Clinical Research

Application of adductor canal block combined with popliteal plexus block in arthroscopic ligament reconstruction

  • Guangkai BU ,
  • Tao TAO
Expand
  • Department of Anesthesiology,the First Affiliated Hospital of Zhejiang Chinese Medicine University,Hangzhou 310006,Zhejiang,China

Received date: 2025-03-25

  Online published: 2025-06-19

Abstract

Objective To investigate the impact of adductor canal block (ACB) in combination with popliteal plexus block (PPB) on patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods Patients who underwent primary unilateral ACLR treatment at our hospital between March 2022 and November 2023 were recruited as the research subjects. They were randomly allocated into the ACB group (n = 43 cases) and the combined PPB group (n = 47 cases) using a coin?toss method. Patients in the ACB group received ACB, while those in the combined PPB group received ACB in conjunction with PPB. The pain intensity, analgesic effect, adverse reactions, and postoperative status following ACLR were compared between the two groups. Results The Visual Analogue Scale (VAS) scores of the combined PPB group were significantly lower than those of the ACB group at 4 hours, 8 hours, 12 hours, 24 hours, and 48 hours post ACLR (P < 0.05). Repeated measures analysis of variance of VAS scores in the resting and active exercise states of ACLR patients in the two groups revealed that the group effect had F?values of 162.052/142.173 and P?values of 0.000/0.000, the time effect had F?values of 74.223/65.515 and P?values of 0.000/0.000, and the interaction effect had an f?value of 4.707/. The cumulative dose of sufentanil, the frequency of postoperative analgesia, and the proportion of posterior knee pain in the combined PPB group were all lower than those in the ACB group (P < 0.05). There was no significant difference in adverse reactions between the ACB group and the combined PPB group (P > 0.05). The hospitalization duration and the time to achieve active straight leg raise in the combined PPB group were shorter than those in the ACB group, while the analgesic satisfaction score was higher than that in the ACB group (P < 0.05). Conclusion The combination of ACB and PPB in ACLR can effectively alleviate postoperative pain, reduce the requirements for sufentanil and analgesic interventions, enhance patient satisfaction, shorten the hospitalization period and the time to achieve active straight leg raise, and promote early patient recovery without increasing the risk of adverse reactions.

Cite this article

Guangkai BU , Tao TAO . Application of adductor canal block combined with popliteal plexus block in arthroscopic ligament reconstruction[J]. The Journal of Practical Medicine, 2025 , 41(11) : 1663 -1668 . DOI: 10.3969/j.issn.1006-5725.2025.11.008

References

1 BARNETT S, MURRAY M M, LIU S, et al. Resolution of Pain and Predictors of Postoperative Opioid use after Bridge-Enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction[J]. Arthrosc Sports Med Rehabil, 2020,2(3):e219-e228. doi:10.1016/j.asmr.2020.02.004
2 MUSAHL V, ENGLER I D, NAZZAL E M, et al. Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation[J]. Knee Surg Sports Traumatol Arthrosc, 2022,30(1):34-51. doi:10.1007/s00167-021-06826-y
3 郭斌,张六弟,郝建红,等. 收肌管阻滞在前交叉韧带重建术后镇痛中的临床应用研究[J]. 陕西医学杂志,2019,48(12):1622-1626.
4 KANDARIAN B S, ELKASSABANY N M, TAMBOLI M, et al. Updates on multimodal analgesia and regional anesthesia for total knee arthroplasty patients[J]. Best Pract Res Clin Anaesthesiol, 2019,33(1):111-123. doi:10.1016/j.bpa.2019.02.004
5 杜生芳,石翊飒,张东,等. 超声引导下神经阻滞技术用于患儿腹部手术后镇痛的进展[J]. 临床麻醉学杂志,2021,37(10):1098-1101.
6 DE ARZUAGA C, MIGUEL M, BIARNéS A, et al. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial[J]. Arch Orthop Trauma Surg, 2023,143(11):6763-6771. doi:10.1007/s00402-023-04960-5
7 王春光,张志强,李艳军,等. 股三角与收肌管入路隐神经阻滞用于膝关节置换术病人术后镇痛效果的比较[J]. 中华麻醉学杂志,2019,39(8):953-956.
8 WANG C G, MA W H, LIU R, et al. The effect of continuous adductor canal block combined with distal interspace between the popliteal artery and capsule of the posterior knee block for total knee arthroplasty: a randomized, double-blind, controlled trial[J]. BMC Anesthesiol, 2022,22(1):175. doi:10.1186/s12871-022-01712-7
9 刘羡,周琴,李仁华. 腘丛神经阻滞对全膝关节置换术患者术后镇痛、应激反应及功能恢复的影响[J]. 医学理论与实践,2023,36(24):4206-4209.
10 TRAN J, PENG P, GOFELD M, et al. Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention[J]. Reg Anesth Pain Med, 2019,44(2):234-238. doi:10.1136/rapm-2018-000015
11 王惯珠,张超鹏. 腘丛神经联合收肌管阻滞对全膝关节置换术后镇痛的影响分析[J]. 山西医药杂志,2024,53(5):248-252.
12 JOSHI G P, ABDELMALAK B B, WEIGEL W A, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting[J]. Anesthesiology, 2023,138(2):132-151. doi:10.1097/aln.0000000000004381
13 MAHMOUD A, BOULES M, BOTROS J, et al. Analgesic Impact of a Popliteal Plexus Block to Standard Adductor Canal Block in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Blind Clinical Trial[J]. Pain Res Manag, 2021,2021(1):1723471. doi:10.1155/2021/1723471
14 BARCALA X, ZAYTOUNY A, REGO-LORCA D, et al. Visual simulations of presbyopic corrections through cataract opacification[J]. J Cataract Refract Surg, 2023,49(1):34-43.
15 苗婷,张晓花,湛守青. Ramsay镇静评分法在主动脉夹层病人孙氏手术后监护中的应用效果[J]. 中西医结合心脑血管病杂志,2023,21(17):3238-3242.
16 彭宇川. 罗哌卡因复合右美托咪定竖脊肌平面阻滞对腹腔镜胆囊切除术患者的应用[D]. 十堰:湖北医药学院,2022.
17 KOHN L, REMBECK E, RAUCH A. Anterior cruciate ligament injury in adults: Diagnostics and treatment[J]. Orthopade, 2020,49(11):1013-1028. doi:10.1007/s00132-020-03997-3
18 黎国权. 膝关节镜下自体腱重建前交叉韧带治疗膝关节损伤的疗效分析[J]. 临床外科杂志,2019,27(1):79-81.
19 LABIANCA L, ANDREOZZI V, PRINCI G, et al. The effectiveness of Kinesio Taping in improving pain and edema during early rehabilitation after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Control Study[J]. Acta Biomed, 2022,92(6):e2021336.
20 SEHMBI H, BRULL R, SHAH U J, et al. 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[J]. Anesth Analg, 2019,128(2):223-238. doi:10.1213/ane.0000000000002570
21 MCKEE E D, CLEMENT N D. Does an Adductor Canal Block Influence Patient-Reported Outcomes at One Year Following Total Knee Arthroplasty?[J]. Cureus, 2023,15(6):e41123.
22 肖李丹,熊伟,徐菀璟,等. 超声引导下近端收肌管阻滞联合远端腘动脉与膝关节后囊间隙阻滞对全膝关节置换术后镇痛的影响[J]. 临床麻醉学杂志,2023,39(6):590-595.
23 STEBLER K, MARTIN R, KIRKHAM K R, et al. Adductor canal block versus local infiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial[J]. Br J Anaesth, 2019,123(2):e343-e349. doi:10.1016/j.bja.2019.04.053
24 ZORRILLA-VACA A, LI J. The role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. J Anesth, 2018,32(3):341-350. doi:10.1007/s00540-018-2480-1
25 RUNGE C, MORIGGL B, B?RGLUM J, et al. The Spread of Ultrasound-Guided Injectate From the Adductor Canal to the Genicular Branch of the Posterior Obturator Nerve and the Popliteal Plexus: A Cadaveric Study[J]. Reg Anesth Pain Med, 2017,42(6):725-730. doi:10.1097/aap.0000000000000675
26 白艳辉,张谦,柳进宁,等. 腘丛神经阻滞、腘动脉与膝关节囊后间隙阻滞用于全膝关节置换术后镇痛效果比较[J]. 临床军医杂志,2024,52(6):861-866
27 满家政,冯仕明,王立伟,等. 超声引导下收肌管联合IPACK阻滞对前交叉韧带重建术后镇痛和关节功能的影响[J]. 实用骨科杂志,2024,30 (3):268-271.
28 杨明玉,刘蕊,杨洋,等. 腘丛神经阻滞联合收肌管阻滞用于全膝关节置换术患者术后镇痛的效果[J]. 临床麻醉学杂志,2022,38(11):1130-1134.
29 刘辉,辛磊,闵红星,等. PPB-收管肌阻滞复合腰硬联合麻醉对全膝关节置换术患者术后疼痛和炎症反应的影响[J]. 川北医学院学报,2023,38(10):1318-1321.
30 PERRY M, LEDUC R, STAKENAS S, et al. Adductor Canal Nerve Block versus Intra-articular Anesthetic in Knee Arthroscopy: A Single-Blinded Prospective Randomized Trial[J]. J Knee Surg, 2024,37(3):220-226. doi:10.1055/a-2037-6418
Outlines

/