Skip to main content
SpringerLink
Log in

Peripheral Nerve Blockade for Total Knee Arthroplasty: An Evidence-Based Review

  • Regional Anesthesia (CJL McCartney, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Total knee arthroplasty (TKA) is associated with significant postoperative pain. Optimization of postoperative analgesia can improve rehabilitation and functional recovery. There is much debate regarding the best peripheral nerve blocks for optimization of postoperative analgesic and functional outcomes following TKA. Continuous femoral nerve block provides excellent postoperative analgesia. In comparison, adductor canal block may provide relative preservation of quadriceps motor weakness, however, its effect on analgesia, mobilization, long-term functional outcomes, and inpatient falls remains unclear. Sciatic nerve block provides effective analgesia in addition to continuous femoral nerve block, and its clinical benefit may be greatest in patients with opioid tolerance or chronic pain. Studies comparing local infiltration analgesia to femoral nerve block are difficult to interpret due to high risk of bias and methodological flaws. Addition of obturator nerve block may improve postoperative analgesia, but the impact of this on functional outcomes remains unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Recently published papers of particular interest have been highlighted as: • Of importance

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–5.

    Article  PubMed  Google Scholar 

  2. Fischer HB, Simanski CJ, Sharp C, PROSPECT Working Group, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63:1105–23.

    Article  PubMed  CAS  Google Scholar 

  3. Lang SA, Yip RW, Chang P, Gerard M. The femoral 3-in-1 block revisited. J Clin Anesth. 1993;5:292–6.

    Article  PubMed  CAS  Google Scholar 

  4. Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg. 2000;90:119–24.

    Article  PubMed  CAS  Google Scholar 

  5. Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d’Athis F. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 1998;86(5):1039–44.

    Article  PubMed  CAS  Google Scholar 

  6. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg. 1998;87(1):93–7.

    Article  PubMed  CAS  Google Scholar 

  7. Szczukowski MJ Jr, Hines JA, Snell JA, Sisca TS. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplast. 2004;19(6):720–5.

    Article  Google Scholar 

  8. Chan M-H, Chen W-H, Tung Y-W, Liu K, Tan P-H, Chia Y-Y. Single-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol Taiwan. 2012;50:54–8.

    Article  PubMed  Google Scholar 

  9. Ozen M, Inan N, Tumer F, Uyar A, Baltaci B. The effect of 3-in-1 femoral nerve block with ropivacaine 0.375% on postoperative morphine consumption in elderly patients after total knee replacement surgery. Agri. 2006;18(4):44–50.

    PubMed  Google Scholar 

  10. Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement. Reg Anesth Pain Med. 2002;27(2):139–44.

    PubMed  Google Scholar 

  11. Hunt KJ, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty. J Arthroplast. 2009;24(4):533–8.

    Article  Google Scholar 

  12. Baranovic S, Maldini B, Milosevic M, Golubic R, Nikolic T. Peripheral regional analgesia with femoral catheter versus intravenous patient controlled analgesia after total knee arthroplasty: a prospective randomized study. Coll Antropol. 2011;35(4):1209–14.

    PubMed  Google Scholar 

  13. Wang H-J, Zhang D-Z, Li S-Z. Comparing the analgesic efficacy of continuous femoral nerve blockade and continuous intravenous analgesia after total knee arthroplasty. Chin Med J. 2010;90(33):2360–2.

    Google Scholar 

  14. Yu H-P, Liu Z-H, Guo W-S, Jiang H-Y, Zhao J. Effect of continuous femoral nerve block in analgesia and the early rehabilitation after total knee replacement. Chin J Orthop Traumatol. 2010;23(11):825–7.

    Google Scholar 

  15. Tang S, Xu ZH, Huang YG, et al. Comparison of the influences of continuous femoral nerve block and patient controlled intravenous analgesia on total knee arthroplasty. Acta Academiae Medicinae Sinicae. 2010;32(5):574–8.

    PubMed  Google Scholar 

  16. Kaloul I, Guay J, Cote C, Fallaha M. The posterior lumbar plexus (psoas compartment) block and the three-in-one femoral nerve block provide similar postoperative analgesia after total knee replacement. Can J Anaesth. 2004;51(1):45–51.

    Article  PubMed  Google Scholar 

  17. Hirst GC, Lang SA, Dust WN, Cassidy JD, Yip RW. Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty. Reg Anesth. 1996;21(4):292–7.

    PubMed  CAS  Google Scholar 

  18. Serpell MG, Millar FA, Thomson MF. Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement. Anaesthesia. 1991;46(4):275–7.

    Article  PubMed  CAS  Google Scholar 

  19. Ganapathy S, Wasserman RA, Watson JT, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg. 1999;89(5):1197–202.

    Article  PubMed  CAS  Google Scholar 

  20. Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplast. 2013;28(4):608–13.

    Article  Google Scholar 

  21. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87(1):88–92.

    Article  PubMed  CAS  Google Scholar 

  22. Kadic L, Boonstra MC, De Waal Malefijt MC, Lako SJ, Van Egmond J, Driessen JJ. Continuous femoral nerve block after total knee arthroplasty? Acta Anaesthesiol Scand. 2009;53(7):914–20.

    Article  PubMed  CAS  Google Scholar 

  23. • Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;13(Issue 5):CD009941. cFNB provides better analgesia compared to FNB following TKA.

  24. Good RP, Snedden MH, Schieber FC, Polachek A. Effects of a preoperative femoral nerve block on pain management and rehabilitation after total knee arthroplasty. Am J Orthop. 2007;36(10):554–7.

    PubMed  Google Scholar 

  25. Ng FY, Ng JKF, Chiu KY, Yan CH, Chan CW. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty. A prospective, crossover, randomized clinical trial. J Arthroplast. 2012;27(6):1234–8.

    Article  Google Scholar 

  26. Seet E, Leong WL, Yeo ASN, Fook-Chong S. Effectiveness of 3-in-1 continuous femoral block of differing concentrations compared to patient controlled intravenous morphine for post total knee arthroplasty analgesia and knee rehabilitation. Anaesth Intensive Care. 2006;34(1):25–30.

    Article  PubMed  CAS  Google Scholar 

  27. Kardash K, Hickey D, Tessler MJ, Payne S, Zukor D, Velly AM. Obturator versus femoral nerve block for analgesia after total knee arthroplasty. Anesth Analg. 2007;105(3):853–8.

    Article  PubMed  Google Scholar 

  28. Salinas FV, Liu SS, Mulroy MF. The effect of single injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg. 2006;102(4):1234–9.

    Article  PubMed  Google Scholar 

  29. Park CK, Cho CK, Lee GG, Lee JH. Optimizing dose infusion of 0.125 % bupivacaine for continuous femoral nerve block after total knee replacement. Korean J Anesthesiol. 2010;58(5):468–76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Wu JW, Wong YC. Elective unilateral total knee replacement using continuous femoral nerve blockade versus conventional patient-controlled analgesia: perioperative patient management based on a multidisciplinary pathway. Hong Kong Med J. 2014;20(1):45–51.

    PubMed  CAS  Google Scholar 

  31. Hillegass MG, Field LC, Stewart SR, et al. The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions. J Clin Anesth. 2013;25:281–8.

    Article  PubMed  CAS  Google Scholar 

  32. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010;113:1144–62.

    Article  PubMed  Google Scholar 

  33. Barrington MJ, Olive DJ, Kluger R. Inappropriate conclusion from meta-analysis of randomized controlled trials. Anesthesiology. 2011;114:1494–5.

    Article  PubMed  Google Scholar 

  34. Wasserstein D, Farlinger C, Brull R, Mahomed N, Gandhi R. Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty. J Arthroplast. 2013;28(7):1121–4.

    Article  Google Scholar 

  35. Kandasami M, Kinninmonth AW, Sarungi M, Baines J, Scott NB. Femoral nerve block for total knee replacement—a word of caution. Knee. 2009;16(2):98–100.

    Article  PubMed  Google Scholar 

  36. Pelt CE, Anderson AW, Anderson MB, Van Dine C, Peters CL. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplast. 2014;29(6):1154–7.

    Article  Google Scholar 

  37. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010;111(6):1552–4.

    Article  PubMed  PubMed Central  Google Scholar 

  38. • Memtsoudis SG, Danninger T, Rasul R et al. Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks. Anesthesiology. 2014;120(3):551–63. No association was found between peripheral nerve blocks and inpatient falls following TKA.

    Article  PubMed  Google Scholar 

  39. Cui Q, Schapiro LH, Kinney MC, Simon P, Poole A, Novicoff WM. Reducing costly falls of total knee replacement patients. Am J Med Qual. 2013;28(4):335–8.

    Article  PubMed  Google Scholar 

  40. Clarke HD, Timm VL, Goldberg BR, Hattrup SJ. Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res. 2012;470(1):244–9.

    Article  PubMed  Google Scholar 

  41. Cook P, Stevens J, Gaudron C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty. J Arthroplast. 2003;18:583–6.

    Article  Google Scholar 

  42. Weber A, Fournier R, Van Gessel E, Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement. Eur J Anaesthesiol. 2002;19:834–6.

    Article  PubMed  CAS  Google Scholar 

  43. Hunt K, Bourne M, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty. J Arthroplast. 2009;24:533–8.

    Article  Google Scholar 

  44. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg. 1998;87:93–7.

    Article  PubMed  CAS  Google Scholar 

  45. Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg. 2004;98:747–9.

    Article  PubMed  Google Scholar 

  46. Pham Dang C, Gautheron E, Guilley J, et al. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005;30:128–33.

    Article  PubMed  Google Scholar 

  47. Morin A, Kratz C, Eberhart LHJ, et al. Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005;30:434–45.

    PubMed  Google Scholar 

  48. Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med. 2011;36:493–8.

    Article  PubMed  Google Scholar 

  49. Wegener JT, van Ooij B, van Dijk CN, Hollmann MW, Preckel B, Stevens MF. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med. 2011;36(5):481–8.

    Article  PubMed  Google Scholar 

  50. Wegener JT, van Ooij B, van Dijk CN, et al. Long-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial. Reg Anesth Pain Med. 2013;38(1):58–63.

    Article  PubMed  Google Scholar 

  51. Sato K, Adachi T, Shirai N, Naoi N. Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty: a prospective, randomized, double-blind study. Reg Anesth Pain Med. 2014;39(3):225–9.

    Article  PubMed  CAS  Google Scholar 

  52. • Cappelleri G, Ghisi D, Fanelli A, Albertin A, Somalvico F, Aldegheri G. Does continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study. Reg Anesth Pain Med. 2011;36(5):489–92. cSNB improves analgesia, decreases morphine request, and improves early rehabilitation compared with SNB in patients undergoing TKA and lumbar plexus block.

    Article  PubMed  Google Scholar 

  53. • Safa B, Gollish J, Haslam L, McCartney CJ. Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty: a prospective, randomized, double-blinded, controlled trial. J Arthroplast. 2014;29(6):1149–53. SNB provided a clinically insignificant opioid sparing effect. SNB and posterior LIA do not provide significant analgesic benefits following TKA.

    Article  PubMed  Google Scholar 

  54. Abdallah FW, Chan VW, Gandhi R, Koshkin A, Abbas S, Brull R. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology. 2014;121:1302–10.

    Article  PubMed  CAS  Google Scholar 

  55. Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am. 2006;88:959–63.

    Article  PubMed  Google Scholar 

  56. Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am. 2006;88:282–9.

    Article  PubMed  Google Scholar 

  57. Andersen LØ, Husted H, Otte KS, Kristensen BB, Kehlet H. High volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 2008;52:1331–5.

    Article  PubMed  CAS  Google Scholar 

  58. Andersen LØ, Husted H, Kristensen BB, Otte KS, Gaarn-Larsen L, Kehlet H. Analgesic efficacy of subcutaneous local anaesthetic wound infiltration in bilateral knee arthroplasty: a randomised, placebo-controlled, double-blind trial. Acta Anaesthesiol Scand. 2010;54:543–8.

    Article  PubMed  CAS  Google Scholar 

  59. Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop. 2010;81:354–60.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Zhang S, Wang F, Lu ZD, Li YP, Zhang L, Jin QH. Effect of single injection versus continuous local infiltration analgesia after total knee arthroplasty: a randomized, double-blind, placebo-controlled study. J Int Med Res. 2011;39:1369–80.

    Article  PubMed  CAS  Google Scholar 

  61. Mauerhan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak GM. Intraarticular morphine and/or bupivacaine in the management of pain after total knee arthroplasty. J Arthroplast. 1997;12(5):546–52.

    Article  CAS  Google Scholar 

  62. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishii S. The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis. J Arthroplast. 2001;16(3):306–11.

    Article  CAS  Google Scholar 

  63. Fajardo M, Collins J, Landa J, Adler E, Meere P, Di Cesare PE. Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA. Orthopedics. 2011;34(5):354.

    Article  PubMed  Google Scholar 

  64. Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee. 2009;16(4):280–4.

    Article  PubMed  Google Scholar 

  65. Qian WW, Weng XS, Fei Q, Li Y, Zhai JL, Bian YY. Application study of periarticular multimodal drug injection in total knee arthroplasty. J Chin Med Assoc. 2010;90(37):2593–6.

    Google Scholar 

  66. Fu PL, Xiao J, Zhu Y, Wu HS, Li XH, Wu YL, et al. Efficacy of a multimodal analgesia protocol in total knee arthroplasty: a randomized, controlled trial. J Int Med Res. 2010;38(4):1404–12.

    Article  PubMed  CAS  Google Scholar 

  67. Chinachoti T, Lungnateetape A, Raksakietisak M. Periarticular infiltration of 0.25 % bupivacaine on top of femoral nerve block and intrathecal morphine improves quality of pain control after total knee arthroplasty: a randomized double-blind placebo controlled clinical trial. J Med Assoc Thai. 2012;95(12):1536–42.

    PubMed  Google Scholar 

  68. Chen Y, Zhang Y, Zhu YL, Fu PL. Efficacy and safety of an intra-operative intraarticular magnesium/ropivacaine injection for pain control following total knee arthroplasty. J Int Med Res. 2012;40(5):2032–40.

    Article  PubMed  CAS  Google Scholar 

  69. Klasen JA, Opitz SA, Melzer C, Thiel A, Hempelmann G. Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty. Acta Anaesthesiol Scand. 1999;43(10):1021–6.

    Article  PubMed  CAS  Google Scholar 

  70. Xu CP, Li X, Wang ZZ, Song JQ, Yu B. Efficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee. 2014;21(3):636–46.

    Article  PubMed  Google Scholar 

  71. Marques EM, Jones HE, Elvers KT, Pyke M, Blom AW, Beswick AD. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short and long-term effectiveness. BMC Musculoskelet Disord. 2014;5(15):220.

    Article  Google Scholar 

  72. • Andersen LØ, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth. 2014;113(3):360–74. LIA may have an analgesic effect in the early postoperative period after TKA, but most trials have high risk of bias and methodological flaws.

    Article  PubMed  CAS  Google Scholar 

  73. Carli F, Clemente A, Asenjo JF, et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs. continuous femoral nerve block. Br J Anaesth. 2010;105:185–95.

    Article  PubMed  CAS  Google Scholar 

  74. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplast. 2007;22:33–8.

    Article  Google Scholar 

  75. Affas F, Nygards EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011;82:441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Mahadevan D, Walter RP, Minto G, Gale TC, McAllen CJ, Oldman M. J Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial. J Arthroplast. 2012;27(10):1806–11.

    Article  Google Scholar 

  77. Gi E, Yamauchi M, Yamakage M, et al. Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block. J Anesth. 2014;28(5):696–701.

    Article  PubMed  Google Scholar 

  78. Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K. Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. J Arthroplast. 2014;29:2462–7.

    Article  Google Scholar 

  79. Spangehl MJ, Clarke HD, Hentz JG, Misra L, Blocher JL, Seamans DP. Periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res. 2014;473:45–53.

    Article  PubMed Central  Google Scholar 

  80. Uesugi K, Kitano N, Kikuchi T, Sekiguchi M, Konno S. Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized, controlled study. Knee. 2014;21(4):848–52.

    Article  PubMed  Google Scholar 

  81. Bagsby DT, Ireland PH, Meneghini MR. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. J Arthroplast. 2014;29:1687–90.

    Article  Google Scholar 

  82. Surdam JW, Licini DJ, Baynes NT, Arce BR. The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients. J Arthroplast. 2014;30:325–9.

    Article  Google Scholar 

  83. • Affas F, Eksborg S, Wretenberg P, Olofsson C, Stephanson N, Stiller CO. Plasma concentration of ketorolac after local infiltration analgesia in hip arthroplasty. Acta Anaesthesiol Scand. 2014;58(9):1140–45. Administration of ketorolac as part of LIA may be comparable to an intramuscular injection of the same dose.

    Article  PubMed  CAS  Google Scholar 

  84. Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand. 2011;55(1):14–9.

    Article  PubMed  CAS  Google Scholar 

  85. Jenstrup MT, Jæger P, Lund J, et al. Effects of adductor canal blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand. 2012;56(3):357–64.

    Article  PubMed  CAS  Google Scholar 

  86. Grevstad U, Mathiesen O, Lind T, Dahl JB. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth. 2014;112(5):912–9.

    Article  PubMed  CAS  Google Scholar 

  87. Jaeger P, Grevstad U, Henningsen MH, Gottschau B, Mathiesen O, Dahl JB. Effect of adductor canal blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand. 2012;56(8):1013–9.

    Article  PubMed  CAS  Google Scholar 

  88. Andersen HL, Gyrn J, Møller L, Christensen B, Zaric D. Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. Reg Anesth Pain Med. 2013;38(2):106–11.

    Article  PubMed  CAS  Google Scholar 

  89. Hanson NA, Allen CJ, Hostetter LS, et al. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg. 2014;118(6):1370–7.

    Article  PubMed  CAS  Google Scholar 

  90. • Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013;118(2):409–15. cACB preserves quadriceps strength compared to cFNB, with no difference in postoperative mobilization.

  91. Kwofie MK, Shastri UD, Gadsden JC, et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med. 2013;38(4):321–5.

    Article  PubMed  Google Scholar 

  92. Mudumbai SC, Kim TE, Howard SK, et al. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014;472(5):1377–83.

    Article  PubMed  Google Scholar 

  93. Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334–9.

    Article  PubMed  Google Scholar 

  94. Memtsoudis SG, Yoo D, Stundner O et al. Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop. 2015;39(4):673–80.

    Article  PubMed  Google Scholar 

  95. Jæger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013;38(6):526–32.

    Article  PubMed  CAS  Google Scholar 

  96. Kim DH, Lin Y, Goytizolo EA, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology. 2014;120(3):540–50.

    Article  PubMed  CAS  Google Scholar 

  97. • Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: A randomized controlled trial. J Arthroplast. 2014;29:2224–9. cACB showed better postoperative outcomes with respect to ambulation ability and early functional recovery compared to cFNB.

    Article  PubMed  Google Scholar 

  98. Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med. 2014;40:3–10.

    Article  Google Scholar 

  99. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005;35:424–36.

    Article  PubMed  Google Scholar 

  100. McNamee DA, Parks L, Milligan KR. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand. 2002;46(1):95–9.

    Article  PubMed  CAS  Google Scholar 

  101. Macalou D, Trueck S, Meuret P, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg. 2004;99(1):251–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada

    Lloyd Turbitt & Stephen Choi

  2. Department of Anesthesiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

    Colin J. L. McCartney

Authors
  1. Lloyd Turbitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Colin J. L. McCartney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lloyd Turbitt.

Additional information

This article is part of the Topical Collection on Regional Anesthesia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Turbitt, L., Choi, S. & McCartney, C.J.L. Peripheral Nerve Blockade for Total Knee Arthroplasty: An Evidence-Based Review. Curr Anesthesiol Rep 5, 225–234 (2015). https://doi.org/10.1007/s40140-015-0104-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-015-0104-y

Keywords

Search

Navigation