Motor-sparing peripheral nerve blocks for hip and knee surgery.

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Increasing trend of same-day discharge for hip and knee surgeries necessitates preservation of lower extremity motor function.
• Early physical therapy is crucial for patient recovery and successful outpatient ambulation after lower extremity procedures.
• Motor-sparing peripheral nerve blocks are emerging as a key strategy to balance analgesia and functional recovery.

Approach:

• Literature review summarizing novel motor-sparing peripheral nerve block techniques for hip and knee surgery.
• Comparison of efficacy and safety profiles of different block techniques.
• Analysis of outcomes related to motor strength, analgesia, and patient ambulation.

Key Points:

• Distal peripheral nerve blocks show potential for preserved quadriceps motor strength and comparable analgesia to traditional methods.
• Studies indicate that for hip surgeries, regional blocks and periarticular infiltration offer similar analgesic effects.
• For knee arthroplasty, combining blocks like adductor canal block (ACB) with iPACK or genicular nerve blocks may optimize pain control and early ambulation.

Conclusions:

• Motor-sparing peripheral nerve blocks facilitate early ambulation, effective pain management, and reduced opioid use, supporting ambulatory lower extremity surgery.
• Further research is required to evaluate the long-term benefits of continuous peripheral nerve block catheters in maintaining motor-sparing and opioid-sparing effects.
• These techniques are vital for enhancing patient recovery and enabling outpatient procedures in orthopedic surgery.