Adductor Canal Block for Total Knee Arthroplasty: A Review of the Current Evidence

The positive impact of regional anesthesia on surgical outcome has continued to evolve. In recent years, the focus of acute pain management strategies following total knee arthroplasty has shifted from femoral nerve block to adductor canal block. We systematically analyzed the safety and efficacy of adductor canal blocks by reviewing 78 peer-reviewed publications, including 13 randomized controlled trials. There are a number of studies supporting the adductor canal nerve block as a viable alternative for postoperative analgesia after total knee arthroplasty. This novel block has been consistently demonstrated to have equivalent analgesic efficacy compared to femoral nerve block, while simultaneously reducing quadriceps weakness significantly less than femoral nerve block, thus facilitating earlier active mobilization. With focus on early rehabilitation, adductor canal block may be considered a contributory factor preventing complications such as deep vein thrombosis and joint rigidity from the lack of early mobilization. These advances could potentially result in a reduction of total length of hospital stay and therefore a reduction in associated health care costs. Based on the current evidence, we recommend that an adductor canal block could replace a femoral nerve block as the primary regional analgesic following total knee arthroplasty.