• Christopher Romano, Andrew Lloyd, Singh Nair, Jenny Y Wang, Shankar Viswanathan, Amaresh Vydyanathan, Karina Gritsenko, Naum Shaparin, and Boleslav Kosharskyy.
• Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
• Anesth Essays Res. 2018 Apr 1; 12 (2): 452-458.

BackgroundAdductor canal blocks (ACBs) have become a popular technique for postoperative pain control in total knee arthroplasty patients. Proximal and distal ACB have been compared previously, but important postoperative outcomes have yet to be assessed.AimsThe primary objective of this study is to compare postoperative analgesia between proximal and distal ACB. Secondary outcomes include functional mobility, length of stay (LOS), and adverse events.Settings And DesignThis study was a single-center, assessor-blinded, randomized trial.Subjects And MethodsFifty-seven patients were randomly assigned to receive a proximal (n = 28) or distal (n = 29) ACB. A 20 mL bolus of 5 mg/mL ropivacaine was injected at the respective location followed by 2.0 mg/mL ropivacaine infusion for 24 h.Statistical AnalysisThe primary outcome was intra- and postoperative 24-h opioid consumption in intravenous (IV) morphine equivalents. Secondary outcomes include percentage change in timed "Up and Go" (TUG) times, LOS, and average postoperative pain scores. Continuous variables were compared using Student's t-test.ResultsThe mean (±standard deviation) 24-h intra-and postoperative opioid consumption showed no difference between the proximal and distal groups (39.72 ± 23.6 and 41.28 ± 19.6 mg IV morphine equivalents, respectively, P = 0.793). There was also no significant difference in the median [minimum, maximum] percentage change in TUG times relative to preoperative performance comparing proximal and distal ACB (334.0 [131, 1084] %-change and 458.5 [169, 1696] %-change, respectively, P = 0.130). In addition, there were no differences in postoperative pain scores or LOS.ConclusionsACB performed at either proximal or distal locations shows no difference in postoperative pain measured by opioid consumption or pain scores. Better TUG performance seen in the proximal group was not statistically significant but might represent a clinically important difference in functional mobility.

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