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The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

대한마취과학회지 2020년 73권 5호 p.417 ~ 424
Gadsden Jeff C., Sata Siddharth, Bullock W. Michael, Kumar Amanda H., Grant Stuart A., Dooley Joshua R.,
소속 상세정보
 ( Gadsden Jeff C. ) - Duke University Duke University Medical Center Department of Anesthesiology
 ( Sata Siddharth ) - Duke University Duke University Medical Center Department of Anesthesiology
 ( Bullock W. Michael ) - Duke University Duke University Medical Center Department of Anesthesiology
 ( Kumar Amanda H. ) - Duke University Duke University Medical Center Department of Anesthesiology
 ( Grant Stuart A. ) - Duke University Duke University Medical Center Department of Anesthesiology
 ( Dooley Joshua R. ) - University of North Carolina University of North Carolina Medical Center Department of Anesthesiology

Abstract


Background: Multiple comparative studies report that adductor canal blocks provide similar pain relief to femoral nerve blocks following total knee arthroplasty. However, adductor canal blockade fails to anesthetize several important femoral nerve branches that contribute to knee innervation. We sought to clarify this anatomic discrepancy by performing both blocks in sequence, using patients as their own controls. We hypothesized that patients would experience additional pain relief following a superimposed femoral nerve block, demonstrating that these techniques are not equivalent.

Methods: Sixteen patients received continuous adductor canal block before undergoing knee arthroplasty under general anesthesia. In the recovery room, patients reported their pain score on a numeric scale of 0?10. Once a patient reached a score of five or greater, he/she was randomized to receive an additional femoral nerve block using 2% chloroprocaine or saline sham, and pain scores recorded every 5 min for 30 min. Patients received opioid rescue as needed. Anesthesiologists performing and assessing block efficacy were blinded to group allocation.

Results: Patients randomized to chloroprocaine versus saline reported significantly improved median pain scores 30 min after the femoral block (2.0 vs. 5.5, P < 0.001). Patients receiving chloroprocaine also required significantly fewer morphine equivalents during the 30 min post-femoral block (1.0 vs. 4.5 mg, P = 0.032).

Conclusions: Adductor canal block is a useful technique for postoperative pain following total knee arthroplasty, but it does not provide equivalent analgesic efficacy to femoral nerve block. Future studies comparing efficacy between various block sites along the thigh are warranted.

키워드

Acute pain; Adductor canal block; Femoral nerve block; Ropivacaine; Total knee arthroplasty; Ultrasound

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