Abstract
IntroductionThe term “major knee surgery” includes anterior cruciate ligament reconstruction, knee arthrolysis, and total knee replacement. Although some improvement has been made in current surgical techniques, post-operative pain in these kinds of procedures is still a problem. There are several analgesic options, each one with its own characteristics, but there is still lack of agreement on the best approach to post-operative pain in this type of surgery. ObjectivesTo present the available evidence on current analgesic techniques for major knee surgery, with a focus on total knee replacement and regional anaesthesia. A brief anatomical review is also given in order to better understand the different nerve block techniques. Materials and methodsA search was carried out in medical data bases (PubMed and Cochrane), as well as anaesthesiology journals (Regional Anaesthesia and Pain Medicine, Anaesthesiology Journal, British Journal of Anaesthesiology, etc.). Search terms were as follows: total knee replacement, regional anaesthesia, IPACK, HDLIA, abductor channel block, femoral nerve block. DiscussionDifferent regional anesthesia approaches are discussed along with their performance techniques and characteristics: High dose local infiltration analgesia (HDLIA), femoral block (both modalities: single shot and continue nerve block), adductor canal block. The pros and cons on each one are considered. ConclusionsThere is no gold standard for total knee replacement post-operative analgesia, since none of the techniques combines early ambulation and effective analgesia. The election criteria for any of the analgesic options should be made according the physicians environment. A combination of different analgesic techniques (Example: continuos femoral block + IPACK or adductor canal block + HDLIA) seems to be an attractive option, but there is still lack of evidence to support their systematic indication.
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