Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block

Abstract

The combination of FNB and PIA provides sufficient analgesia after TKA. The rapid and convenient periarticular infiltration technique could be a good alternative to SNB.

Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis

“…Five trials that compared SNB with various analgesic modalities, but lacked an appropriate FNB control group, were also excluded. 15,18,20,22,23 A single relevant RCT comparing single-shot FNB to single-shot FNB ? SNB was identified in the trial registries (clinical trials registry NCT02135120, relevant sample size = 30), but it was still in the recruitment phase with no available outcome results.…”

“…Such small RCTs could increase the likelihood of detecting a treatment effect and/or misestimating its magnitude because of a combination of mere chance and publication bias. Third, analgesic techniques other than SNB (e.g., intra-articular local anesthetic infiltration, 18,23 posterior knee capsule injection 56 have achieved effective pain relief following TKA, whether in combination with or as substitutes for SNB. The influence of the aforementioned analgesic options on SNB analgesia is not within the scope of our systematic review.…”

“…14 Recently, however, nine RCTs have been separately published, with seemingly mixed results. [15][16][17][18][19][20][21][22][23] In this updated meta-analysis, we aimed to quantify the analgesic effects of adding proximal single-shot or continuous SNB to single-shot or continuous FNB in the absence of LIA on analgesic consumption and pain scores during the first 48 hr postoperatively in adult patients undergoing unilateral TKA.…”

Lower extremity regional anesthesia: essentials of our current understanding

“…Proposed alternatives to sciatic nerve block include LA infiltration of the posterior capsule of the knee joint, selective tibial nerve block,384 and sensory posterior articular nerve of the knee (ie, SPANK) block 385. Posterior capsular infiltration remains controversial, as Gi et al 386 found it to a be viable alternative to sciatic nerve block whereas Safa et al 387 and Pinsornak et al 388 concluded that it confers no additional analgesia when combined with femoral nerve block or standard LA infiltration of the knee, respectively. Although selective tibial nerve block spares the peroneal nerve (and prevents the occurrence of foot drop), its impact on ambulation and rehabilitation remains unknown.…”

The Optimal Analgesic Block for Total Knee Arthroplasty

“…48,49 Pain from the posterior knee region after TKA is probably not from the posterior part of the knee capsule, because it is not intersected during surgery. It is rather referred pain from the intra-articular innervation.…”