Adductor Canal Block vs Epidural Analgesia for Total Knee Arthroplasty: A Narrative Review of Analgesic Efficacy, Functional Recovery, and Safety

Dr. Raghul Ramesh¹, Dr. Dilip Kumar^2*, Dr. Krishna Prasad T³, Dr. Gopi Krishna P⁴

¹ Postgraduate Resident, Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India. Email: raghulindra@gmail.com

^2* Professor, Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India. (Corresponding Author) Email: dilipko@gmail.com

³ Professor, Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India. Email: drkrishna86@gmail.com

⁴ Postgraduate Resident, Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram District, Tamil Nadu, India. Email: gopikrishnan2737@gmail.com

Author Contributions
Dr. Dilip Kumar conceptualized the study, supervised clinical management, and critically revised the manuscript.
Dr. Raghul Ramesh and Dr. Gopi Krishna P were involved in data collection, perioperative management, and initial drafting of the manuscript.
Dr. Krishna Prasad T contributed to intraoperative management and provided critical intellectual input during manuscript revision.
All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.

Declaration
Conflicts of Interest: The authors declare no conflicts of interest.
Funding: No financial support was received for this study.

Received: 20th Feb, 2026 | Revised: 4th Mar, 2026 | Accepted: 25th Mar, 2026 | Available Online: 10th Apr, 2026

ABSTRACT

Background: Total knee arthroplasty (TKA) is commonly associated with significant postoperative pain, which can impair early mobilization and delay functional recovery. Effective analgesia is therefore essential to optimize outcomes and support enhanced recovery after surgery (ERAS) protocols. Epidural analgesia (EA) has traditionally been considered the gold standard for postoperative pain control; however, its use is limited by adverse effects such as motor blockade, hypotension, and urinary retention. Adductor canal block (ACB), a motor-sparing peripheral nerve block, has emerged as a promising alternative.

Objective: To compare adductor canal block and epidural analgesia in patients undergoing total knee arthroplasty with respect to analgesic efficacy, functional recovery, and safety outcomes.

Methods: A narrative review of the literature was conducted using databases including PubMed, Scopus, Web of Science, and the Cochrane Library. Relevant randomized controlled trials, cohort studies, and systematic reviews comparing ACB and EA in TKA were included. Key outcomes analyzed were postoperative pain scores, opioid consumption, quadriceps strength, time to ambulation, length of hospital stay, and incidence of adverse effects.

Results: Both ACB and EA provide effective postoperative analgesia following TKA. Epidural analgesia may offer slightly superior pain control in the immediate postoperative period; however, it is associated with significant adverse effects including motor blockade, hypotension, and urinary retention. In contrast, ACB provides comparable analgesia while preserving quadriceps strength, facilitating early mobilization and improved functional recovery. Additionally, ACB demonstrates a more favorable safety profile with fewer systemic complications. Opioid consumption is generally similar between the two techniques when used as part of multimodal analgesia.

Conclusion: Adductor canal block represents a safe and effective alternative to epidural analgesia in total knee arthroplasty. Its motor-sparing properties and favorable safety profile make it particularly suitable for ERAS protocols aimed at early mobilization and enhanced recovery. While epidural analgesia may still have a role in selected cases, current evidence supports the preferential use of ACB in modern perioperative practice.

Keywords: Adductor canal block; Epidural analgesia; Total knee arthroplasty; Postoperative pain; Functional recovery; Regional anesthesia.

How to cite this article: Ramesh R, Kumar D, Krishna Prasad T, Gopi Krishna P. Adductor Canal Block vs Epidural Analgesia for Total Knee Arthroplasty: A Narrative Review of Analgesic Efficacy, Functional Recovery, and Safety. Int J Drug Deliv Technol. 2026;16(31s):1-7. DOI: 10.25258/ijddt.16.31s.1

Source of support: Nil.

Conflict of interest: The authors declare no conflicts of interest.