Advances in Peripheral Nerve Block Techniques and Clinical Strategies for Their Implementation Following Total Knee Arthroplasty: A Narrative Review

TL;DR

This paper reviews different nerve block techniques used after knee replacement surgery to manage pain and improve recovery.

Contribution

The paper provides a narrative review of motor-blocking and motor-sparing nerve block techniques for post-TKA pain management.

Findings

Traditional motor-blocking techniques like femoral and sciatic nerve blocks cause quadriceps weakness.

Motor-sparing techniques such as adductor canal and genicular nerve blocks are preferred for faster recovery.

Combining multiple nerve blocks and using continuous catheters improves analgesia and postoperative outcomes.

Abstract

Total knee arthroplasty (TKA) is one of the most performed surgical procedures in the United States and is often associated with moderate to severe postoperative pain. Multimodal postoperative analgesia following TKA is essential for optimizing postoperative recovery and enabling early postoperative mobilization. Regional anesthesia using ultrasound-guided peripheral nerve blocks plays an important part in perioperative pain management by targeting the femoral, obturator, and sciatic nerves of the knee joint. A variety of peripheral nerve block techniques have been described, which can be classified as either motor-blocking or motor-sparing techniques. Traditional motor-blocking regional anesthesia techniques, such as femoral and sciatic nerve blocks, provide excellent analgesia but can result in significant quadriceps weakness that delays ambulation after TKA. Motor-sparing regional anesthesia techniques, including the adductor canal block, iPACK block, and genicular nerve block, are becoming more widely used in enhanced postoperative recovery protocols for outpatient and short-stay inpatient TKAs. The peripheral nerve block technique can be selected according to the type of surgical procedure, the planned length of stay, rehabilitation goals, and patient comorbidities. Multiple peripheral nerve blocks provide better analgesia than single-injection blocks, and continuous catheter techniques are used for prolonging analgesia in select patients. An individualized multimodal regional anesthesia approach should be utilized to maximize analgesia after TKA to optimize postoperative outcomes. We present a narrative review of peripheral nerve block techniques and strategies for their use following inpatient or outpatient TKA.

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