Motor-sparing nerve blocks for total knee replacement: A scoping review

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Total knee replacement (TKR) is a common orthopedic procedure.
• Effective postoperative pain management is crucial for patient recovery and satisfaction.
• Motor-sparing analgesic interventions aim to provide pain relief without compromising motor function.

Purpose of the Study:

• To conduct a scoping review on the optimal combination of motor-sparing analgesic interventions for TKR.
• To synthesize current evidence on the efficacy of various analgesic techniques in TKR patients.

Main Methods:

• Scoping review of randomized controlled trials.
• Searched MEDLINE, EMBASE, and CINAHL databases up to May 2020.
• Included trials with motor-sparing interventions; excluded RCTs lacking prospective registration and blinded assessment.

Main Results:

• Femoral triangle blocks demonstrated superiority over placebo and periarticular infiltration.
• Combining femoral triangle blocks with periarticular infiltration improved pain control, patient satisfaction, and decreased opioid consumption.
• Continuous femoral triangle blocks offered better postoperative analgesia than single injections, though adjuvants showed diminished benefits. Combined femoral triangle-obturator blocks led to enhanced analgesia and faster discharge.

Conclusions:

• An optimal analgesic strategy for TKR may involve combining periarticular infiltration, femoral triangle blocks, and obturator nerve blocks.
• Further research is needed to evaluate the benefits of IPACK, popliteal plexus block, and genicular nerve block in TKR.