Combined Ultrasound-Guided Adductor Canal Block and Lateral Genicular Nerves Block versus Sole Adductor Canal Block in Anterior Cruciate Ligament Reconstruction: A Randomized Comparative Trial

Postoperative pain after anterior cruciate ligament (ACL) reconstruction is moderate to severe in most patients. Thus, proper plane for pain management is important concern to improve both knee function and patient satisfaction. Femoral nerve block has gained popularity for being the gold standard technique for pain management following ACL reconstruction. Currently, there is a move to block the saphenous branch of the femoral nerve within the adductor canal (AC) due to the motor sparing properties at this location. Moreover, adductor canal block (ACB) has the advantage of providing additional analgesic properties over the saphenous nerve due to the presence of extrasensory branches from the obturator nerve supplying the knee, within the canal. ACB provides adequate analgesia at anteromedial aspect of knee; however, it has minimal or no effect on the posterior and lateral aspects of the knee. Thus, a hybrid block had been described to improve the analgesic properties of ACB. Genicular nerves are the main innervating articular branches for the knee joint. The superior medial genicular nerve (SMGN) and the inferior medial genicular nerve (IMGN) supply the medial and posterior aspect of knee joint while the superior lateral genicular never (SLGN) and inferior lateral genicular nerve (ILGN) supply the lateral and anterior aspect of knee joint. We speculate that addition of blockage of both SLGN and ILGN will improve the results of ACB, specifically at the lateral aspect of the knee in patients undergoing ACL reconstruction.This study aimed to assess the safety and efficacy of combined ultrasound-guided ACB plus LGNB compared to ACB alone in patients undergoing ACL reconstruction.