Narrowing the blockade field: development of an optimal postoperative analgesia regimen for total knee arthroplasty

Excerpt

Total knee arthroplasty (TKA) is associated with significant postoperative pain. Pain management for TKA is complex, and even with administration of multiple nerve blocks, high-quality postoperative analgesia cannot always be achieved. Multiple regional approaches, including femoral nerve block (FNB), fascia iliaca block, conventional or three-in-one (i.e., inguinal paravascular) lumbar plexus block, and adductor canal block (ACB) (with or without periarticular infiltration), have been attempted to minimize knee pain following the procedure with variable success.1,2 Historically, FNB has been the most commonly performed regional technique. Although FNB provides substantial coverage of the operative area, it may spare areas innervated by other inferior branches of the lumbar plexus, including the lateral femoral cutaneous and obturator nerves, resulting in inadequate analgesia. Since branches of the sciatic nerve also innervate the knee, various studies have examined whether supplementing FNB with sciatic nerve block (SNB) provides superior analgesia following TKA. In this issue, Abdallah et al. discuss their meta-analysis of several recent randomized-controlled trials, which they performed in an attempt to address the effectiveness of a combined FNB and SNB approach.3 The authors show that, although individual studies provide mixed results, overall trends suggest that combining SNB and FNB can reduce opioid consumption and alleviate knee pain postoperatively compared with FNB alone. …