Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor Canal Nerve Block—A Systematic Review and Meta-analysis
Bibliographic record
Abstract
BACKGROUND: Adductor canal block (ACB) has emerged as an effective analgesic regional technique for major knee surgeries in the last decade. Its motor-sparing properties make it particularly attractive for ambulatory knee surgery, but evidence supporting its use in ambulatory arthroscopic knee surgery is conflicting. This systematic review and meta-analysis evaluates the analgesic effects of ACB for ambulatory arthroscopic knee surgeries. METHODS: We conducted a comprehensive search of electronic databases for randomized controlled trials examining the analgesic effects of ACB compared to control or any other analgesic modality. Both minor arthroscopic and anterior cruciate ligament reconstruction (ACLR) surgeries were considered. Rest and dynamic pain scores, opioid consumption, opioid-related adverse effects, time to first analgesic request, patient satisfaction, quadriceps strength, and block-related complications were evaluated. Data were pooled using random-effects modeling. RESULTS: Our search yielded 10 randomized controlled trials comparing ACB with placebo or femoral nerve block (FNB); these were subgrouped according to the type of knee surgery. For minor knee arthroscopic surgery, ACB provided reduced postoperative resting pain scores by a mean difference (95% confidence interval) of -1.46 cm (-2.03 to -0.90) (P < .00001), -0.51 cm (-0.92 to -0.10) (P = .02), and -0.48 cm (-0.93 to -0.04) (P = .03) at 0, 6, and 8 hours, respectively, compared to control. Dynamic pain scores were reduced by a mean difference (95% confidence interval) of -1.50 cm (-2.10 to -0.90) (P < .00001), -0.50 cm (-0.95 to -0.04) (P = .03), and -0.59 cm (-1.12 to -0.05) (P = .03) at 0, 6, and 8 hours, respectively, compared to control. ACB also reduced the cumulative 24-hour oral morphine equivalent consumption by -7.41 mg (-14.75 to -0.08) (P = .05) compared to control. For ACLR surgery, ACB did not provide any analgesic benefits and did not improve any of the examined outcomes, compared to control. ACB was also not different from FNB for these outcomes. CONCLUSIONS: After minor ambulatory arthroscopic knee surgery, ACB provides modest analgesic benefits, including improved relief for rest pain, and reduced opioid consumption for up to 8 and 24 hours, respectively. The analgesic benefits of ACB are not different from placebo or FNB after ambulatory ACLR, suggesting a limited role of both blocks in this procedure. Paucity of trials dictates cautious interpretation of these findings. Future studies are needed to determine the role of ACB in the setting of local anesthetic instillation and/or graft donor-site analgesia.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".