JOA - 2026-07-01 - Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
The Chitranjan S. Ranawat Award: Surgeon-Performed, Intraoperative Adductor Canal Blocks are Non-Inferior to Anesthesiologist-Performed Adductor Canal Blocks in Total Knee Arthroplasty.
Benavides BO, Charlebois A, Dervin GF, Grammatopoulos G, Ottawa Arthroplasty Group, Mbadjeu Hondjeu AR, Duncan K, Garceau SP
Topics
Key Takeaway
Surgeon-performed intraoperative adductor canal blocks achieved non-inferior time to discharge (209.5 vs 231.1 minutes, P=0.06) compared to anesthesiologist-performed blocks in 200 same-day discharge TKA patients.
Summary Depth
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Summary
This RCT asked whether surgeon-performed intraoperative ACBs (sACB) are non-inferior to anesthesiologist-performed preoperative ACBs (aACB) in same-day discharge TKA. 200 patients were randomized and assessed for time from spinal reversal to discharge, pain scores, 24-hour opioid consumption, SDD failure, and 2-week PROMs. No significant differences were found across all outcomes: discharge NPRS 2.9 vs 2.4 (P=0.07), 24-hour MME 43.6 vs 35.8 (P=0.31), and SDD failure 5 vs 8 patients (P=0.42).
Key Limitation
The non-inferiority margin of 15% difference in discharge time was not formally validated against a minimum clinically important difference, meaning the threshold for acceptable inferiority was arbitrarily defined.
Original Abstract
BACKGROUND
For total knee arthroplasty (TKA) performed in an ambulatory setting, reliable analgesia is essential for same-day discharge (SDD). Although adductor canal blocks (ACBs) are effective, access to anesthesiologist-performed ACBs (aACBs) may be limited by regional anesthesia availability in resource-constrained centers. Even when expertise exists, lack of perioperative workflow integration can reduce efficiency, prolong procedural time, and increase costs. The objective of this study was to evaluate whether surgeon-performed ACBs (sACBs) are non-inferior to aACBs regarding time to discharge, perioperative outcomes, and patient-reported outcome measures.
METHODS
A prospective randomized controlled trial of 200 SDD TKA patients was conducted. Participants were randomized to receive preoperative aACB or intraoperative sACB. The primary outcome was time from spinal anesthetic reversal to discharge. The secondary outcomes included Numeric Pain Rating Scale (NPRS), 24-hour morphine milligram equivalent use, SDD failure, 24-hour readmission, and patient-reported outcome measures at baseline and two weeks postoperatively. Power analysis used a representative SDD TKA sample detecting a 15% difference in the primary outcome (power 80%, α = 0.05).
RESULTS
Time to discharge was not different in sACB compared to aACB: 209.5 minutes (range, 10 to 510) compared to 231.1 (range, 59 to 455), P = 0.06. Secondary outcomes showed no significant differences: NPRS at baseline, 4.3 (aACB) versus 4.3 (sACB), P = 0.87; and NPRS at discharge, 2.4 (aACB) versus 2.9 (sACB), P = 0.07. The 24-hour opioid consumption was 35.8 morphine milligram equivalent (aACB) versus 43.6 (sACB), P = 0.31. There were no 24-hour readmissions. There were 13 patients who failed
SDD
eight (aACB) versus five (sACB), P = 0.42.
CONCLUSIONS
The sACBs were non-inferior to aACBs for outpatient TKA. An sACB represents a safe alternative that may reduce reliance on limited anesthesia resources. With standardized perioperative integration, sACB may improve operating room efficiency and reduce costs.