Peripheral nerve blocks for total knee arthroplasty: a bibliometric and visual analysis, 2016-2025

Total knee arthroplasty (TKA) is associated with substantial postoperative pain that may delay mobilization and recovery. Peripheral nerve blocks (PNBs) are widely studied within multimodal analgesia and enhanced recovery after surgery (ERAS) pathways, but the structure and evolution of this literature have not been comprehensively mapped. This bibliometric study evaluated global publication trends, collaboration patterns, citation structures, and prominent research themes in PNB research for TKA from 2016 to 2025.

Records published from January 1, 2016, to December 31, 2025, were retrieved from the Web of Science Core Collection (WoSCC) and Scopus on January 7, 2026. After database-specific filtering, multistep deduplication, and eligibility screening, 1,225 unique English-language articles were included. Bibliometric analyses were conducted using VOSviewer (version 1.6.20), CiteSpace (version 6.2.R4), and the bibliometrix package in R (version 4.1.2). Full database-specific strategies, screening criteria, data harmonization rules, and analysis settings are provided in the Supplementary Methods.

Annual publication output fluctuated but increased overall from 105 records in 2016 to 129 in 2025, with a peak of 134 in 2024. The compound annual growth rate was 2.31% across the nine year-to-year intervals from 2016 to 2025. The United States and China contributed the largest publication volumes, and the Hospital for Special Surgery was the most productive institution. Keyword clustering identified nine clusters (modularity Q > 0.7; mean silhouette >0.8), demonstrating substantial publication activity around motor-sparing techniques, including adductor canal block and IPACK, as well as liposomal bupivacaine and chronic postsurgical pain.

The literature on PNBs for TKA has increasingly examined motor-sparing techniques, functional recovery, long-acting local anesthetic formulations, and longer-term outcomes. Liposomal bupivacaine, chronic postsurgical pain, sleep disturbance, and cognitive outcomes were prominent themes. However, bibliometric prominence should not be interpreted as evidence of clinical superiority or as a basis for treatment recommendations. These findings identify areas of research activity and uncertainty that warrant further evaluation through comparative clinical studies and systematic evidence synthesis.