Comparison of Genicular Nerve Block in Combination With Adductor Canal Block in Both Primary and Revision Total Knee Arthroplasty: A Retrospective Case Series

Abstract

The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. The genicular nerve block has recently been demonstrated to provide effective analgesia to the anterior and posterior knee capsule in recent studies. In this retrospective case series, we compare the efficacy of combined genicular nerve block (GNB) and adductor canal block (ACB) to only ACB in both primary and revision TKA patients. This combined novel approach for TKA patients can be utilized to improve patient pain scores and early ambulation, limiting the use of opioids and early discharge.

VAS Scores, Pain-Free Duration, Range of Motion, and IL-6 Levels are Better in Adductor Canal Block Compared to Genicular Nerve Block in Patients with Chronic Pain of Degenerative Disease of the Knee Joint

“…RCT research by Tan et al also reported a significant improvement of VAS scores 2-24 hours after the ACB procedure and this result was similar to the Femoral Nerve Block (FNB) procedure [17]. Retrospective studies by [13] compared ACB procedures with a combination of ACB and GNB. The study found an improving VAS scores in both groups, while the ACB and GNB combination groups had a lower VAS score than ACB only [13].…”

“…Based on the analysis test on the VAS score variable, significance between the ACB and GNB procedures (P <0.05) was decided. This is because the ACB procedure targets the saphenous nerve, medial cutaneous femoral nerve, medial vastus nerve, and the articular branch of the obturator nerve [13]. There is no other study that compares the post procedure VAS score with ACB and GNB.…”

Adductor Canal Block (ACB) provides Adequate Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty (TKA): Case Report

“…Nevertheless, no single regional anesthesia technique can provide ideal analgesia, especially without any motor weakness after TKA [14]. Some patients will not achieve adequate posterior knee analgesia as ACB pain relief is primarily limited to the anterior capsule of the knee [6,14].…”

“…Nevertheless, no single regional anesthesia technique can provide ideal analgesia, especially without any motor weakness after TKA [14]. Some patients will not achieve adequate posterior knee analgesia as ACB pain relief is primarily limited to the anterior capsule of the knee [6,14]. Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) and genicular nerve block (GNB) combined with ACB has been studied to cover this problem with promising results [14,15].…”

“…Some patients will not achieve adequate posterior knee analgesia as ACB pain relief is primarily limited to the anterior capsule of the knee [6,14]. Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) and genicular nerve block (GNB) combined with ACB has been studied to cover this problem with promising results [14,15]. Combined ACB and local infiltration analgesia (LIA) also showed enhanced early ambulation with reduced and delayed rescue analgesia after TKA [16].…”