Adductor Canal Block for Pain Management in Chronic Knee Osteoarthritis: A Systematic Review and Meta-Analysis
ASA Poster Gallery. Donato G. 10/11/25; 4178117; A1409
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Type: Regional Anesthesia and Acute Pain I - ePosters Monitor 26
Topic: REGIONAL ANESTHESIA AND ACUTE PAIN - Transitional Pain, Chronic Pain Prevention
Yara Dias, MD1, Lucas Macedo Nascimento, MS2, Glaudir Donato, MS3, Helvécio Neves Feitosa Filho, MS4, Caroline Busato Ramalho de Campos, MS5, Gabriel Stumpf Bastos Amorim, MS6, Karla Mickaela Araújo dos Santos, MS7, Natália Rezende Novais, MS8, Gabryel Cordeiro de Lima, MD9, Kelson Koiti Ogata, MD10.
1Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA, 2Faculty of Medicine, University of Brasília, Brasília, Brazil, 3Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil, 4Faculty of Medicine, University of Fortaleza, Fortaleza, Brazil, 5Faculty of Medicine, University of Nove de Juho, Mauá, Brazil, 6Faculty of Medicine, University of Piauí, Teresina, Brazil, 7Faculty of Medicine, University of Nove de Julho, Mauá, Brazil, 8University Center of the Central Plateau Apparecido dos Santos, Brasília, Brazil, 9Higher School of Health Sciences, Brasília, Brazil, 10Department of Anesthesiology, Pain and Intensive Care, Federal University of São Paulo, São Paulo, Brazil.
Introduction:
Knee osteoarthritis (KOA) is a chronic degenerative disease and the most prevalent joint disease globally. Its management typically includes exercise, weight loss, and education, often supplemented with NSAIDs, corticosteroids, and, in refractory cases, surgery. Despite these treatments, effective pain control remains a challenge. In this context, the adductor canal block (ACB) has emerged as a potential method for pain relief. However, its role in chronic KOA pain as non-surgical treatment remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of ACB in reducing pain in KOA patients outside of surgical settings.
Methods:
A systematic literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science through March 2024. Studies assessing ACB pain outcomes in KOA patients with ≥4 weeks of follow-up were included. Studies combining ACB with other blocks/analgesics, perioperative applications, or non-KOA populations were excluded. Both randomized controlled trials (RCTs) and observational studies were analyzed. Risk of bias was evaluated via RoB 2 and ROBINS-I tools. Standardized Mean Differences (SMD) assessed pooled pain scores at 1 and 3 months. Heterogeneity was measured with I² statistics, using a random-effects model when I² > 50%. Leave-one-out sensitivity analysis tested robustness.
Results:
Seven studies with 303 participants met inclusion criteria. The mean age was 64.30 ± 11.27 years, and 71% were women. All blocks were performed under ultrasound-guidance for accessing the adductor canal; six were performed at mid-thigh and one at the distal medial thigh. Local anesthetics varied: four studies used bupivacaine, one levobupivacaine, and two lidocaine. Follow-up ranged from 1 to 12 months. Of the three non-randomized studies, two had a moderate risk of bias, and one had a high risk of bias. All RCTs were classified as low risk. Pain scores at 1 month post ACB were reported in six studies, with a total of 273 patients included in analysis. ACB significantly reduced pain at 1 month (SMD = −2.15, 95% CI [−3.42; −0.88]; P = 0.0009; I² = 93%) (Figure 1). Sensitivity analysis confirmed robustness. Subgroup analysis revealed enhanced effect with local anesthetic plus adjuvants (SMD = −2.74, 95% CI [−4.45; −1.03]; P < 0.01; I² = 95%) versus anesthetic alone (SMD = −0.98, 95% CI [−1.41; −0.55]; P = 0.83; I² = 0%). Four studies, involving 183 patients assessed pain scores at 3 months. For this investigation, ACB did not significantly reduce pain (SMD = −2.19, 95% CI [−4.59; 0.21]; P = 0.0739; I² = 95%) (Figure 2). However, leave-one-out sensitivity analysis yielded significant reduction (SMD = −0.97, 95% CI [−1.50; −0.44]; P = 0.0003; I² = 80%), suggesting potential benefit under certain conditions.
Conclusion:
The ACB may provide significant short-term pain relief in chronic knee osteoarthritis, particularly when used with adjuvants, making it a promising non-surgical option for pain management. However, its efficacy at 3 months remains uncertain due to heterogeneity in the data, although sensitivity analysis suggests potential benefits. Further high-quality RCTs are needed to confirm its long-term efficacy and optimize treatment protocols.
Topic: REGIONAL ANESTHESIA AND ACUTE PAIN - Transitional Pain, Chronic Pain Prevention
Yara Dias, MD1, Lucas Macedo Nascimento, MS2, Glaudir Donato, MS3, Helvécio Neves Feitosa Filho, MS4, Caroline Busato Ramalho de Campos, MS5, Gabriel Stumpf Bastos Amorim, MS6, Karla Mickaela Araújo dos Santos, MS7, Natália Rezende Novais, MS8, Gabryel Cordeiro de Lima, MD9, Kelson Koiti Ogata, MD10.
1Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA, 2Faculty of Medicine, University of Brasília, Brasília, Brazil, 3Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil, 4Faculty of Medicine, University of Fortaleza, Fortaleza, Brazil, 5Faculty of Medicine, University of Nove de Juho, Mauá, Brazil, 6Faculty of Medicine, University of Piauí, Teresina, Brazil, 7Faculty of Medicine, University of Nove de Julho, Mauá, Brazil, 8University Center of the Central Plateau Apparecido dos Santos, Brasília, Brazil, 9Higher School of Health Sciences, Brasília, Brazil, 10Department of Anesthesiology, Pain and Intensive Care, Federal University of São Paulo, São Paulo, Brazil.
Introduction:
Knee osteoarthritis (KOA) is a chronic degenerative disease and the most prevalent joint disease globally. Its management typically includes exercise, weight loss, and education, often supplemented with NSAIDs, corticosteroids, and, in refractory cases, surgery. Despite these treatments, effective pain control remains a challenge. In this context, the adductor canal block (ACB) has emerged as a potential method for pain relief. However, its role in chronic KOA pain as non-surgical treatment remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of ACB in reducing pain in KOA patients outside of surgical settings.
Methods:
A systematic literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science through March 2024. Studies assessing ACB pain outcomes in KOA patients with ≥4 weeks of follow-up were included. Studies combining ACB with other blocks/analgesics, perioperative applications, or non-KOA populations were excluded. Both randomized controlled trials (RCTs) and observational studies were analyzed. Risk of bias was evaluated via RoB 2 and ROBINS-I tools. Standardized Mean Differences (SMD) assessed pooled pain scores at 1 and 3 months. Heterogeneity was measured with I² statistics, using a random-effects model when I² > 50%. Leave-one-out sensitivity analysis tested robustness.
Results:
Seven studies with 303 participants met inclusion criteria. The mean age was 64.30 ± 11.27 years, and 71% were women. All blocks were performed under ultrasound-guidance for accessing the adductor canal; six were performed at mid-thigh and one at the distal medial thigh. Local anesthetics varied: four studies used bupivacaine, one levobupivacaine, and two lidocaine. Follow-up ranged from 1 to 12 months. Of the three non-randomized studies, two had a moderate risk of bias, and one had a high risk of bias. All RCTs were classified as low risk. Pain scores at 1 month post ACB were reported in six studies, with a total of 273 patients included in analysis. ACB significantly reduced pain at 1 month (SMD = −2.15, 95% CI [−3.42; −0.88]; P = 0.0009; I² = 93%) (Figure 1). Sensitivity analysis confirmed robustness. Subgroup analysis revealed enhanced effect with local anesthetic plus adjuvants (SMD = −2.74, 95% CI [−4.45; −1.03]; P < 0.01; I² = 95%) versus anesthetic alone (SMD = −0.98, 95% CI [−1.41; −0.55]; P = 0.83; I² = 0%). Four studies, involving 183 patients assessed pain scores at 3 months. For this investigation, ACB did not significantly reduce pain (SMD = −2.19, 95% CI [−4.59; 0.21]; P = 0.0739; I² = 95%) (Figure 2). However, leave-one-out sensitivity analysis yielded significant reduction (SMD = −0.97, 95% CI [−1.50; −0.44]; P = 0.0003; I² = 80%), suggesting potential benefit under certain conditions.
Conclusion:
The ACB may provide significant short-term pain relief in chronic knee osteoarthritis, particularly when used with adjuvants, making it a promising non-surgical option for pain management. However, its efficacy at 3 months remains uncertain due to heterogeneity in the data, although sensitivity analysis suggests potential benefits. Further high-quality RCTs are needed to confirm its long-term efficacy and optimize treatment protocols.
Type: Regional Anesthesia and Acute Pain I - ePosters Monitor 26
Topic: REGIONAL ANESTHESIA AND ACUTE PAIN - Transitional Pain, Chronic Pain Prevention
Yara Dias, MD1, Lucas Macedo Nascimento, MS2, Glaudir Donato, MS3, Helvécio Neves Feitosa Filho, MS4, Caroline Busato Ramalho de Campos, MS5, Gabriel Stumpf Bastos Amorim, MS6, Karla Mickaela Araújo dos Santos, MS7, Natália Rezende Novais, MS8, Gabryel Cordeiro de Lima, MD9, Kelson Koiti Ogata, MD10.
1Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA, 2Faculty of Medicine, University of Brasília, Brasília, Brazil, 3Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil, 4Faculty of Medicine, University of Fortaleza, Fortaleza, Brazil, 5Faculty of Medicine, University of Nove de Juho, Mauá, Brazil, 6Faculty of Medicine, University of Piauí, Teresina, Brazil, 7Faculty of Medicine, University of Nove de Julho, Mauá, Brazil, 8University Center of the Central Plateau Apparecido dos Santos, Brasília, Brazil, 9Higher School of Health Sciences, Brasília, Brazil, 10Department of Anesthesiology, Pain and Intensive Care, Federal University of São Paulo, São Paulo, Brazil.
Introduction:
Knee osteoarthritis (KOA) is a chronic degenerative disease and the most prevalent joint disease globally. Its management typically includes exercise, weight loss, and education, often supplemented with NSAIDs, corticosteroids, and, in refractory cases, surgery. Despite these treatments, effective pain control remains a challenge. In this context, the adductor canal block (ACB) has emerged as a potential method for pain relief. However, its role in chronic KOA pain as non-surgical treatment remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of ACB in reducing pain in KOA patients outside of surgical settings.
Methods:
A systematic literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science through March 2024. Studies assessing ACB pain outcomes in KOA patients with ≥4 weeks of follow-up were included. Studies combining ACB with other blocks/analgesics, perioperative applications, or non-KOA populations were excluded. Both randomized controlled trials (RCTs) and observational studies were analyzed. Risk of bias was evaluated via RoB 2 and ROBINS-I tools. Standardized Mean Differences (SMD) assessed pooled pain scores at 1 and 3 months. Heterogeneity was measured with I² statistics, using a random-effects model when I² > 50%. Leave-one-out sensitivity analysis tested robustness.
Results:
Seven studies with 303 participants met inclusion criteria. The mean age was 64.30 ± 11.27 years, and 71% were women. All blocks were performed under ultrasound-guidance for accessing the adductor canal; six were performed at mid-thigh and one at the distal medial thigh. Local anesthetics varied: four studies used bupivacaine, one levobupivacaine, and two lidocaine. Follow-up ranged from 1 to 12 months. Of the three non-randomized studies, two had a moderate risk of bias, and one had a high risk of bias. All RCTs were classified as low risk. Pain scores at 1 month post ACB were reported in six studies, with a total of 273 patients included in analysis. ACB significantly reduced pain at 1 month (SMD = −2.15, 95% CI [−3.42; −0.88]; P = 0.0009; I² = 93%) (Figure 1). Sensitivity analysis confirmed robustness. Subgroup analysis revealed enhanced effect with local anesthetic plus adjuvants (SMD = −2.74, 95% CI [−4.45; −1.03]; P < 0.01; I² = 95%) versus anesthetic alone (SMD = −0.98, 95% CI [−1.41; −0.55]; P = 0.83; I² = 0%). Four studies, involving 183 patients assessed pain scores at 3 months. For this investigation, ACB did not significantly reduce pain (SMD = −2.19, 95% CI [−4.59; 0.21]; P = 0.0739; I² = 95%) (Figure 2). However, leave-one-out sensitivity analysis yielded significant reduction (SMD = −0.97, 95% CI [−1.50; −0.44]; P = 0.0003; I² = 80%), suggesting potential benefit under certain conditions.
Conclusion:
The ACB may provide significant short-term pain relief in chronic knee osteoarthritis, particularly when used with adjuvants, making it a promising non-surgical option for pain management. However, its efficacy at 3 months remains uncertain due to heterogeneity in the data, although sensitivity analysis suggests potential benefits. Further high-quality RCTs are needed to confirm its long-term efficacy and optimize treatment protocols.
Topic: REGIONAL ANESTHESIA AND ACUTE PAIN - Transitional Pain, Chronic Pain Prevention
Yara Dias, MD1, Lucas Macedo Nascimento, MS2, Glaudir Donato, MS3, Helvécio Neves Feitosa Filho, MS4, Caroline Busato Ramalho de Campos, MS5, Gabriel Stumpf Bastos Amorim, MS6, Karla Mickaela Araújo dos Santos, MS7, Natália Rezende Novais, MS8, Gabryel Cordeiro de Lima, MD9, Kelson Koiti Ogata, MD10.
1Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA, 2Faculty of Medicine, University of Brasília, Brasília, Brazil, 3Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil, 4Faculty of Medicine, University of Fortaleza, Fortaleza, Brazil, 5Faculty of Medicine, University of Nove de Juho, Mauá, Brazil, 6Faculty of Medicine, University of Piauí, Teresina, Brazil, 7Faculty of Medicine, University of Nove de Julho, Mauá, Brazil, 8University Center of the Central Plateau Apparecido dos Santos, Brasília, Brazil, 9Higher School of Health Sciences, Brasília, Brazil, 10Department of Anesthesiology, Pain and Intensive Care, Federal University of São Paulo, São Paulo, Brazil.
Introduction:
Knee osteoarthritis (KOA) is a chronic degenerative disease and the most prevalent joint disease globally. Its management typically includes exercise, weight loss, and education, often supplemented with NSAIDs, corticosteroids, and, in refractory cases, surgery. Despite these treatments, effective pain control remains a challenge. In this context, the adductor canal block (ACB) has emerged as a potential method for pain relief. However, its role in chronic KOA pain as non-surgical treatment remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of ACB in reducing pain in KOA patients outside of surgical settings.
Methods:
A systematic literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science through March 2024. Studies assessing ACB pain outcomes in KOA patients with ≥4 weeks of follow-up were included. Studies combining ACB with other blocks/analgesics, perioperative applications, or non-KOA populations were excluded. Both randomized controlled trials (RCTs) and observational studies were analyzed. Risk of bias was evaluated via RoB 2 and ROBINS-I tools. Standardized Mean Differences (SMD) assessed pooled pain scores at 1 and 3 months. Heterogeneity was measured with I² statistics, using a random-effects model when I² > 50%. Leave-one-out sensitivity analysis tested robustness.
Results:
Seven studies with 303 participants met inclusion criteria. The mean age was 64.30 ± 11.27 years, and 71% were women. All blocks were performed under ultrasound-guidance for accessing the adductor canal; six were performed at mid-thigh and one at the distal medial thigh. Local anesthetics varied: four studies used bupivacaine, one levobupivacaine, and two lidocaine. Follow-up ranged from 1 to 12 months. Of the three non-randomized studies, two had a moderate risk of bias, and one had a high risk of bias. All RCTs were classified as low risk. Pain scores at 1 month post ACB were reported in six studies, with a total of 273 patients included in analysis. ACB significantly reduced pain at 1 month (SMD = −2.15, 95% CI [−3.42; −0.88]; P = 0.0009; I² = 93%) (Figure 1). Sensitivity analysis confirmed robustness. Subgroup analysis revealed enhanced effect with local anesthetic plus adjuvants (SMD = −2.74, 95% CI [−4.45; −1.03]; P < 0.01; I² = 95%) versus anesthetic alone (SMD = −0.98, 95% CI [−1.41; −0.55]; P = 0.83; I² = 0%). Four studies, involving 183 patients assessed pain scores at 3 months. For this investigation, ACB did not significantly reduce pain (SMD = −2.19, 95% CI [−4.59; 0.21]; P = 0.0739; I² = 95%) (Figure 2). However, leave-one-out sensitivity analysis yielded significant reduction (SMD = −0.97, 95% CI [−1.50; −0.44]; P = 0.0003; I² = 80%), suggesting potential benefit under certain conditions.
Conclusion:
The ACB may provide significant short-term pain relief in chronic knee osteoarthritis, particularly when used with adjuvants, making it a promising non-surgical option for pain management. However, its efficacy at 3 months remains uncertain due to heterogeneity in the data, although sensitivity analysis suggests potential benefits. Further high-quality RCTs are needed to confirm its long-term efficacy and optimize treatment protocols.
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