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Slightly improved pain control found with adductor canal block during TKA

Although use of adductor canal block briefly decreased pain after TKA, the cost was higher compared with intra-articular catheter.

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DALLAS — Compared with intra-articular catheter, patients who received adductor canal block during primary total knee arthroplasty experienced better pain control and reduced narcotic consumption, according to results presented here.

“We found that adductor canal blocks provided equivalent to better pain control, and they reduced narcotic consumption; however, they are more expensive,” Antonia F. Chen, MD, MBA, said in her presentation at the American Association of Hip and Knee Surgeons Annual Meeting.

Adductor vs. intra-articular

Chen, William J. Hozack, MD, and colleagues randomly assigned 85 patients undergoing total knee arthroplasty (TKA) to receive either intra-articular catheter or postoperative adductor canal block. Overall, 42 patients received the intra-articular catheter with a constant infusion of 0.5% bupivacaine at 4 mL per hour and 43 patients received the adductor canal block with 0.2% ropivacaine at 10 mL per hour.

Primary outcome measures included VAS scale performed before, during and after physical therapy and the Wong-Baker pain scale.

“Secondary outcomes included total narcotic consumption, range of motion, patient satisfaction and length of stay,” Chen said.

Four hours after the spinal anesthesia wore off, patients in the adductor canal group exhibited the lowest pain scores compared with patients in the intra-articular group. The adductor canal group also experienced the lowest pain scores during physical therapy on postoperative day 1.

“Looking at total morphine equivalence, we found that it was lower in the adductor canal group after 24 hours, but they were pretty similar at 48 hours,” Chen said. “There was no difference in range of motion, satisfaction and length of stay.”

However, Chen and colleagues determined the cost of intra-articular catheter was lower than with adductor canal ($155 vs. $258).

Pros, cons for adductor canal

“A previous study found that pain is well controlled using intra-articular catheters, so we were not surprised to see that pain was also well controlled when compared to a different modality, but there are benefits and downsides to this modality,” Chen told Orthopedics Today. “The downsides are that you need an anesthesia team who can do a specialized block, as an adductor canal block is not routinely used.”

However, she said an upside to using adductor canal is it goes on the outside of the patient’s knee, leaving nothing left inside the joint compared with intra-articular catheters. This feature may also potentially reduce the risk for infection.

“We have shown that adductor canal blocks are essentially equivalent to intra-articular catheters,” Chen said. “Now we want to compare adductor canal blocks to what we have started using more regularly now which is intra-articular injections.” – by Casey Tingle

Chen AF, et al. Paper #37. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 7-9, 2015; Dallas.

For more information:

Antonia F. Chen, MD, MBA, can be reached at the Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107; email: antonia.chen@rothmaninstitute.com.