Purpose
To compare femoral nerve blockade (FNB) versus adductor canal nerve blockade (ACB)
for postoperative pain control and quadriceps muscle function in patients undergoing
anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft.
Methods
A randomized therapeutic trial of 90 patients undergoing ACL reconstruction with patellar
tendon autograft was conducted comparing ACB versus FNB at 24 hours, 2 and 4 weeks,
and 6 months postsurgery. Early outcome measures included average pain score and morphine
equivalent units (milligrams) consumed, quadriceps surface electromyography, straight
leg raise, and ability to ambulate without assistive devices. The 6-month outcome
measures included knee range of motion (ROM), isokinetic knee extension peak torque,
single-leg squat, and single-leg hop performance. Complications were recorded throughout
the study for the development of anterior knee pain, knee extension ROM loss, deep
vein thrombosis, and graft failure. Mixed-model analysis of variance and Mann-Whitney
U tests were performed using an alpha of .05.
Results
Quadriceps surface electromyography deficits were higher for FNB at 24 hours (P < .001) and 2 weeks (P < .001) when compared with the ACB group. There were no between-groups difference
for subjective pain (P = .793) or morphine consumption (P = .358) within the first 24 hours of surgery. A higher percentage of patients in
the ACB group met the full ambulation criteria at 4 weeks compared with the FNB group
(100% vs 84.2%, P < .001). No between-group differences were observed at 6 months; however, the rate
of knee extension ROM loss was higher for the FNB group versus the ACB group (21.1%
vs 5.0%, P = .026), respectively.
Conclusions
ACB was as effective as FNB at providing pain control while eliciting fewer quadriceps
muscle activation deficits and fewer postoperative complications. Based on previous
evidence and the results of this study, we recommend the use of ACB over FNB for the analgesic
management of patients undergoing ACL reconstruction with patellar tendon autograft.
Level of Evidence
Level I, prospective randomized controlled trial.
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Article Info
Publication History
Published online: February 04, 2019
Accepted:
October 21,
2018
Received:
June 12,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: This study was internally funded by the Memorial Hermann Heath System and the UT Department of Orthopedics . Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This trial is registered at the US National Institutes of Health (ClinicalTrials.gov) as #NCT03704376.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America. Published by Elsevier. All rights reserved.
