title: Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials.
abstract: Femoral nerve blocks (FNB) can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty (TKA). Adductor canal block (ACB) is a relatively new alternative providing pure sensory blockade with minimal effect on quadriceps strength. The meta-analysis was designed to evaluate whether ACB exhibited better outcomes with respect to quadriceps strength, pain control, ambulation ability, and complications. PubMed, Embase, Web of Science, Wan Fang, China National Knowledge Internet (CNKI) and the Cochrane Database were searched for RCTs comparing ACB with FNB after TKAs. Of 309 citations identified by our search strategy, 12 RCTs met the inclusion criteria. Compared to FNB, quadriceps maximum voluntary isometric contraction (MVIC) was significantly higher for ACB, which was consistent with the results regarding quadriceps strength assessed with manual muscle strength scale. Moreover, ACB had significantly higher risk of falling versus FNB. At any follow-up time, ACB was not inferior to FNB regarding pain control or opioid consumption, and showed better range of motion in comparison with FNB. ACB is superior to the FNB regarding sparing of quadriceps strength and faster knee function recovery. It provides pain relief and opioid consumption comparable to FNB and is associated with decreased risk of falls.
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Duan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Prosthodontics, West China College of Stomatology, Sichuan University, Chengdu 610041, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Breast Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Shen-Li
authors.initials: SL
authors.lastname: Tang
authors.affiliation: Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Wei-Nan
authors.initials: WN
authors.lastname: Zeng
authors.affiliation: Tianjin hospital, Tianjin, 300041, P.R. China.
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Tian-Hang
authors.initials: TH
authors.lastname: Xie
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Fu-Xing
authors.initials: FX
authors.lastname: Pei
authors.affiliation: Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Ling-Li
authors.initials: LL
authors.lastname: Li
authors.affiliation: Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, P.R. China.
authors.forename: Zong-Ke
authors.initials: ZK
authors.lastname: Zhou
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D001340:Autonomic Nerve Block / Q000379:methods; D019468:Disease Management; D005267:Femoral Nerve / Q000187:drug effects*; D006801:Humans; D053580:Muscle Strength; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D011183:Postoperative Complications; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular
chemical_list: D000701:Analgesics, Opioid