Single-injection nerve blocks for total knee arthroplasty : femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial
Salvadores de Arzuaga, Carlos Ignacio (Hospital Universitari Vall d'Hebron)
Miguel, Marcos (Hospital Universitari Vall d'Hebron)
Biarnés, Alfons (Hospital Universitari Vall d'Hebron)
García, Marcelo (Hospital Universitari Vall d'Hebron)
Naya, José (Hospital Universitari Vall d'Hebron)
Khoudeir, Andrea (Hospital Universitari Vall d'Hebron)
Minguell-Monyart, Joan (Hospital Universitari Vall d'Hebron)
Pujol, Oriol (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	Introduction: Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. Methods: This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. Results: Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0. 001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0. 01), 24 h (p = 0. 005) and 48 h (p = 0. 01). The highest cumulative opioid requirement was reported in ACB-G3. Conclusion: For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. Clinical trial registration: This study was registered in clinicaltrials. gov (NCT03518450; https://clinicaltrials. gov/ct2/show/NCT03518450 ; submitted March 17, 2018).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	Archives of Orthopaedic and Trauma Surgery, Vol. 143 Núm. 11 (november 2023) , p. 6763-6771, ISSN 1434-3916

DOI: 10.1007/s00402-023-04960-5
PMID: 37391523

9 p, 710.9 KB

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