Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty

Soner Kina; Ayşe Surhan Çınar; Kerim Şahin; Onur Demircioğlu

Research Article

Year 2025, Volume: 15 Issue: 1, 64 - 70, 30.04.2025

Soner Kina , Ayşe Surhan Çınar Kerim Şahin , Onur Demircioğlu

Abstract

References

1. Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg. 2019;11:755–761.
2. Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthopaedica Belgica. 2023;89(1):97–102.
3. Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Park BY.b Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg. 2017;9:303–309.
4. Dimaculangan D, Chen JF, Borzio RB, Jauregui JJ, Rasquinha VJ, Maheshwari AV. Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial. J Clin Orthop Trauma. 2019;10(1):81–86.
5. Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14(3):126–135.
6. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial. Acta Orthop. 2007;78(2):172–179.
7. Hasegawa M, Singh D, Urits I, Pi M, Nakasone C, Viswanath O, Kaye AD. Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia. Orthop Rev (Pavia). 2022;14(3):37405.
8. Szczukowski MJ Jr, Hines JA, Snell JA, Sisca TS. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplasty. 2004;19(6):720–5.
9. Berikashvili LB, Yadgarov MY, Kuzovlev AN, Smirnova AV, Kadantseva KK, Kuznetsov IV, Polyakov PA, Likhvantsev VV. Adductor Canal Block Versus Femoral Nerve Block in Total Knee Arthroplasty: Network Meta-Analysis. Clin J Pain. 2024;40(7):447–457.
10. Karkhur Y, Mahajan R, Kakralia A, Pandey AP, Kapoor MC. A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review. J Anaesthesiol Clin Pharmacol. 2018;34(4):433–438.
11. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007;22(6 Suppl 2):33–8.
12. Starks I, Wainwright T, Middleton R. Local anaesthetic infiltration in joint replacement surgery: What is its role in enhanced recovery?. International Scholarly Research Notices. 2011;2011(1):742927.
13. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, Criswell A. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. The Journal of Arthroplasty. 2001;16(4):436–445.
14. Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine. 2018;97(48):e13391.
15. Thacher RR, Hickernell TR, Grosso MJ, Shah R, Cooper HJ, Maniker R, et al. Decreased risk of knee buckling with adductor canal block versus femoral nerve block in total knee arthroplasty: a retrospective cohort study. Arthroplasty Today. 2017;3(4):281–285.
16. Wang D, Yang Y, Li Q, Tang SL, Zeng WN, Xu J, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Scientific Reports. 2017;7(1):40721.
17. Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Survey of Anesthesiology. 2014;58(4):199–200.
18. Canbek U, Akgun U, Aydogan NH, Kilinc CY, et al. Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: a prospective randomized controlled trial. Acta Orthopaedica et Traumatologica Turcica. 2019;53(5):334–339.
19. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. The Journal of Arthroplasty. 2014;29(11):2224–2229.
20. Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor‐canal‐blockade for adjuvant postoperative analgesia after major knee surgery: preliminary results. Acta Anaesthesiologica Scandinavica. 2011;55(1):14–19.
21. Gonano C, Leitgeb U, Sitzwohl C, Ihra G, Weinstabl C, Kettner SC. Spinal versus general anesthesia for orthopedic surgery:anesthesia drug and supply costs. Anesthesia & Analgesia. 2006;102(2):524–529.
22. Patterson ME, Bland KS, Thomas LC, Elliott CE, Soberon Jr JR, Nossaman BD, Osteen K. The adductor canal block provides effective analgesia similar to a femoral nerve block in patients undergoing total knee arthroplasty -a retrospective study. Journal of Clinical Anesthesia. 2015;27(1):39–44.
23. Ryu JH, Jeon YT, Min B, Hwang JY, Sohn HM. Effects of palonosetron for prophylaxis of postoperative nausea and vomiting in high-risk patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled study. PLoS One. 2018;13(5):e0196388.
24. Ludwigson JL, Tillmans SD, Galgon RE, Chambers TA, Heiner JP, Schroeder KM. A comparison of single-shot adductor canal block vs femoral nerve catheter for total knee arthroplasty. The Journal of Arthroplasty. 2016;31(3):741.
25. Elkassabany NM, Antosh S, Ahmed M, Nelson C, Israelite C, Badiola I., et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block:a double-blinded randomized controlled study. Anesthesia & Analgesia. 2016;122(5):1696–1703.
26. Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Regional Anesthesia & Pain Medicine. 2015;40(1):3–10.
27. Machi AT, Sztain JF, Kormylo NJ, Madison SJ, Abramson WB, Monahan AM, et al. Discharge readiness after tricompartment knee arthroplasty: adductor canal versus femoral continuous nerve blocks—a dual-center, randomized trial. Anesthesiology. 2015;123(2):444–456.

Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty

Year 2025, Volume: 15 Issue: 1, 64 - 70, 30.04.2025

Soner Kina , Ayşe Surhan Çınar Kerim Şahin , Onur Demircioğlu

Abstract

Aim: Total knee arthroplasty (TKA) is a major orthopedic procedure often associated with significant postoperative pain. Effective pain management is critical for early mobilization, rehabilitation, and reducing complications such as chronic pain. With the increasing use of ultrasound in regional anesthesia, the frequency of femoral nerve block (FNB) and adductor canal block (ACB) for analgesia after TKA is rising. This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative analgesia in patients undergoing unilateral knee arthroplasty.
Material and Methods: The study was conducted with the approval of the ethics committee, and written consent was obtained from the patients. It was carried out on 70 patients aged 18–70, with an American Society of Anesthesiologists (ASA) score of I-II, who planned to undergo elective TKA surgery. The study was designed as a prospective, randomized, and single-blind trial. Demographic data of the patients were recorded, and routine monitoring and general anesthesia induction were performed. Patients were divided into two groups: those who received FNB (Group F) and those who received ACB (Group A). Both groups were administered 20 mL of 0.375% bupivacaine. Heart rate (HR) and mean arterial pressure (MAP) were recorded intraoperatively before and after induction and every 30 minutes. In the postoperative period, patient-controlled analgesia (PCA) with intravenous tramadol was applied. Total tramadol usage and the number of times analgesia was needed were recorded. HR, MAP, and visual analog scale (VAS) scores were recorded at postoperative 30 minutes, 1, 2, 4, 6, 12, and 24 hours. Complications (nausea/vomiting, hypotension, bradycardia, itching) were recorded for 24 hours.
Results: Mean VAS scores were significantly lower in the FNB group at postoperative 0, 1, 2, and 6 hours (p<0.05). Total tramadol consumption and bolus requests were higher in the ACB group (p<0.001). Both techniques achieved VAS scores below 4, with no significant differences in additional analgesic use or complications. Nausea and vomiting rates were 5% (FNB) and 10% (ACB). No significant differences were observed in perioperative and postoperative MAP or HR between the groups.
Conclusions: Femoral nerve block and ACB provide effective analgesia after TKA, with VAS scores below 3 and high patient satisfaction. However, FNB demonstrated superior early postoperative pain control and lower opioid consumption. ACB, as a sensory block, is advantageous for minimizing quadriceps weakness and should be considered part of multimodal analgesia strategies. It was concluded that femoral nerve block is more effective in providing postoperative analgesia for patients undergoing unilateral knee arthroplasty.

Keywords

total knee arthroplasty, femoral nerve block, adductor canal block, multimodal analgesia; postoperative analgesia

References

1. Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg. 2019;11:755–761.
2. Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthopaedica Belgica. 2023;89(1):97–102.
3. Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Park BY.b Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty. Clin Orthop Surg. 2017;9:303–309.
4. Dimaculangan D, Chen JF, Borzio RB, Jauregui JJ, Rasquinha VJ, Maheshwari AV. Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial. J Clin Orthop Trauma. 2019;10(1):81–86.
5. Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J Am Acad Orthop Surg. 2006;14(3):126–135.
6. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial. Acta Orthop. 2007;78(2):172–179.
7. Hasegawa M, Singh D, Urits I, Pi M, Nakasone C, Viswanath O, Kaye AD. Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia. Orthop Rev (Pavia). 2022;14(3):37405.
8. Szczukowski MJ Jr, Hines JA, Snell JA, Sisca TS. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplasty. 2004;19(6):720–5.
9. Berikashvili LB, Yadgarov MY, Kuzovlev AN, Smirnova AV, Kadantseva KK, Kuznetsov IV, Polyakov PA, Likhvantsev VV. Adductor Canal Block Versus Femoral Nerve Block in Total Knee Arthroplasty: Network Meta-Analysis. Clin J Pain. 2024;40(7):447–457.
10. Karkhur Y, Mahajan R, Kakralia A, Pandey AP, Kapoor MC. A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review. J Anaesthesiol Clin Pharmacol. 2018;34(4):433–438.
11. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007;22(6 Suppl 2):33–8.
12. Starks I, Wainwright T, Middleton R. Local anaesthetic infiltration in joint replacement surgery: What is its role in enhanced recovery?. International Scholarly Research Notices. 2011;2011(1):742927.
13. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, Criswell A. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. The Journal of Arthroplasty. 2001;16(4):436–445.
14. Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine. 2018;97(48):e13391.
15. Thacher RR, Hickernell TR, Grosso MJ, Shah R, Cooper HJ, Maniker R, et al. Decreased risk of knee buckling with adductor canal block versus femoral nerve block in total knee arthroplasty: a retrospective cohort study. Arthroplasty Today. 2017;3(4):281–285.
16. Wang D, Yang Y, Li Q, Tang SL, Zeng WN, Xu J, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Scientific Reports. 2017;7(1):40721.
17. Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Survey of Anesthesiology. 2014;58(4):199–200.
18. Canbek U, Akgun U, Aydogan NH, Kilinc CY, et al. Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: a prospective randomized controlled trial. Acta Orthopaedica et Traumatologica Turcica. 2019;53(5):334–339.
19. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. The Journal of Arthroplasty. 2014;29(11):2224–2229.
20. Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor‐canal‐blockade for adjuvant postoperative analgesia after major knee surgery: preliminary results. Acta Anaesthesiologica Scandinavica. 2011;55(1):14–19.
21. Gonano C, Leitgeb U, Sitzwohl C, Ihra G, Weinstabl C, Kettner SC. Spinal versus general anesthesia for orthopedic surgery:anesthesia drug and supply costs. Anesthesia & Analgesia. 2006;102(2):524–529.
22. Patterson ME, Bland KS, Thomas LC, Elliott CE, Soberon Jr JR, Nossaman BD, Osteen K. The adductor canal block provides effective analgesia similar to a femoral nerve block in patients undergoing total knee arthroplasty -a retrospective study. Journal of Clinical Anesthesia. 2015;27(1):39–44.
23. Ryu JH, Jeon YT, Min B, Hwang JY, Sohn HM. Effects of palonosetron for prophylaxis of postoperative nausea and vomiting in high-risk patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled study. PLoS One. 2018;13(5):e0196388.
24. Ludwigson JL, Tillmans SD, Galgon RE, Chambers TA, Heiner JP, Schroeder KM. A comparison of single-shot adductor canal block vs femoral nerve catheter for total knee arthroplasty. The Journal of Arthroplasty. 2016;31(3):741.
25. Elkassabany NM, Antosh S, Ahmed M, Nelson C, Israelite C, Badiola I., et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block:a double-blinded randomized controlled study. Anesthesia & Analgesia. 2016;122(5):1696–1703.
26. Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Regional Anesthesia & Pain Medicine. 2015;40(1):3–10.
27. Machi AT, Sztain JF, Kormylo NJ, Madison SJ, Abramson WB, Monahan AM, et al. Discharge readiness after tricompartment knee arthroplasty: adductor canal versus femoral continuous nerve blocks—a dual-center, randomized trial. Anesthesiology. 2015;123(2):444–456.

There are 27 citations in total.

Details

Primary Language	English
Subjects	Anaesthesiology
Journal Section	Research Article
Authors	Soner Kina Ayşe Surhan Çınar Kerim Şahin Onur Demircioğlu
Publication Date	April 30, 2025
Submission Date	December 28, 2024
Acceptance Date	February 18, 2025
Published in Issue	Year 2025 Volume: 15 Issue: 1

Cite

APA	Kina, S., Surhan Çınar, A., Şahin, K., Demircioğlu, O. (2025). Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty. Kafkas Journal of Medical Sciences, 15(1), 64-70.
AMA	Kina S, Surhan Çınar A, Şahin K, Demircioğlu O. Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty. KAFKAS TIP BİL DERG. April 2025;15(1):64-70.
Chicago	Kina, Soner, Ayşe Surhan Çınar, Kerim Şahin, and Onur Demircioğlu. “Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty”. Kafkas Journal of Medical Sciences 15, no. 1 (April 2025): 64-70.
EndNote	Kina S, Surhan Çınar A, Şahin K, Demircioğlu O (April 1, 2025) Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty. Kafkas Journal of Medical Sciences 15 1 64–70.
IEEE	S. Kina, A. Surhan Çınar, K. Şahin, and O. Demircioğlu, “Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty”, KAFKAS TIP BİL DERG, vol. 15, no. 1, pp. 64–70, 2025.
ISNAD	Kina, Soner et al. “Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty”. Kafkas Journal of Medical Sciences 15/1 (April 2025), 64-70.
JAMA	Kina S, Surhan Çınar A, Şahin K, Demircioğlu O. Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty. KAFKAS TIP BİL DERG. 2025;15:64–70.
MLA	Kina, Soner et al. “Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty”. Kafkas Journal of Medical Sciences, vol. 15, no. 1, 2025, pp. 64-70.
Vancouver	Kina S, Surhan Çınar A, Şahin K, Demircioğlu O. Comparison of the Effects of Femoral Nerve Block and Adductor Canal Block on Postoperative Analgesia in Patients to Undergo Unilateral Knee Arthroplasty. KAFKAS TIP BİL DERG. 2025;15(1):64-70.

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