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4712
Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Block Effects? A Randomized, Subject-Masked, Controlled Clinical Trial
Session: MP-04c
Thurs, April 19, 3:30-5:00 pm
Plymouth (Shubert Complex), 6th floor

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Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Block Effects?A Randomized, Subject-Masked, Controlled Clinical Trial

 

Sztain JF, Khatibi B, Monahan AM,Said ET, Gabriel RA, Finneran JJ, Bellars RH, Ball ST, Gonzales FB , Ahmed SS, Padwal JA, Ilfeld BM

 

From the University of California at San Diego

 

Background

A continuous adductor canal block provides analgesia following surgical procedures of

the knee (1). Neuroanatomy of the thigh and knee has led to speculation that local

anesthetic deposited in the distal thigh close to the adductor hiatus would provide

superior analgesia than a more proximal location (2-4). We therefore tested the

hypothesis that during a continuous adductor canal nerve block, postoperative analgesia

will be improved with the perineural catheter tip inserted in a distal location 2-3 cm

cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal

location) compared to a more proximal location at the midpoint between the anterior

superior iliac spine and the superior border of the patella (proximal location).

 

Methods

The protocol was registered (NCT02523235), approved by the local IRB, and all subjects

provided written informed consent. Preoperatively, subjects undergoing total knee

arthroplasty received an ultrasound-guided perineural catheter inserted either in the

proximal (5) or distal location (4) within the adductor canal in a randomized, subjectmasked

fashion. Subjects received a single-injection of lidocaine 2% via the catheter

preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus,

30 min lockout) for the study duration. The primary end point was the average level of

pain as measured on a numeric rating scale (NRS) during the time period of 08:00-24:00

the day following surgery.

 

Results

The average NRS of subjects with a catheter inserted at the proximal location (n=22) was

a mean (SD) of 2.1 (2.4) versus 3.7 (2.8) for subjects with a catheter inserted in the distal

location (n=25; P=0.038). Average and maximum/worst NRS at most other time points

were lower in the proximal group, but these differences did not reach statistical

significance (Figures; red star indicates p<0.05). Similarly, there were no clinicallyrelevant

or statistically significant differences between the treatment groups for any

other secondary end point (Tables).

 

Conclusion

For continuous adductor canal blocks, analgesia the day following knee arthroplasty is improved with a catheter

inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the

patella, compared with a more distal insertion closer to the adductor hiatus.

 

References

 

1. .Machi AT, et al: Discharge readiness after tricompartment knee arthroplasty: Adductor canal versus femoral continuous nerve blocks. A dual-center, randomized trial.

Anesthesiology 2015; 123: 444-56

2. Bendtsen TF, et al:Defining adductor canal block. Reg Anesth Pain Med 2014; 39: 253-4

3. Bendtsen TF et al: The Optimal Analgesic Block for Total Knee Arthroplasty. Reg Anesth Pain Med 2016; 41: 711-719

4. Manickam B,, et all: Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med 2009; 34: 578-580

5. Jaeger P et all: Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 2013; 38:

526-32

The average NRS of subjects with a catheter inserted at the proximal location (n=22) was

a mean (SD) of 2.1 (2.4) versus 3.7 (2.8) for subjects with a catheter inserted in the distal

location (n=25; P=0.038). Average and maximum/worst NRS at most other time points

were lower in the proximal group, but these differences did not reach statistical

significance (Figures; red star indicates p<0.05). Similarly, there were no clinicallyrelevant

or statistically significant differences between the treatment groups fo

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