title: Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment: a randomised and blinded clinical trial.
abstract: BACKGROUND
  Continuous femoral nerve blocks for total knee arthroplasty can cause motor weakness of the quadriceps muscle and thus prevent early mobilisation. Perioperative falls may result as an iatrogenic complication. In this randomised and blinded trial, we tested the hypothesis that a continuous adductor canal block is superior to continuous femoral nerve block regarding mobilisation ('timed up-and-go' test and other tests) after total knee arthroplasty under general anaesthesia.
  
  
  METHODS
  In our study, we included patients scheduled for unilateral knee arthroplasty under general anaesthesia into a blinded and randomised trial. Patients were allocated to a continuous adductor canal block (CACB) or a continuous femoral nerve block (CFNB) for three postoperative days (POD 1-3); with a bolus of 15 ml ropivacaine 0.375%, followed by continuous infusion of ropivacaine 0.2% and patient-controlled bolus administration. Both groups received an additional continuous sciatic nerve block as well as a multimodal systemic analgesic treatment. The primary outcome parameter was mobilisation capability, assessed by 'timed up-and-go' (TUG) test. Analgesic quality, need for opioid rescue and local anaesthetic consumption were also assessed.
  
  
  RESULTS
  Forty-two patients were included and analysed (21 patients per group). No significant difference was noted in respect to mobilisation at POD 3 (TUG [s]: CACB 45, CFNB 51). It is worth saying that pain scores (numeric rating scale, NRS) were similar in both groups at POD 3 {rest [median (interquartile range)]: CACB 0 (0-3), CFNB 1 (0-3); stress: CACB 4 (2-5), CFNB 3 (2-4)}.
  
  
  CONCLUSIONS
  Concerning the mobilisation capability, we did not actually observe a superior effect of CACB compared with CFNB technique in our patients following total knee arthroplasty. Moreover, no difference was observed concerning analgesia quality.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany. wiesmann@med.uni-marburg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiesmann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.|Department of Anaesthesiology and Intensive Care, University Hospital of Bern, Bern, Switzerland.
authors.forename: Karolin
authors.initials: K
authors.lastname: Piechowiak
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Duderstadt
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Haupt
authors.affiliation: Department of Orthopaedics and Rheumatology, University Hospital, Philipps University, Marburg, Germany.|Department of Orthopaedics and Traumatology, Lahn-Dill-Klinikum Wetzlar, Wetzlar, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Department of Traumatology, University Hospital Marburg, University Hospital, Philipps University, Marburg, Germany.
authors.forename: Daphne
authors.initials: D
authors.lastname: Eschbach
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Feldmann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Zoremba
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Philipps University, Marburg, Baldingerstrasse, 35033, Marburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004311:Double-Blind Method; D004434:Early Ambulation; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D026741:Physical Therapy Modalities; D010892:Pirinitramide / Q000627:therapeutic use; D011184:Postoperative Period; D052097:Quadriceps Muscle; D000077212:Ropivacaine; D012584:Sciatic Nerve; D013848:Thigh; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077212:Ropivacaine
keywords: Adductor canal block; Femoral nerve; Knee arthroplasty; Mobilisation; Motor weakness; Regional anaesthesia; Sciatic nerve