Periarticular Injection and Peripheral Nerve Blocks 
With Standard Agents

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Sensory nerve blocks are crucial in multimodal pain management following total knee arthroplasty (TKA).
• Clinical practice guidelines from major orthopedic and anesthesia societies offer recommendations on nerve blocks and periarticular injections.
• Evidence supports combining periarticular injections with intra-articular saphenous nerve blocks.

Purpose of the Study:

• To evaluate the efficacy and safety of nerve blocks, specifically saphenous nerve blocks and adductor canal blocks, as part of pain management after total knee arthroplasty.
• To review current clinical practice guidelines and experimental evidence regarding regional anesthesia techniques in TKA.

Main Methods:

• Review of 2022 clinical practice guidelines from the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, and American Academy of Orthopaedic Surgeons.
• Analysis of experimental and clinical evidence supporting combined periarticular injection and intra-articular saphenous nerve block.
• Assessment of high-dose bupivacaine injection efficacy and safety.

Main Results:

• High-dose bupivacaine injection for saphenous nerve blocks has demonstrated effectiveness and safety.
• The utility of the adductor canal block in this context remains uncertain.
• Current guidelines provide varying strengths of recommendations for different nerve block techniques.

Conclusions:

• Saphenous nerve blocks, particularly with high-dose bupivacaine, are a valuable component of post-TKA pain management.
• Further research is necessary to clarify the role of the adductor canal block.
• Future studies should focus on developing longer-acting local anesthetic agents and innovative techniques for TKA pain control.