Two broken pieces make a whole: adductor canal block
Keywords:Adductor canal blockade, Catheter fracture, Ultrasound guided, Total knee arthroplasty
Total knee arthroplasty (TKA) is expounded to intense postoperative pain with a desire for early ambulation and reduce postoperative complications. Adductor canal blockade (ACB) blocks primarily the pain sensation while preserving the quadriceps strength facilitating early rehabilitation after knee surgery. ACB has been gaining popularity over femoral nerve block (FNB), continuous epidural analgesia (CEA), and psoas compartment block (PCB). Studies show that use of ultrasound alone reduced the possibilities of vascular and multiple skin punctures. Though there's emerging evidence proving the efficacy of ACB, there's limited literature on safe use of continuous ACB catheters. We report 2 cases of catheter fracture with USG guided ACB employed in TKA.
Kuang MJ, Ma JX, Fu L, He WW. Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. The Journal of Arthroplasty. 2017;32(10):3238-48.
Alsheikh KA, Alkhelaifi AS, Alharbi MK, Alhabradi FA. Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study. Saudi Journal of Anaesthesia. 2020;14(1):38.
Henshaw DS, Jaffe JD, Reynolds JW, Dobson S. An evaluation of ultrasound-guided adductor canal blockade for postoperative analgesia after medial unicondylar knee arthroplasty. Anesthesia & Analgesia. 2016;122(4):1192-201.
Elkassabany NM, Cai LF, Badiola I, Kase B. prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. The bone & joint journal. 2019;101(3):340-7.
Kim MK, Moon HY, Ryu CG, Kang H. The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty: a randomized controlled trial. The Korean journal of pain. 2019;32(1):30.
Zhang LK, Zhang BY, Quan RF, Xu H. Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty: A PRISMA-compliant meta-analysis. Medicine. 2019;98(20).
Lee S, Rooban N, Vaghadia H, Sawka AN, Tang R. A randomized non-inferiority trial of adductor canal block for analgesia after total knee arthroplasty: single injection versus catheter technique. The Journal of arthroplasty. 2018;33(4):1045-51.
Turner JD, Dobson SW, Henshaw DS, Edwards CJ. Single-injection adductor canal block with multiple adjuvants provides equivalent analgesia when compared with continuous adductor canal blockade for primary total knee arthroplasty: a double-blinded, randomized, controlled, equivalency trial. The Journal of arthroplasty. 2018;33(10):3160-6.
Schnabel A, Reichl SU, Weibel S, Zahn PK. Adductor canal blocks for postoperative pain treatment in adults undergoing knee surgery. Cochrane Database of Systematic Reviews. 2019(10).