Ultrasound‐guided genicular nerves block vs. local infiltration analgesia for total knee arthroplasty: a randomised controlled non‐inferiority trial

Abstract

Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local infiltration analgesia vs. 20 ml with genicular nerves block). This randomised non-inferiority trial compared the analgesic efficacy of genicular nerves block vs. local infiltration analgesia in the first 24 h following total knee arthroplasty. Sixty patients were randomly allocated to receive either ultrasound-guided block of five genicular nerves or local infiltration analgesia. The primary outcome was rest pain numeric rating scale (0-10) at 24 h. Secondary outcomes included pain numeric rating scale (rest and movement) and cumulative opioid consumption during the first 24 h. We analysed 29 patients in the genicular nerves block group and 30 in the local infiltration analgesia group. We found that the median difference (95%CI) in postoperative rest pain at 24 h (non-inferiority criteria, D = 1) was À1.0 (À2.0 to 1.0, p < 0.001). Median difference in cumulative opioid consumption was 0.0 mg (À3.0-5.0, p < 0.001) meeting the non-inferiority criteria, D = 23 mg. We conclude that genicular nerves block of five nerves provides non-inferior analgesia in the first 24 h following surgery compared with local infiltration analgesia, but with a considerable reduction in the local anaesthetic dose.

Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection

“…† : Significantly different from Preoperative, # : Significantly different from 30th day. used and the level of pain in the first 24 hours were significantly lower in the GNB group, and concluded that GNB was a good alternative for pain management in TKA 22 . In another similar study, Pierangela et al found GNB to be a reasonable alternative in TKA, in line with the results of this study 23 .…”

Application of Genicular Nerves Block Combined with iPACK Block in Postoperative Analgesia of Total Knee Arthroplasty

“…GNB is used for the treatment of persistent pain after osteoarthritis and total knee arthroplasty [3,4] to reduce chronic postoperative pain. GNB selectively blocks the articular branch of the anterior capsule of the knee, and it has been reported to result in lower pain scores at 24 hours after surgery and greatly reduced use of local anesthetic solutions than local infiltration analgesia [5,6]. Although the genicular nerves block is injected at five points, its position is superficial, and the bony landmarks are obvious, so the operation is simple, and the time required is short (about 6 minutes).…”

Ultrasound-guided quadratus lumborum block: a powerful way for reducing postoperative pain

“…In contrast, nerve blocks are free of these risks, making QLB a promising method for clinical application. With advancements in technology, the proficiency of anesthesiologists in using ultrasound has also increased, making ultrasound-guided nerve blocks more accurate, less invasive, and more beneficial for patients 5 . Because there is no obvious breakthrough sensation, QLB can only be performed using ultrasound-guided puncture techniques.…”