The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block in total knee arthroplasty:  a randomized controlled trial

Kampitak, Wirinaree; Tanavalee, Aree; Tansatit, Tanvaa; Ngarmukos, Srihatach; Songborassamee, Nattaporn; Vichainarong, Chutikant

doi:10.4097/kja.21120

Cited by 6 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adjunct use of an IPBSN block is associated with significant pain relief after anterior cruciate ligament repair for 16‒24 h [ 18 ]. The addition of anterior femoral cutaneous nerve (AFCN, including the IFCN and MFCN) block to femoral triangle block (FTB) decreases the opioid requirement compared to that of FTB alone after TKA [ 19 ]. These studies indicated that anaesthesia for the superficial tissue of the knee facilitates postoperative analgesia after knee surgery.…”

Section: Discussionmentioning

confidence: 99%

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Gong¹,

Zhang

et al. 2022

BMC Anesthesiol

View full text Add to dashboard Cite

Background Developing adequate regional anaesthesia for knee surgeries without affecting lower limb mobilization is crucial to perioperative analgesia. However, reports in this regard are limited. We proposed a technique for ultrasound-guided peripatellar plexus (PP) block. Compared with the femoral nerve (FN) block, we hypothesized that this technique would provide a noninferior block duration and a complete cutaneous sensory block in the peripatellar region without affecting lower limb mobilization. An investigation was conducted to verify our hypothesis in cadavers and volunteers. Methods The study was designed in two parts. First, eight cadaveric lower limbs were dissected to verify the feasibility of PP block after methylene blue injection under ultrasound. Second, using a noninferiority study design, 50 healthy volunteers were randomized to receive either a PP block (PP group) or an FN block (FN group). The primary outcome was the duration of peripatellar cutaneous sensory block, with the prespecified noninferiority margin of -3.08 h; the secondary outcome was the area of peripatellar cutaneous sensory block; in addition, the number of complete anaesthesias of the incision line for total knee arthroplasty and the Bromage score 30 min after block were recorded. Results The PP was successfully dyed, whereas the FN and saphenous nerve were unstained in all cadaveric limbs. The mean difference of the block duration between the two groups was − 1.24 (95% CI, -2.81 − 0.33) h, and the lower boundary of the two-sided 95% CI was higher than the prespecified noninferiority margin (Pnoninferiority = 0.023), confirming the noninferiority of our technique over FN block. The cutaneous sensory loss covered the entire peripatellar region in the PP group. PP block achieved complete anaesthesia of the incision line used for total knee arthroplasty and a Bromage score of 0 in 25 volunteers, which differed significantly from that of volunteers who underwent FN block. Conclusion Ultrasound-guided PP block is a feasible technique. Compared with FN block, PP block provides noninferior block duration and complete blocking of the peripatellar region without affecting lower limb mobilization. Trial registration This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2000041547, registration date 28/12/2020).

show abstract

Section: Discussionmentioning

confidence: 99%

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Gong¹,

Zhang

et al. 2022

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Very few studies have investigated the effect of a selective block of the MFCN on acute pain after total knee arthroplasty. Kampitak et al showed that a selective block of the anterior femoral cutaneous nerve branches (i.e., an intermediate femoral cutaneous nerve block and MFCN block) combined with a distal femoral triangle block significantly improved acute pain relief after total knee arthroplasty compared to a standalone distal femoral triangle block [ 12 , 13 ]. Furthermore, several clinical studies have compared an injection lateral to the femoral artery at the level where the medial border of the sartorius muscle first covers the femoral artery (i.e., in the proximal femoral triangle) to an injection at the midthigh level midway between the anterior superior iliac spine and the base of the patella (distal femoral triangle block) [ 14 , 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty

Bjørn,

Nielsen,

Jensen

et al. 2024

JCM

View full text Add to dashboard Cite

Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery.

show abstract

“…On the day of the surgery, acetaminophen (650 mg) was administered orally to all patients 30 minutes before surgery as premedication. All surgeries were conducted under spinal anesthesia with 3 mL of 0.5% hyperbaric bupivacaine through a paramedian approach using a 27-gauge, 90-mm spinal needle by a single anesthesiologist (WK) which is an expert regional anesthesiologist with abundant scientific reports about this technique [15][16][17] . If the blockade was insufficient, the patient was excluded.…”

Section: Phase Ii: Clinical Studymentioning

confidence: 99%

“…), which is an expert regional anesthesiologist with abundant scientific reports about this technique. [15][16][17] If the blockade was insufficient, the patient was excluded. All patients received 10 mg of intravenous dexamethasone and 4 mg of ondansetron for postoperative nausea and vomiting prophylaxis.…”

Section: Phase Ii: Clinical Studymentioning

confidence: 99%

Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial

et al. 2023

Self Cite

View full text Add to dashboard Cite

Purpose: A continuous adductor canal block (cACB) for pain control in total knee arthroplasty (TKA) is always performed by an anesthesiologist. A surgeon-performed cACB during surgery is somewhat questionable in terms of feasibility, reproducibility, and efficacy. Methods: This study was divided into 2 phases. In Phase I, an experimental dissection of 16 cadaveric knees to expose the Saphenous nerve and related muscles around the adductor canal was conducted. The extent of dye after injection via a catheter inserted into the adductor canal at the time of TKA was evaluated. In phase II, an RCT study comparing clinical outcomes between surgeon-performed (Group 1) and anesthesiologist-performed cACB (Group 2) during TKA in 63 patients was evaluated. The visual analog scale (VAS) at rest and during movement at several time points and functional outcomes during hospitalization were compared. Results: The phase I study demonstrated surgeon-performed cACB during surgery feasible and reproducible with consistent dye extension into the adductor canal after injection via a catheter. In the phase II study, 29 patients of Group 1 and 30 patients of Group 2 completed the evaluation with no differences in baseline parameters. The VAS during movement at 24 and 36 hours, quadriceps strength, time up and go test, and knee motion at different time points, and total morphine consumption showed no differences between both groups. There were no procedure-related complications. Conclusion: The surgeon-performed cACB during surgery was feasible and reproducible with similar VAS scores and functional outcomes during hospitalization to anesthesiologist cACB. Level of evidence Level I, prospective randomized trial. Keywords: adductor canal block, peripheral nerve block, total knee arthroplasty, surgeon-performed ACB

show abstract

The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block in total knee arthroplasty: a randomized controlled trial

Abstract: This article has been accepted for publication and has undergone full peer review but has not beenthrough the copyediting, typesetting, pagination, and proofreading processes, which may lead to differences between this version and the version of record.

Cited by 6 publications

References 27 publications

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty

Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial

Contact Info

Product

Resources

About