Background

This video evaluates the effect of an adductor canal block (ACB) on short-term outcomes in patients who underwent a medial opening wedge high tibial osteotomy compared with a placebo.

Methods

Thirty-five patients who underwent a unilateral medial opening wedge high tibial osteotomy between 2017 and 2019 were prospectively reviewed and randomly divided into two groups: 19 patients underwent a single-shot ACB and 16 patients underwent a saline injection (placebo group). The primary outcomes were pain (measured via the visual analog scale and range of motion), patient satisfaction, postoperative need for additional opioids (https://www.sciencedirect.com/topics/medicine-and-dentistry/opiate) quadriceps strength (measured via time to straight leg raise), clinical outcomes, and complications.

Results

Pain scores were lower in the ACB group than in the placebo group during the first 12 hours postoperatively (P = 0.04). The ACB group did not exhibit substantially less quadriceps strength weakness postoperatively. No statistical difference was reported in the time to straight leg raise between the ACB and placebo groups (23.5 ± 17.7 hours versus 27.6 ± 11.4 hours, respectively; P = 0.520). The opioid consumption rate in the first 12 hours postoperatively was significantly decreased in the ACB group compared with the placebo group (16.7% versus 70%; P = 0.017). The proportion of patients who underwent more than five opioid injections during the first 72 hours postoperatively was lower in the ACB group compared with the placebo group (8.3% versus 50%; P = 0.043). No localized or systemic complications were reported in either group.

Conclusion

ACB after a medial opening wedge high tibial osteotomy is associated with better outcomes than a placebo with respect to opioid consumption, with no changes in quadriceps strength and complications.