Periarticular Injection and Peripheral Nerve Blocks 
With Standard Agents

The block of sensory nerves in the ipsilateral limb or locally is an integral part of the multimodal pain management protocol after primary total knee arthroplasty. The 2022 clinical practice guidelines published by the American Association of Hip and Knee Surgeons, the American Society of Regional Anesthesia and Pain Medicine, and the American Academy of Orthopaedic Surgeons describe various strengths of recommendations concerning the use of nerve blocks and periarticular injection. There is also experimental and clinical evidence to support a technique for the surgeon to perform both the periarticular injection and an intra-articular saphenous nerve block. High-dose bupivacaine injection has been shown to be effective and safe. The value of adductor canal block is currently uncertain. Future studies are needed concerning longer-lasting local anesthetic agents and techniques.