Abstract
The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. The genicular nerve block has recently been demonstrated to provide effective analgesia to the anterior and posterior knee capsule in recent studies. In this retrospective case series, we compare the efficacy of combined genicular nerve block (GNB) and adductor canal block (ACB) to only ACB in both primary and revision TKA patients. This combined novel approach for TKA patients can be utilized to improve patient pain scores and early ambulation, limiting the use of opioids and early discharge.
Highlights
Chronic knee osteoarthritis (OA), an epidemic among aging populations, is a leading source of chronic pain in the United States and other developed countries [1]
The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness
When considering only primary TKA patients, average pain scores for the genicular plus adductor canal block (ACB) group were lower across all recorded time points during the study (Table 1), with a statistically significant p-value (0.001) at the six hours postoperatively
Summary
Chronic knee osteoarthritis (OA), an epidemic among aging populations, is a leading source of chronic pain in the United States and other developed countries [1]. The rise in prevalence of knee OA is a direct result of factors including longer life expectancy and increased body mass index (BMI), and it has been reported that at least 19% of American adults aged 45 years and older are affected [1,2]. TKA is the most common surgical procedure in the United States, and the rate continues to rise as it is projected that the number of surgeries will reach 3.48 million annually by the year 2030 [5]. Postoperative pain management following TKA remains a challenge for physicians as more than half of these patients experience extreme knee pain immediately post-surgery [5]. Reducing postoperative pain and early mobilization has become critical in reducing early mortality, preventing future chronic pain, and limiting the use of opioids [7]
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