Evidence profile for adult patients having single shot versus continuous catheter adductor canal block for total knee arthroplasty
| Outcomes | Limitations | Inconsistency | Indirectness | Imprecision | Small study effects | Mean difference or OR (95% CI) | No of participants (studies) | Strength or certainty of the evidence (GRADE) |
| Primary outcomes | ||||||||
| Analgesic consumption between 0 and 48 hours postoperatively (mg) | No serious limitations | High test for inconsistency; however, resolution with sensitivity analysis | Not detected | Not detected | Not detected | 0.28 (–0.47 to 1.03) | 711 (8) | ⊕⊕⊕⊕ High |
| AUC rest pain scores between 0 and 48 hours postoperatively (cm.h) | No serious limitations | High test for inconsistency (I2 of 96%) | Not detected | Not detected | Major asymmetry per LFK index | 2.18 (–2.38 to 6.74) | 325 (4) | ⊕⊕⊖⊖ Low |
| Secondary outcomes | ||||||||
| Rest pain at PACU, assessed with NRS score: 0–10 cm (worst) | No serious limitations | High test for inconsistency (I2 of 85%) | Not detected | Not detected | Not detected | 0.70 (–0.32 to 1.72) | 325 (4) | ⊕⊕⊕⊖ Moderate |
| Rest pain at 6 hours, assessed with NRS score: 0–10 cm (worst) | No serious limitations | High test for inconsistency (I2 of 96%) | Not detected | Possible risk* | Not detected | 1.52 (0.05 to 2.99) | 584 (7) | ⊕⊕⊖⊖ Low |
| Rest pain at 12 hours, assessed with NRS score: 0–10 cm (worst) | No serious limitations | High test for inconsistency (I2 of 92%) | Not detected | Not detected | Not detected | 0.46 (–0.41 to 1.33) | 504 (5) | ⊕⊕⊕⊖ Moderate |
| Rest pain at 24 hours, assessed with NRS score: 0–10 cm (worst) | No serious limitations | High test for inconsistency (I2 of 91%) | Not detected | Not detected | Not detected | 0.78 (–0.10 to 1.67) | 809 (9) | ⊕⊕⊕⊖ Moderate |
| Rest pain at 48 hours, assessed with NRS score: 0–10 cm (worst) | No serious limitations | High test for inconsistency (I2 of 93%) | Not detected | Not detected | Not detected | 1.19 (0.56 to 2.32) | 856 (9) | ⊕⊕⊕⊖ Moderate |
| AUC rest pain scores between 24 and 48 hours postoperatively (cm.h) | No serious limitations | High test for inconsistency (I2 of 89%) | Not detected | Not detected | Not detected | 0.75 (–0.09 to 1.59) | 761 (8) | ⊕⊕⊕⊖ Moderate |
| Analgesic consumption at PACU (mg) | No serious limitations | Not pooled | Not detected | Not detected | Not detected | N/A | 44 (1) | N/A |
| Analgesic consumption between 0 and 24 hours postoperatively (mg) | No serious limitations | High test for inconsistency (I2 of 85%) | Not detected | Not detected | Not detected | 0.25 (–0.40 to 0.90) | 796 (9) | ⊕⊕⊕⊖ Moderate |
| Analgesic consumption between 24 and 48 hours postoperatively (mg) | No serious limitations | High test for inconsistency (I2 of 52%) | Not detected | Not detected | Not detected | 0.12 (–0.19 to 0.43) | 711 (8) | ⊕⊕⊕⊖ Moderate |
| Time to analgesic request (hour) | No serious limitations | Not pooled | Not detected | Not detected | Not detected | N/A | 236 (2) | N/A |
| Functional recovery (high log odds=better function)† | No serious limitations | High test for inconsistency (I2 of 86%) | Possible indirectness‡ | Not detected | Not detected | 0.04 (–0.79 to 0.89) | 776 (10) | ⊕⊕⊖⊖ Low |
| Duration of PACU stay (h) | No serious limitations | Not pooled | Not detected | Not detected | Not detected | N/A | 105 (1) | N/A |
| Duration of hospital stay (days) | No serious limitations | Low test for inconsistency | Not detected | Not detected | Not detected | 0.21 (0.00 to 0.42) | 715 (8) | ⊕⊕⊕⊕ High |
| Block procedure time (minute) | No serious limitations | Not pooled | Not detected | Not detected | Not detected | N/A | 48 (1) | N/A |
| Opioid related side effect of nausea/vomiting | No serious limitations | Low test for inconsistency | Not detected | Not detected | Not detected | 0.79 (0.5 to 1.25) | 712 (8) | ⊕⊕⊕⊕ High |
| Opioid related side effect of Drowsiness | No serious limitations | Not pooled | Not detected | Not detected | Not detected | N/A | 60 (1) | N/A |
| Nerve block related side effects | No serious limitations | Low test for inconsistency | Not detected | Not detected | Not detected | 0.24 (0.14 to 0.41) | 884 (10) | ⊕⊕⊕⊕ High |
*Minimal clinically important difference met by upper bound of 95% CI (0.05 to 2.99) for rest pain of 2.26 cm.
†Log (OR) reported.
‡Multiple different tools used to assess postoperative function. Time intervals not consistent for assessment.
AUC, area under the curve; GRADE, Grades of Recommendation, Assessment, Development and Evaluation; LFK, Luis Furuya–Kanamori; N/A, not available; NRS, Numeric Rating Scale; PACU, postanesthesia care unit.