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Abstract
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Background and Aims This comprehensive review critically assesses the anatomical precision of adductor canal block (ACB) and its impact on analgesic efficacy in total knee arthroplasty (TKA). By conducting subgroup analyses on the femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), this study investigates the motor-sparing effects and analgesic efficacy of ultrasound-guided techniques. The intricate anatomical complexities within the femoral triangle, adductor canal, and subsartorial region are synthesized to elucidate the intricacies of nerve targeting.
Methods A critical evaluation of published randomized controlled trials from 2013 to 2023 revealed flaws in the technique of ACB administration, leading to potentially misleading conclusions. To address these shortcomings, a novel approach called Dual subsartorial block (DSB) is advocated, which rectifies the identified flaws and provides superior analgesia for TKA by covering both the anterior and posterior components of pain.
Results The findings highlight the inadequacy of conventional ACB methods in achieving procedure-specific analgesia, underscoring the importance of anatomical precision and nerve localization. In contrast, the DSB approach shows promise by leveraging selective motor effects and optimizing local anesthetic delivery.
Sonoanatomy at various levels of the thigh and demarcation of the femoral triangle and adductor canal
Defining the location of adductor canal
Sonoanatomy at various levels of the thigh and demarcation of the femoral triangle, adductor canal and subsartorial region
Conclusions This study emphasizes the necessity of refining anatomical representations for procedure-specific analgesia in TKA. Existing randomized controlled trials and meta-analyses are critiqued for proposing guidelines based on flawed anatomical understanding. By delineating the nuances of ACB and advocating for DSB, a paradigm shift towards tailored analgesic strategies is encouraged, aiming to enhance patient outcomes and post-surgical recovery.