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World J Orthop. Jul 18, 2014; 5(3): 225-232
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.225
Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks
Thomas Danninger, Mathias Opperer, Stavros G Memtsoudis
Thomas Danninger, Stavros G Memtsoudis, Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, United States
Mathias Opperer, Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg 5020, Austria
Author contributions: Danninger T, Opperer M and Memtsoudis SG contributed equally to this work.
Correspondence to: Stavros G Memtsoudis, MD, PhD, FCCP, Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, United States. memtsoudiss@hss.edu
Telephone: +1-212-6061206 Fax: +1-212-5174481
Received: December 19, 2013
Revised: April 7, 2014
Accepted: May 13, 2014
Published online: July 18, 2014
Abstract

Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for peripheral nerve blockades, either landmark or, more recently, ultrasound guided have been described over the last decades. This includes but is not restricted to techniques discussed in this review. The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block. Moreover, ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction; this is important as hospital rankings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications, considerations and outcomes.

Keywords: Regional anesthesia, Peripheral nerve blockade, Total knee arthroplasty, Perioperative pain control, Postoperative outcome

Core tip: Over the last decades, the number of total knee arthroplasty procedures performed has increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing related implications, considerations and outcomes.