Popliteal plexus block in total knee arthroplasty: a single-center randomized controlled double-blinded trial

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Postoperative pain management after total knee arthroplasty (TKA) is crucial.
• The efficacy of popliteal plexus blocks in conjunction with femoral nerve blocks for TKA is under investigation.
• Continuous femoral nerve blocks are a common approach for TKA pain control.

Purpose of the Study:

• To evaluate if a popliteal plexus block enhances pain relief following TKA.
• To determine if adding a popliteal plexus block reduces postoperative opioid requirements when combined with a continuous femoral nerve block.
• To assess the impact on pain scores and opioid consumption.

Main Methods:

• A randomized trial involving 66 patients undergoing TKA.
• Intervention group: continuous femoral nerve block + popliteal plexus block (n=32).
• Control group: continuous femoral nerve block alone (n=34).
• Primary endpoint: 12-hour postoperative morphine-equivalent consumption.

Main Results:

• The intervention group showed lower median 12-hour morphine-equivalent consumption (6.1 mg vs. 10 mg, p=0.04).
• Lower pain intensity was observed in the postanesthesia care unit for the intervention group (p=0.01).
• Fewer patients in the intervention group reported lateroposterior knee pain at 12 hours (34.4% vs. 61.8%, p=0.03).
• Benefits diminished after 24 hours.

Conclusions:

• Adding a popliteal plexus block to a continuous femoral nerve block significantly decreases opioid utilization within the first 12 hours post-TKA.
• The observed effect size is small, prompting consideration of its clinical relevance.
• Further research may be needed to optimize multimodal analgesia strategies for TKA.