Anesth Pain Med.  2019 Jul;14(3):249-254. 10.17085/apm.2019.14.3.249.

Nerve blocks for optimal postoperative analgesia after total knee arthroplasty

• Lee B
• Choi YS

• KMID: 2454807
• DOI: http://doi.org/10.17085/apm.2019.14.3.249

Abstract

The use of ideal pain management modalities after total knee arthroplasty facilitates enhanced recovery by promoting early ambulation and controlling postoperative pain. To achieve these goals, multimodal analgesia, including motor-sparing peripheral nerve blocks, appears to be promising in older adults undergoing total knee arthroplasty. This review describes optimal nerve blocks, as a part of multimodal analgesia for total knee arthroplasty, and the scientific basis of each technique.

Keyword

Nerve blocks; Pain management; Total knee arthroplasty

MeSH Terms

Adult
Analgesia*
Arthroplasty, Replacement, Knee*
Early Ambulation
Humans
Nerve Block*
Pain Management
Pain, Postoperative
Peripheral Nerves

Figure

• 

  Fig. 1 Ultrasound images revealing the relevant sono-anatomy for femoral nerve (FN) block before (A) and after (B) local anesthetic (LA) injection, and perineural catheter (C).

• 

  Fig. 2 Ultrasound images of the short-axis view of halfway between the anterior superior iliac spine and base of the patella (A) and proximal end of the adductor canal (B). FA: femoral artery, SN: saphenous nerve, VM: vastus medialis.

• 

  Fig. 3 Ultrasound images of the short axis view of proximal (A) and distal (B) obturator nerve block. SPR: superior pubic ramus, OE: obturator externus, AB: anterior branch of obturator nerve, PB: posterior branch of obturator nerve.

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  Fig. 4 Ultrasound image for infiltration between the popliteal artery and capsule of the posterior knee block. PA: popliteal artery, PV: popliteal vein, TN: tibial nerve.

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