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. 2025 Feb 18;17(2):e79215.
doi: 10.7759/cureus.79215. eCollection 2025 Feb.

Effects of Genicular Nerve Blocks in Combination With an Adductor Canal Block in Patients Undergoing Arthroscopic Knee Surgery: A Randomized Controlled Trial

Poramed Amorntodsapornpong  1 , Kornkanok Yuwapattanawong  1 , Shinichi Sakura  2
Affiliations

Effects of Genicular Nerve Blocks in Combination With an Adductor Canal Block in Patients Undergoing Arthroscopic Knee Surgery: A Randomized Controlled Trial

Poramed Amorntodsapornpong et al. Cureus. .

Abstract

Background and objectives: Arthroscopic knee surgery is increasingly popular. Optimal postoperative pain management enhances patient satisfaction and minimizes hospitalization. Numerous studies have demonstrated the benefits of adductor canal blocks (ACBs) and genicular nerve blocks (GNBs) in postoperative analgesia. This study aims to evaluate the efficacy of adding GNBs to an ACB in reducing postoperative pain scores compared to an ACB alone. Additionally, it seeks to compare secondary outcomes, including opioid consumption, motor blockade, nausea and vomiting, rash, and itching during the postoperative period.

Method: This prospective, randomized, controlled clinical trial included 49 patients undergoing arthroscopic knee surgery. The study group received a GNB with 0.25% bupivacaine (3 mL) at each quadrant of the knee, except for the inferolateral quadrant, in combination with an ACB using 0.25% bupivacaine (20 mL). The control group received an ACB alone. Fentanyl (1-2 mcg/kg IV) was administered as rescue analgesia during the perioperative period. Pain scores (visual analog score (VAS)), cumulative opioid consumption, motor blockade, and incidences of postoperative nausea and vomiting (PONV) and itching were assessed at six, 12, 24, and 48 hours postoperatively.

Results: No statistically significant differences in median pain scores were observed between the groups. However, postoperative opioid consumption was significantly lower in the study group, with median values (interquartile range (IQR)) of 0 (0, 30) at 12, 24, and 48 hours postoperatively compared to the control group (p ≤ 0.001). Additionally, no significant differences were found between groups regarding motor blockade or opioid-related side effects.

Conclusion: Adding GNBs to an ACB did not demonstrate superiority in reducing postoperative pain scores. However, it effectively reduced perioperative opioid consumption at 12 to 48 hours postoperatively without increasing adverse effects such as nausea, vomiting, or motor blockade. These findings highlight the potential of GNBs as a valuable component of postoperative pain management strategies for arthroscopic knee surgery.

Keywords: adductor canal block; analgesia; genicular nerve blocks; knee arthroscopic surgery; opioid consumption; peripheral nerve blocks; postoperative pain.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Review Board (IRB) of the Faculty of Medicine Vajira Hospital issued approval (COA 138/2566). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A CONSORT diagram shows the flow of each stage of the randomized controlled trial
CONSORT: Consolidated Standards of Reporting Trials; NSAIDs: nonsteroidal anti-inflammatory drugs
Figure 2
Figure 2. Pain score (VAS) assessment performed at the first 48 hours post operation at rest
NS: no statistically significant difference; VAS: visual analog score
Figure 3
Figure 3. Pain score (VAS) assessment performed first 48 hours post operation on movement
NS: no statistically significant difference; VAS: visual analog score
Figure 4
Figure 4. Postoperative fentanyl consumption (mcg) at the first 48 hours post operation
(*) = statistically significant difference
See this image and copyright information in PMC

References

    1. Trends in the use of knee arthroscopy in adults. Howard DH. JAMA Intern Med. 2018;178:1557–1558. - PMC - PubMed
    1. Post-operative pain after knee arthroscopy and related factors. Drosos GI, Stavropoulos NI, Katsis A, Kesidis K, Kazakos K, Verettas DA. Open Orthop J. 2008;2:110–114. - PMC - PubMed
    1. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Jenstrup MT, Jæger P, Lund J, et al. Acta Anaesthesiol Scand. 2012;56:357–364. - PubMed
    1. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial. Hanson NA, Derby RE, Auyong DB, et al. Can J Anaesth. 2013;60:874–880. - PubMed
    1. Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain. Konya ZY, Akin Takmaz S, Başar H, Baltaci B, Babaoğlu G. Turk J Med Sci. 2020;50:86–95. - PMC - PubMed

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