Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty A meta-analysis of randomized controlled trials

Background: This meta-analysis aimed to evaluate the efficiency and safety of the combined adductor canal block with periarticular infiltration versus periarticular infiltration alone for pain control after total knee arthroplasty (TKA). Methods: PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify articles comparing the combined adductor canal block with peri-articular infiltration and periarticular infiltration alone for pain control after TKA. Main outcomes were numeric rating scale (NRS) at postoperative day (POD) 0-2 and opioid consumption. Meta-analysis was performed using Stata 11.0 software. Results: Four randomized controlled trial (RCTs) including 297 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between the groups regarding NRS score at POD 0 (weighted mean difference [WMD]= -0.849, 95% confidence interval [CI]: -1.345 to -0.353, P=. 001), POD 1 (WMD= -0.960, 95% CI: -1.474 to -0.446, P=. 000), and POD 2 (WMD= -0.672, 95% CI: -1.163 to -0.181, P=. 007) after TKA. Significant differences were found in terms of opioid consumption at POD 0 (WMD= -3.761, 95% CI: -6.192 to -1.329, P=.002), POD 1 (WMD= -4.795, 95% CI: -8.181 to -1.409, P=.006), and POD 2 (WMD= -2.867, 95% CI: -4.907 to -0.827, P=.006). Conclusion: Combined adductor canal block with peri-articular infiltration could significantly reduce NRS scores and opioid consumption in comparison with periarticular infiltration alone following TKA. Additionally, there is a lower incidence of nausea and vomiting in the combined groups.