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Background: Several local regional anesthesia regimes have been described in the literature to reduce post-surgical pain following total knee arthroplasty (TKA), but it is unclear which regime has the best analgetic effect combined with the best motor function. The aim of this study was to determine if patients with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) combined with an adductor canal block (SACB) had less pain, better motor function, and less opioid consumption after TKA than patients with a femoral nerve block (FNB) combined with a popliteal sciatic nerve block (PSB). Methods: In a retrospective cohort analysis, 342 patients following primary TKA were examined; 175 patients were treated with an IPACK combined with a SACB, and 167 patients with a femoral FNB combined with a PSB. The outcome parameters postoperative pain (visual analogue scale (VAS) for mobilization and at rest, functional recovery, opioid consumption, hospital discharge, and complications were analyzed and compared between both groups. Results: The IPACK/SACB group had a higher postoperative need for opioids despite higher doses of ropivacaine compared to the FNB/PSB group, accompanied by higher VAS scores. Patients' satisfaction was equal between the groups. Both groups showed comparable mobilization rates and walking distances following TKA. Conclusions: IPACK/SACB showed equal results compared to FNB/PSB for mobilization rates and patients' satisfaction following TKA without a reduction in opioid consumption. [ABSTRACT FROM AUTHOR]

Background: The most prevalent joint condition worldwide is osteoarthritis (OA). The most popular and successful treatment to lessen pain and increase functionality is knee replacement surgery. Pain management following total knee arthroplasty is an essential component in recovery to ensure shorter recovery period. Methods: We conducted a prospective, randomized, comparative study involving patients scheduled for unilateral total knee arthroplasty (TKA) under central neuraxial anesthesia. Following surgery, patients randomly allocated into 2 groups. Group ACB received 12-hourly boluses of 15 ml ropivacaine 0.5% through adductor canal catheter, up-to 48 hours (total 4 doses). Group FNB received 12-hourly boluses of 15 ml ropivacaine 0.5% through femoral nerve catheter, up-to 48 hours (total 4 doses). The primary objective was to evaluate the postoperative Visual Analog Scale (VAS) score, while the secondary outcomes included the assessment of quadriceps muscle strength and the degree of flexion at the knee joint. Results: Out of the 70 patients evaluated for eligibility, 63 were enrolled, and 60 were included in the final analysis. Visual Analog Scale (VAS) scores during periods of rest at 30 minutes, 6 hours, 12 hours, and 48 hours post-operatively in both the groups did not exhibit any significant differences. However, VAS scores during rest at 24 hours and during exercise at 24 hours and 48 hours demonstrated a notable disparity. Furthermore, there was a significant difference in favour of adductor canal block (ACB) over femoral nerve block (FNB) regarding quadriceps muscle strength and the degree of knee flexion at 24 hours and 48 hours post-operatively. Conclusion: Adductor canal block (ACB) delivers comparable pain relief to femoral nerve block (FNB) both at rest and during passive exercise for up to 48 hours after surgery. ACB notably maintains the motor strength of quadriceps muscles when contrasted with FNB, and this preservation comes without introducing any additional complications. [ABSTRACT FROM AUTHOR]

Abstract Background Inadequate pain management after total knee replacement (TKR) prolongs recovery time and increases the risk of postoperative complications. Peripheral nerve fibres blockade has been used as a mode of analgesia after TKR. Femoral nerve block (FNB) is often used to provide postoperative analgesia after TKR. However, FNB causes quadriceps muscle weakness leading to delayed ambulation, patient discomfort and prolonged hospital stay. Nowadays, saphenous nerve block is a relatively new alternative being superior to FNB for providing pure blockage of sensory nerve fibres with preserving quadriceps muscle strength. Results Results of this study showed that leg raising test percentages were significantly higher in group S compared to group F (86.7% versus 43.3% respectively), whereas, time up and go (TUG) test values were significantly lower in group S compared to group F (Mean ±SD values were 22.47 ± 4.93 versus 44.6 ± 4.18 respectively with a p-value < 0.0001). Numerical rating score (NRS) for pain scoring was measured at 30 min after admission to PACU, 3, 6, 12 and 24hrs postoperatively showed no significant differences in both groups F & S (1;(0-2), 1;(1-2), 2;(1-2), 2;(1-2), 2;(2-2) versus 1;(0-2), 1;(1-2), 2;(1-3), 2;(1-2), 2;(2-3) respectively with a p-value 0.42, 0.1, 0.1, 0.49, 0.67). Also, both groups showed no significant difference in cumulative 1st 24hrs Nalbuphine consumption (Mean ±SD were 15.33 ± 7.3 for F group versus 14.33 ± 6.26 for S group with a p-value 0.57). Conclusions Despite the excellent analgesic effect of FNB, saphenous nerve block could be a favorable choice as a mode of analgesia after TKR, as it preserves quadriceps motor strength and promotes early mobilization compared to FNB.

Background: Inadequate pain management after total knee replacement (TKR) prolongs recovery time and increases the risk of postoperative complications. Peripheral nerve fibres blockade has been used as a mode of analgesia after TKR. Femoral nerve block (FNB) is often used to provide postoperative analgesia after TKR. However, FNB causes quadriceps muscle weakness leading to delayed ambulation, patient discomfort and prolonged hospital stay. Nowadays, saphenous nerve block is a relatively new alternative being superior to FNB for providing pure blockage of sensory nerve fibres with preserving quadriceps muscle strength. Results: Results of this study showed that leg raising test percentages were significantly higher in group S compared to group F (86.7% versus 43.3% respectively), whereas, time up and go (TUG) test values were significantly lower in group S compared to group F (Mean ±SD values were 22.47 ± 4.93 versus 44.6 ± 4.18 respectively with a p-value < 0.0001). Numerical rating score (NRS) for pain scoring was measured at 30 min after admission to PACU, 3, 6, 12 and 24hrs postoperatively showed no significant differences in both groups F & S (1;(0-2), 1;(1-2), 2;(1-2), 2;(1-2), 2;(2-2) versus 1;(0-2), 1;(1-2), 2;(1-3), 2;(1-2), 2;(2-3) respectively with a p-value 0.42, 0.1, 0.1, 0.49, 0.67). Also, both groups showed no significant difference in cumulative 1st 24hrs Nalbuphine consumption (Mean ±SD were 15.33 ± 7.3 for F group versus 14.33 ± 6.26 for S group with a p-value 0.57). Conclusions: Despite the excellent analgesic effect of FNB, saphenous nerve block could be a favorable choice as a mode of analgesia after TKR, as it preserves quadriceps motor strength and promotes early mobilization compared to FNB. [ABSTRACT FROM AUTHOR]

Background: Local infiltration anesthesia (LIA) and femoral nerve block (FNB) are commonly used analgesia methods after total knee arthroplasty (TKA). However, there is no definitive conclusion about which of these two analgesia modes is superior. Therefore, this study aimed to systematically evaluate the analgesic effects of LIA and FNB after TKA., Methods: We used the terms "total knee replacement, knee replacement, total knee arthroplasty, knee arthroplasty, local infiltration analgesia, periarticular infiltration, periarticular injection, intra-articular infiltration, intra-articular injection, peripheral nerve block, femoral nerve block" to search the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases. The search period was set from the date of establishment of the database to September 2021. The Cochrane risk of bias tool was used to evaluate the quality of the included studies, and network meta-analysis was performed using Stata14.0 and RevMan 5.30 software., Results: Nine articles were included for analysis. The results of meta-analysis showed that compared with LIA and FNB, the difference in opioid use [mean difference (MD) -4.35, 95% confidence interval (CI): -7.26 to -1.45] was statistically significant. However, there was no significant difference between the static visual analogue score at 24 hours postoperatively (MD 0.20, 95% CI: -0.91 to 1.31), the visual analogue score for exercise visual analogy at 24 hours after surgery (MD 0.10, 95% CI: -0.12 to 0.32), and the length of hospital stay (MD 0.05, 95% CI: -0.40 to 0.50)., Discussion: LIA and FNB have similar effects on pain relief after TKA, but LIA can reduce the use of analgesic drugs and is easy to operate. Therefore, LIA can be used as the priority analgesic method for patients with TKA. However, multi-center, large-sample, high-quality, randomized controlled trials are still needed for further verification., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-286/coif). The authors have no conflicts of interest to declare., (2022 Annals of Translational Medicine. All rights reserved.)