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Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Gao, Fuqiang MD; Ma, Jinhui MD; Sun, Wei MD; Guo, Wanshou MD; Li, Zirong MD; Wang, Weiguo MD

doi: 10.1097/AJP.0000000000000402
Review Articles

Objectives: The efficacy and safety of adductor canal block (ACB) as compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) remains controversial. We therefore performed a meta-analysis of randomized-controlled trials (RCTs) to compare ACB with FNB in TKA.

Materials and Methods: Databases, including Pubmed, Medline, Embase, Web of Science, and Cochrane library were searched to identify RCTs comparing ACB with FNB for pain management in patients undergoing TKA. The primary outcomes included pain score with rest or activity and opioid consumption. Secondary outcomes were mobilization ability, quadriceps strength and grade, length of hospital stay, and complications (nausea or vomiting).

Results: A total of 573 TKAs in 514 patients from 7 RCTs were included in the meta-analysis. Two studies with 155 TKAs reported the mobilization ability assessed by Timed Up and Go Test. The ACB patients performed significantly faster than the FNB patients in the early postoperative period (mean difference=−5.08; 95% confidence interval, −6.03 to −4.13; P<0.00001). The subgroup analysis showed that the outcomes of pain, morphine consumption, quadriceps strength, and length of hospital stay in single shot and continuous subgroups were not statistically different between the 2 groups (P>0.05).

Discussion: ACB may achieve faster mobilization ability recovery for patients after TKA without a reduction in analgesia when compared with FNB in the early postoperative period. However, due to the variations in the included studies, additional studies are needed to validate these conclusions.

*Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction

Peking University, China-Japan Friendship School of Clinical Medicine, Beijing, China

Supported by the National Natural Science Foundation of China, BeiJing (81372013) and the Research Fund of China-Japan Friendship Hospital, BeiJing (2013-MS-27, 2014-4-QN-29). China-Japan Friendship Hospital Youth Science and Technology Excellence project, BeiJing (2014-QNYC-A-06). The authors declare no conflict of interest.

Reprints: Wei Sun, MD, Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing 100029, China (e-mail:

Received December 4, 2015

Received in revised form November 4, 2016

Accepted June 11, 2016

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