Motor-sparing nerve blocks for total knee replacement: A scoping review - 16/12/20
: Clinical Instructor, Julián Aliste, MD a : Assistant Professor, Daniela Bravo, MD a : Assistant Professor, Mohammed Saadawi, MD b : Fellow, Francis V. Salinas, MD c : Staff Anesthesiologist, De Q. Tran, MD, FRCPC b : ProfessorAbstract |
Study objective |
This scoping review investigates the optimal combination of motor-sparing analgesic interventions for patients undergoing total knee replacement (TKR).
Design |
Scoping review.
Intervention |
MEDLINE, EMBASE and CINAHL databases were searched (inception-last week of May 2020). Only trials including motor-sparing interventions were included. Randomized controlled trials lacking prospective registration and blinded assessment were excluded.
Main results |
The cumulative evidence suggests that femoral triangle blocks outperform placebo and periarticular infiltration. When combined with the latter, femoral triangle blocks are associated with improved pain control, higher patient satisfaction and decreased opioid consumption. Continuous femoral triangle blocks provide superior postoperative analgesia compared with their single-injection counterparts. However, these benefits seem less pronounced when perineural adjuvants are used. Combined femoral triangle-obturator blocks result in improved analgesia and swifter discharge compared with femoral triangle blocks alone.
Conclusions |
The optimal analgesic strategy for TKR may include a combination of different analgesic modalities (periarticular infiltration, femoral triangle blocks, obturator nerve block). Future trials are required to investigate the incremental benefits provided by local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK), popliteal plexus block and genicular nerve block.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Femoral triangle blocks outperform placebo and periarticular infiltration. |
• | Femoral triangle blocks combined with periarticular infiltration (PAI) improve pain control compared to PAI alone. |
• | Combined femoral triangle-obturator blocks result in improved analgesia compared with femoral triangle blocks alone. |
• | Future trials are required to investigate the benefits provided by IPACK, popliteal plexus block and genicular nerve block. |
Keywords : Knee arthroplasty, Nerve block
Plan
| ☆ | This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors and the authors declare no competing interests. |
Vol 68
Article 110076- février 2021 Retour au numéro
Article précédent
- Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks
- Mohammed Saadawi, Sebastián Layera, Julián Aliste, Daniela Bravo, Prangmalee Leurcharusmee, De Q. Tran
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- Philip Heesen, Stephen H. Halpern, Yaakov Beilin, Paola A. Mauri, Leonid A. Eidelman, Michael Heesen, Sharon Orbach-Zinger
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