: Eighty subjects were randomized, and 76 completed the study per-protocol. The least-square mean difference in cumulative morphine consumption over 48 hours (block − sham) was −16.68 mg (95% confidence interval, −29.78 to −3.59, P = 0.013). Total morphine use between 24 and 48 hours (after predicted femoral nerve block resolution) also differed by least-square mean −11.17 mg (95% confidence interval,: −19.93 to −2.42, P = 0.013). Intention-to-treat analysis was similar to the per-protocol results. Functional outcomes revealed subjects in the adductor canal catheter group had better quadriceps strength (P = 0.010) and further distance ambulated (P = 0.034) on postoperative day 2.

CONCLUSIONS: A continuous adductor canal block for total knee arthroplasty reduces opioid consumption compared with that of placebo in the first 48 hours after surgery. Other outcomes including quadriceps strength, distance ambulated, and pain scores all show benefit from an adductor canal catheter after total knee arthroplasty but require further study before being interpreted as conclusive.

From the *Department of Anesthesiology, Virginia Mason Medical Center; Department of Anesthesiology, Physicians Anesthesia Service, Seattle, Washington; and Axio Research, Seattle, Washington.

Accepted for publication January 21, 2014.

Ryan Nagy, MD, is currently affiliated with Department of Anesthesiology, University Hospital at Indiana University Health, Indianapolis, Indiana.

Ryan E. Derby, MD, MPH, is currently affiliated with Department of Anesthesiology, Stanford School of Medicine, Palo Alto, California.

Funding: Internal support, Virginia Mason Medical Center.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to David B. Auyong, MD, Virginia Mason Medical Center, 1100 Ninth Ave., MS: B2-AN, Seattle, WA 98101. Address e-mail to

© 2014 International Anesthesia Research Society