Date of Award
Doctor of Medical Science (DMSc)
Department of Physician Assistant Medicine
Curt Stilp, EdD, PA-C
Julianna Castaneda, CRNA
Justin M. Gambini, DMSc, MSAPS, PA-C, DFAAPA
Total knee arthroplasty (TKA) is one of the most commonly performed procedures in the developed world, with several hundred thousand performed yearly in the United States alone.1 Majority of the patients will experience severe post-operation pain following TKA, limiting early mobilization and slowing the rehabilitation process. 2 Femoral nerve blocks (FNB) are often used for TKA analgesia, but cause a decrease in quadricep strength, increasing the risk of postoperative falls as well as limiting early post-operative mobilization.2 Other nerve blocks, such as femoral triangle block and adductor canal block are thought to preserve quadricep strength aiding in quicker recovery times and decrease the number of post-operative complications such as inpatient falls.2 The aim of this review is to assess the effects of FNB on quadricep strength, and subsequent effect on early mobilizations and risk of falls, compared to Adductor Canal Block (ACB) and Femoral Triangle Block (FTB) in patients undergoing TKA. Methods The search engine PubMed was used to find and collect data related to nerve blocks during TKA. The general search feature on PubMed were initially used to search “Total Knee Arthroplasty and Nerve Blocks”. Using the advanced search tool, further exploration was conducted using the key terms “Total Knee Arthroplasty”, “Femoral Nerve Block”, and “Adductor Canal Nerve Block”. A final follow-up search adding the key term “Reducing Falls” was completed.
Pain management and leg strength are two key factors to maximize rehabilitation and recovery from TKA. It is clear that both ACB and FNB provide benefits but what is not clear is which nerve block provides the best route for recovery and minimizes post-operative complications, although it will be institutional dependent. Further large-scale studies are needed to accurately assess the best role for nerve blocks in TKA.
Castaneda, Miguel, "Regional Anesthesia Techniques for Total Knee Arthroplasty: Reducing Post-Operative Complications and Improving Rehabilitation and Recovery" (2022). Doctor of Medical Science (DMSc). 2.