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

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.