This randomized trial asks whether a total knee arthroplasty surgeon can place an adductor canal block intraoperatively, by landmarks alone, as effectively as an anesthesiologist placing one preoperatively under ultrasound. All 200 same-day-discharge patients got a standardized periarticular infiltration; the only variable was who did the block and how. The primary endpoint was time from spinal reversal to meeting discharge criteria.
When regional anesthesia coverage is thin or block-room throughput bottlenecks your outpatient TKA schedule, this trial says the surgeon can place the adductor canal block intraoperatively and expect the same discharge time, pain scores, and opioid use.
The technique is landmark-based and folds into the periarticular infiltration you already do: blunt-dissect the interval between vastus medialis obliquus and medial femur, then direct an 18G needle posteriorly, proximally, and 15 degrees medially at the adductor tubercle, aspirating before injecting.
Weight the evidence appropriately. This is a single-center RCT with only 2-week follow-up, and the sACB arm had more women, so generalizability and longer-term pain differences remain open.
One design detail worth remembering: excluding patients with PCS >16 sharpens the signal but means these results apply to non-catastrophizing patients. Both arms still received a standardized PAI, so the block is an adjunct, not a stand-alone analgesic.
This randomized trial asks whether a total knee arthroplasty surgeon can place an adductor canal block intraoperatively, by landmarks alone, as effectively as an anesthesiologist placing one preoperatively under ultrasound. All 200 same-day-discharge patients got a standardized periarticular infiltration; the only variable was who did the block and how. The primary endpoint was time from spinal reversal to meeting discharge criteria.
When regional anesthesia coverage is thin or block-room throughput bottlenecks your outpatient TKA schedule, this trial says the surgeon can place the adductor canal block intraoperatively and expect the same discharge time, pain scores, and opioid use.
The technique is landmark-based and folds into the periarticular infiltration you already do: blunt-dissect the interval between vastus medialis obliquus and medial femur, then direct an 18G needle posteriorly, proximally, and 15 degrees medially at the adductor tubercle, aspirating before injecting.
Weight the evidence appropriately. This is a single-center RCT with only 2-week follow-up, and the sACB arm had more women, so generalizability and longer-term pain differences remain open.
One design detail worth remembering: excluding patients with PCS >16 sharpens the signal but means these results apply to non-catastrophizing patients. Both arms still received a standardized PAI, so the block is an adjunct, not a stand-alone analgesic.