Agarwal Nikhil, Kay Robert, Duckworth Andrew D, Clement Nicholas D, Griffith David M
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
BJA Open. 2025 Mar 18;14:100381. doi: 10.1016/j.bjao.2025.100381. eCollection 2025 Jun.
An adductor canal block is commonly used to reduce pain after total knee arthroplasty. Practice varies in terms of site of injection, local anaesthetic, and adjuncts used, with poor consensus in relation to the best approach. The aim of this scoping review was to assess the evidence for efficacy and safety of adductor canal block, determine variation in the technique used, type and dose of medication, and compare the efficacy of adductor canal block with other nerve block techniques.
Four databases were searched to identify relevant studies (Medline, Embase, Cochrane, and ClinicalTrials.gov). A total of 285 articles were found, and data was extracted from 130 randomised controlled trials.
Adductor canal block is a safe and potentially effective peripheral nerve block for reducing postoperative pain after total knee arthroplasty while preserving motor function. Of all adjuncts to adductor canal block assessed, either dexamethasone or dexmedetomidine provide additional analgesic benefit. Adductor canal block combined with peri-articular local anaesthetic injection provides the best outcomes. Continuous infusion of local anaesthetic through a catheter placed in the adductor canal provides no additional benefit over a single injection. The site of injection used for adductor canal block does not seem to affect efficacy. There was no evidence to support the superiority of any single local anaesthetic agent.
This scoping review has identified variation in the use of medications, doses, techniques, and adjuncts for adductor canal block. As such, definitive conclusions regarding the most effective practice for adductor canal block cannot be made.
收肌管阻滞常用于减轻全膝关节置换术后的疼痛。在注射部位、局部麻醉药及辅助用药方面，实践存在差异，对于最佳方法也缺乏共识。本综述的目的是评估收肌管阻滞有效性和安全性的证据，确定所使用技术、药物类型和剂量的差异，并比较收肌管阻滞与其他神经阻滞技术的疗效。
检索四个数据库以识别相关研究（医学期刊数据库、荷兰医学文摘数据库、考克兰系统评价数据库和美国国立医学图书馆临床试验注册库）。共找到285篇文章，并从130项随机对照试验中提取数据。
收肌管阻滞是一种安全且可能有效的周围神经阻滞，可减轻全膝关节置换术后的疼痛，同时保留运动功能。在评估的所有收肌管阻滞辅助用药中，地塞米松或右美托咪定可提供额外的镇痛益处。收肌管阻滞联合关节周围局部麻醉药注射可获得最佳效果。通过置于收肌管的导管持续输注局部麻醉药与单次注射相比并无额外益处。收肌管阻滞的注射部位似乎不影响疗效。没有证据支持任何单一局部麻醉药的优越性。
本综述发现收肌管阻滞在药物使用、剂量、技术和辅助用药方面存在差异。因此，无法就收肌管阻滞最有效的实践得出明确结论。
