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  • Continuous Adductor Canal Versus Continuous Femoral Nerve Blocks: Relative Effects on Discharge Readiness Following Unicompartment Knee Arthroplasty

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Continuous Adductor Canal Versus Continuous Femoral Nerve Blocks: Relative Effects on Discharge Readiness Following Unicompartment Knee Arthroplasty
  1. Jacklynn F. Sztain, MD*,
  2. Anthony T. Machi, MD*,
  3. Nicholas J. Kormylo, MD*,
  4. Wendy B. Abramson, MD*,
  5. Sarah J. Madison, MD*,
  6. Amanda M. Monahan, MD*,
  7. Bahareh Khatibi, MD*,
  8. Scott T. Ball, MD†,
  9. Francis B. Gonzales, MD†,
  10. Daniel I. Sessler, MD‡,
  11. Edward J. Mascha, PhD‡,§,
  12. Jing You, MS‡,§,
  13. Ken A. Nakanote, BA∥ and
  14. Brian M. Ilfeld, MD, MS*
  1. From the Departments of *Anesthesiology and †Orthopaedic Surgery, University of California San Diego, San Diego, CA; Departments of ‡Outcomes Research and §Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH; and ∥School of Medicine, University of California San Diego, San Diego, CA
  1. Address correspondence to: Brian M. Ilfeld, MD, MS, Department of Anesthesiology, 200 W Arbor Dr, MC 8770, San Diego, CA 92103 (e-mail: bilfeld{at}ucsd.edu).

Abstract

Background We tested the hypothesis that, following unicompartment knee arthroplasty, a continuous adductor canal block decreases the time to reach 4 discharge criteria compared with a continuous femoral nerve block.

Methods Subjects were randomized to either an adductor canal or femoral perineural catheter (2-day ropivacaine 0.2% infusion) in an unmasked fashion. The primary outcome was the time to attain 4 discharge criteria: (1) adequate analgesia; (2) intravenous opioid independence; (3) ability to independently stand, walk 3 m, return, and sit down; and (4) ambulate 30 m.

Results Subjects with an adductor canal catheter (n = 15) reached all 4 criteria in a median of 35 hours (interquartile range, 24–43 hours), compared with 40 hours (interquartile range, 27–69 hours) for those with a femoral catheter (n = 15; Wilcoxon rank sum test: P = 0.46; log-rank test: P = 0.16). However, the percentages of subjects (adductor canal: femoral) who reached the 2 mobilization criteria were 27%:0% on postoperative day (POD) 0, 93%:53% on POD 1, and 100%:73% on POD 2. Of adductor canal subjects, 100% were discharge ready by POD 2, compared with only 73% of femoral subjects (P < 0.001).

Conclusions Compared with a continuous femoral nerve block, a continuous adductor canal block did not appreciably decrease the median number of hours to overall discharge readiness, yet did decrease the number of discrete days until discharge readiness. These results are applicable to only unicompartment knee arthroplasty and must be considered preliminary because of the limited sample size of this pilot study.

https://doi.org/10.1097/AAP.0000000000000279

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    Footnotes

    • Funding for this project was provided by the University California Academic Senate (San Diego, CA); Summit Medical (Sandy, UT); and Teleflex Medical (Research Triangle Park, NC). Teleflex Medical also provided the perineural catheters used in this investigation.

      This work was submitted, in part, as a scientific abstract for the Annual Meeting of the American Society of Regional Anesthesia and Pain Medicine in Las Vegas, NV, May 14 to 16, 2015.

      The authors declare no conflict of interest.

      Neither company had input into any aspect of study conceptualization, design, or implementation; data collection, analysis and interpretation; or manuscript preparation. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entities.