Authors: Topalidou X et al.
A & A Practice. 20(1):e02104, January 2026. 10.1213/XAA.0000000000002104
Summary
This systematic review and meta-analysis evaluated the comparative efficacy of adductor canal block (ACB) in patients undergoing total knee arthroplasty, focusing on whether ACB alone or in combination with local infiltration analgesia improves postoperative outcomes compared with local infiltration analgesia alone. Given the increasing emphasis on motor-sparing regional techniques in multimodal analgesia pathways, the authors sought to clarify the analgesic and functional benefits of ACB using randomized controlled trial data.
A total of 26 randomized controlled trials involving approximately 2,400 patients were included. When ACB was combined with local infiltration analgesia, postoperative pain scores at rest and during activity were significantly lower at both 24 and 48 hours compared with local infiltration analgesia alone. In contrast, ACB used as a standalone technique was associated with improved pain control during activity but did not consistently reduce resting pain scores. The combination strategy was also associated with reduced opioid consumption and improved knee range of motion at 24 hours, though these benefits were not consistently sustained beyond the immediate postoperative period.
Additional outcomes showed that patients receiving ACB experienced lower rates of postoperative nausea and vomiting, while no significant differences were observed in hospital length of stay. The overall certainty of evidence ranged from moderate to very low, with moderate to high risk of bias across studies based on trial quality assessments. Despite these limitations, the findings support the analgesic benefit of incorporating ACB into multimodal pain strategies for total knee arthroplasty, particularly when combined with local infiltration analgesia.
What You Should Know
Adding adductor canal block to local infiltration analgesia improves postoperative pain scores at rest and with activity after total knee arthroplasty.
Adductor canal block alone primarily improves pain with activity, with less effect on resting pain.
Combination therapy may reduce early opioid consumption and improve early knee range of motion.
Benefits appear strongest in the first 24 to 48 hours after surgery.
Key Points
Question: Does adductor canal block with or without local infiltration analgesia improve pain and recovery outcomes after total knee arthroplasty?
Findings: Adductor canal block combined with local infiltration analgesia reduced pain scores at rest and with activity, while adductor canal block alone improved activity-related pain.
Meaning: Incorporating adductor canal block into multimodal analgesia protocols for total knee arthroplasty may enhance early postoperative pain control, particularly when combined with local infiltration techniques.
Thank you to A & A Practice for publishing this comprehensive analysis of regional anesthesia strategies in total knee arthroplasty.