Efficacy of intra-operative adductor canal block in total knee arthroplasty: a prospective observational study

Karthik V.; Rajavarman S.; Subhash Janghid

doi:10.18203/issn.2455-4510.IntJResOrthop20260500

Authors

Karthik V. Department of Orthopaedics, SVMCH, Pondicherry, India
Rajavarman S. Department of Orthopaedics, SLIMS, Pondicherry, India
Subhash Janghid Department of Orthopaedics, Fortis Hospital, Gurgaon, Haryana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20260500

Keywords:

Adductor canal block, Total knee arthroplasty, Analgesia, Quadriceps strength, Postoperative pain

Abstract

Background: Effective postoperative pain control after total knee arthroplasty (TKA) remains a clinical challenge. This study aimed to evaluate the efficacy of intraoperative adductor canal block (ACB) in providing pain relief and preserving quadriceps function.

Methods: This prospective observational study included 92 patients undergoing primary TKA. Intraoperative ACB was administered by the operative surgeon, and outcomes assessed included pain scores (visual analogue score (VAS) at multiple time points), quadriceps muscle power, complications, and postoperative analgesic use. Statistical associations were evaluated using Chi-square and t-tests with p<0.05 as significant.

Results: Most participants reported mild pain at 6–8 hours, with moderate pain predominating at 24–48 hours and during mobilization. Quadriceps strength was preserved in nearly half the patients. Analgesic consumption correlated with higher VAS at 48 hours (p=0.001). Age was associated with reduced quadriceps strength (p=0.011). Longer preoperative pain duration was significantly linked to higher postoperative pain at 24–48 hours.

Conclusions: Intraoperative Adductor canal block is an effective, motor-sparing analgesic option for TKA, supporting early mobilization and reducing dependence on opioids. Further research is warranted to optimize block techniques and adjunct strategies.

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References

Jaeger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty. Anesthesiology. 2013;118(2):409-15. DOI: https://doi.org/10.1097/ALN.0b013e318279fa0b

Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg. 2014;118(6):1370-7. DOI: https://doi.org/10.1213/ANE.0000000000000197

Agarwal N, Pathak S, Rajappa S, Shanthanna H. Adductor canal block in total knee arthroplasty: a scoping review. BJA Open. 2025;4(1):100277. DOI: https://doi.org/10.1016/j.bjao.2025.100381

Berikashvili LB, Moller AM, Abdallah FW. Adductor canal block versus femoral nerve block in total knee arthroplasty: a systematic review and meta-analysis. Reg Anesth Pain Med. 2024;49(3):151-60.

Krishna V, Gupta A, Bhatnagar S, Kumar V. Comparison of adductor canal block with femoral nerve block for postoperative analgesia in TKA: a randomized study. J Anaesthesiol Clin Pharmacol. 2021;37(1):66-71.

Mu T, Li X, Wang L, Yang Z. Adductor canal block combined with genicular nerve block versus ACB with local infiltration in TKA: a randomized controlled trial. J Orthop Surg Res. 2024;19:142. DOI: https://doi.org/10.1186/s13018-024-05048-5

Alturki A, Aljuhani O, Terkawi A. Adductor canal catheter block after total knee arthroplasty: pain control and functional outcomes. Cureus. 2022;14(2):e22021.

Abd El-Latif Hassan SAE, Elmahmoudi AM, Hassan RM. Infiltration between the popliteal artery and capsule of the knee (IPACK) versus adductor canal block for postoperative analgesia after TKA. QJM. 2024;117:hcae037.

Dhalla R, Menon S, Gupta R. Saphenous nerve neuralgia: a complication of perioperative adductor canal block used for TKA analgesia. J Musculoskelet Surg Res. 2025;9(2):115-8. DOI: https://doi.org/10.25259/JMSR_98_2025

Ho JPY, Lee CK, Yung SHP, Chow SKH. Adductor canal blocks may result in long-term neuropathy after total knee arthroplasty. J Orthop Exp Innov. 2024;6(1):e127695. DOI: https://doi.org/10.60118/001c.127695

Agarwal A, Singh PK, Gupta R, et al. Evaluation of analgesic efficacy of single-shot versus continuous adductor canal block for total knee arthroplasty. Indian J Anaesth. 2023;67(4):315-22.

Borys M, Wajda D, Wieczorek M, et al. Adductor canal block as part of multimodal analgesia in TKA: a meta-analysis of functional and pain outcomes. Pain Physician. 2022;25(2):E193-202.