Ultrasound (US) Guided Upper Leg Peripheral Nerve Blocks Provides Surgical Anesthesia for Total Knee Arthroplasty (TKA)

AbstractAs surgical techniques and pharmacology advance, the management of postoperative pain in patients undergoing total knee arthroplasty (TKA) continues to evolve. The current standards of care are composed of multimodal pain management including opioids, nonsteroidal anti-inflammatory drugs and gabapentinoids, peripheral nerve blocks, and periarticular injections. Newer modalities are composed of delayed release local anesthetics and cryoneurolysis. To summarize the current evidence-based treatment modalities and forecast changes in the management of patients having TKAs, we reviewed available data on: (1) oral analgesics; (2) periarticular injections; (3) peripheral nerve blocks; (4) multimodal regimens; and (5) newer modalities in post-TKA pain management. Multimodal analgesic regimens that target numerous pain pathways may provide the best pain management, rehabilitation, patient satisfaction, and reduce opioid use and related side effects. Periarticular injections of delayed-release local anesthetics may further enhance pain management.

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Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4187-x ◽

2016 ◽

Vol 24 (10) ◽

pp. 3299-3305 ◽

Cited By ~ 9

Author(s):

Pedro Hinarejos ◽

Bruno Capurro ◽

Xavier Santiveri ◽

Pere Ortiz ◽

Joan Leal ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Peripheral Nerve ◽

Knee Arthroplasty ◽

Pain Control ◽

Local Infiltration Analgesia ◽

Nerve Blocks ◽

Local Infiltration ◽

Peripheral Nerve Blocks ◽

Total Knee ◽

Infiltration Analgesia

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Evidence-based Review of Periarticular Injections and Peripheral Nerve Blocks in Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325002014010069 ◽

2020 ◽

Vol 14 (1) ◽

pp. 69-72

Author(s):

Alexander Gaukhman ◽

Simon Garceau ◽

Ran Schwarzkopf ◽

James Slover

Keyword(s):

Total Knee Arthroplasty ◽

Pain Management ◽

Peripheral Nerve ◽

Regional Anesthesia ◽

Knee Arthroplasty ◽

Motor Blockade ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Post Operative Pain ◽

Total Knee

Background: Recently, post-operative pain management after Total Knee Arthroplasty (TKA) has focused on a multimodal approach for reducing opioid requirements, promoting early rehabilitation, and expediting discharge from hospital. Regional anesthesia, in the form of Periarticular Injections (PAI) and Peripheral Nerve Blocks (PNB), has shown promise as adjunctive therapy to oral analgesics. Objective: To review the current literature surrounding regional anesthesia for TKA. Discussion: PNBs provide effective analgesia after TKA. Historically, femoral nerve blocks (FNB) have been commonly employed. FNBs, however, lead to the significant motor blockade to the quadriceps musculature, which can dampen early rehabilitation efforts and increase the risk of post-operative falls. Adductor Canal Blocks (ACB) have shown excellent results in reducing post-operative pain while minimizing motor blockade. Periarticular injections (PAI), and infiltration between the popliteal Artery and Capsule of the Knee (IPACK) have similarly helped in reducing patient discomfort after TKA and providing analgesia to the posterior capsular region of the knee. Conclusion: PAIs, and PNBs are important elements in many multimodal postoperative pain management protocols after TKA. Current evidence appears to suggest that a combination of an ACB supplemented by posterior capsular analgesic coverage through PAI or IPACK may provide optimal results.

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