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Meta-Analysis
, 2019 (10)

Adductor Canal Blocks for Postoperative Pain Treatment in Adults Undergoing Knee Surgery

Affiliations
Meta-Analysis

Adductor Canal Blocks for Postoperative Pain Treatment in Adults Undergoing Knee Surgery

Alexander Schnabel et al. Cochrane Database Syst Rev.

Abstract

Background: Peripheral regional anaesthesia techniques are well established for postoperative pain treatment following knee surgery. The adductor canal block (ACB) is a new technique, which can be applied as a single shot or by catheter for continuous regional analgesia.

Objectives: To compare the analgesic efficacy and adverse events of ACB versus other regional analgesic techniques or systemic analgesic treatment for adults undergoing knee surgery.

Search methods: We searched CENTRAL, MEDLINE, and Embase, five other databases, and one trial register on 19 September 2018; we checked references, searched citations, and contacted study authors to identify additional studies.

Selection criteria: We included all randomized controlled trials (RCTs) comparing single or continuous ACB versus other regional analgesic techniques or systemic analgesic treatment. Inclusion was independent of the technique used (landmarks, peripheral nerve stimulator, or ultrasound) and the level of training of providers.

Data collection and analysis: We used Cochrane's standard methodological procedures. Our primary outcomes were pain intensity at rest and during movement; rate of accidental falls; and rates of opioid-related adverse events. We used GRADE to assess the quality of evidence for primary outcomes.

Main results: We included 25 RCTs (1688 participants) in this review (23 trials combined within meta-analyses). In 18 studies, participants underwent total knee arthroplasty (TKA), whereas seven trials investigated patients undergoing arthroscopic knee surgery. We identified 11 studies awaiting classification and 11 ongoing studies. We investigated the following comparisons. ACB versus sham treatment We included eight trials for this comparison. We found no significant differences in postoperative pain intensity at rest (2 hours: standardized mean difference (SMD) -0.56, 95% confidence interval (CI) -1.20 to 0.07, 4 trials, 208 participants, low-quality evidence; 24 hours: SMD -0.49, 95% CI -1.05 to 0.07, 6 trials, 272 participants, low-quality evidence) or during movement (2 hours: SMD -0.59, 95% CI -1.5 to 0.33; 3 trials, 160 participants, very low-quality evidence; 24 hours: SMD 0.03, 95% CI -0.26 to 0.32, 4 trials, 184 participants, low-quality evidence). Furthermore, they noted no evidence of a difference in postoperative nausea between groups (24 hours: risk ratio (RR) 1.91, 95% CI 0.48 to 7.58, 3 trials, 121 participants, low-quality evidence). One trial reported that no accidental falls occurred 24 hours postoperatively (low-quality evidence). ACB versus femoral nerve block We included 15 RCTs for this comparison. We found no evidence of a difference in postoperative pain intensity at rest (2 hours: SMD -0.74, 95% CI -1.76 to 0.28, 5 trials, 298 participants, low-quality evidence; 24 hours: SMD 0.04, 95% CI -0.09 to 0.18, 12 trials, 868 participants, high-quality evidence) or during movement (2 hours: SMD -0.47, 95% CI -1.86 to 0.93, 2 trials, 88 participants, very low-quality evidence; 24 hours: SMD 0.56, 95% CI -0.00 to 1.12, 9 trials, 576 participants, very low-quality evidence). They noted no evidence of a difference in postoperative nausea (24 hours: RR 1.22, 95% CI 0.42 to 3.54, 2 trials, 138 participants, low-quality evidence) and no evidence that the rate of accidental falls during postoperative care was significantly different between groups (24 hours: RR 0.20, 95% CI 0.04 to 1.15, 3 trials, 172 participants, low-quality evidence).

Authors' conclusions: We are currently uncertain whether patients treated with ACB suffer from lower pain intensity at rest and during movement, fewer opioid-related adverse events, and fewer accidental falls during postoperative care compared to patients receiving sham treatment. The same holds true for the comparison of ACB versus femoral nerve block focusing on postoperative pain intensity. The overall evidence level was mostly low or very low, so further research might change the conclusion. The 11 studies awaiting classification and the 11 ongoing studies, once assessed, may alter the conclusions of this review.

Conflict of interest statement

Alexander Schnabel: none known.

Sylvia U Reichl: none known.

Stephanie Weibel is an academic researcher. She has received personal payments for consultancies and lecture fees from Genelux Corporation, San Diego, USA (ended March 2014). Genelux Corporation does not produce any products for the intervention of interest in this review.

Christine Meyer‐Frießem has no conflicts of interest regarding the topic of this review. She received a sponsorship award for young pain scientists in May 2012 from Janssen‐Cilag GmbH (Eur. 5.000). Further, she received payments for two clinical lectures from OrionPharma in June 2013 (Eur 300) and from the Grünenthal Group in September 2013 (Eur 1000), all unrelated to the current review and relationships in the past. To her knowledge, the product portfolio of these companies has no direct connection to any topic or aim of the current meta‐analysis.

Peter K Zahn: none known.

Peter Kranke has no conflicts of interest regarding the topic of this review. He has received lecture fees (from FreseniusKabi, MSD, Ratiopharm, Covidien) and has provided consultancy (to MSD, FreseniusKabi, Ratiopharm, Covidien) on topics not related to the current review. He has been involved in the conduct of phase II and phase III clinical trials not related to the current review.

Esther Pogatzki‐Zahn received financial support from Mundipharma GmbH and Grunenthal for research activities, advisory and lecture fees from Grünenthal, MSD Sharp & DOHME GmbH, Mundipharma GmbH, Mundipharma International, Janssen‐Cilag GmbH, TEVA, Fresenius Kabi and AcelRx. She receives scientific support from the DFG, the BMBF, and the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. Funding was not related to the present research.

Update of

  • Cochrane Database Syst Rev. doi: 10.1002/14651858.CD012262

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