Objective:To determine whether any strength, range of motion (ROM), or functional improvement exists in the adductor canal block (ACB) group after completion of inpatient rehabilitation and following the removal of the continuous block.Design:Retrospective cohort.Setting:Inpatient rehabilitation at discharge and outpatient orthopedic clinic for follow-up.Participants:Two hundred forty-six consecutive primary total knee arthroplasties (TKAs; N = 221 patients) performed by a single surgeon in a single institution between July 2013 and August 2015 for a diagnosis of osteoarthritis.Interventions:All TKA cases received a continuous femoral nerve block (FNB) from July 2013 to August 2014 for postoperative pain control. From August 2014 through August 2015, all TKAs received a continuous ACB.Main Outcome Measures:Manual muscle tests (MMTs; 0-5 scale) of the quadriceps and passive ROM of the knee were assessed at 3 time periods (hospital discharge [HD], 1-2 weeks, and 1 month). Patient-oriented outcomes and clinical knee scores were examined preoperatively and postoperatively at 3 and 6 months.Results:63.6% of FNB cases had an MMT less than 3 at HD and 36.4% of FNB cases had an MMT of 3 or greater at HD. Conversely, 46% of ACB cases had an MMT less than 3 at HD and 54% had an MMT of 3 or greater at HD. There were no statistically significant differences in all postoperative variables at all tested time periods.Conclusions:This study showed no short-term postoperative advantages in the ACB group after catheter removal. The superior inpatient rehabilitation course in the continuous ACB group is likely not long enough to translate into any maintained benefit following catheter removal. Nevertheless, the trend toward greater strength in the ACB group in the immediate short term at HD warrants further investigation.

Coccygeal pain is a difficult chronic pain problem with mixed response to various treatments. This is a report of a case of coccygeal pain that after failing various conservative and interventional procedures over five years was evaluated with a temporary peripheral sacral fascial lead followed by implantation of bilateral sacral paramedian leads for peripheral nerve field stimulation (PNFS). This resulted in marked pain control and resumption of full activity. The visual analog scale (VAS) pain score improved from eight pre-implant to one after implant and has remained at that level in follow-up. Peripheral nerve field stimulation has been reported for axial chronic back pain, post-laminectomy pain and sacroiliac joint pain either alone or in conjunction with epidural spinal cord stimulation. Both single and parallel leads have been used to provide wider stimulation but differences in location have not been examined. This is the first case report of the use of PNFS for treatment of intractable chronic coccygeal pain. The effectiveness of PNFS was established for this patient by using a prolonged 10-day temporary trial period followed by a 30-day interval without stimulation during which the pain returned to the pre-trial level before proceeding with permanent implantation, it was clear that in this case, PNFS was effective for pain control. Interestingly, the trial and permanent leads were both in the posterior sacral fascia but not in identical positions yet equally effective for pain control. The observation of the effectiveness of different positions may indicate that at least for peripheral field stimulation there may be significant current spread in the fascia. Two and three months after the implant, we examined the effect of different lead settings and the effect of unilateral stimulation compared with bilateral stimulation with and without interlead communication. The patient feedback in this case provides some understanding of the effect of field stimulation with different lead placements. A trial of a deep peripheral fascial lead for sacral and coccygeal field stimulation is a simple option and may be a reasonable approach to consider in the range of treatments for chronic coccygeal pain.