A Novel Multiple Sensory Nerve Block Combination Using Ultrasound Guidance in Knee Arthroplasty: A Randomized Clinical Trial.

TL;DR

An eight-nerve block combination provided equivalent analgesia to local infiltration analgesia (LIA) after total knee arthroplasty with no difference in pain scores. The nerve block approach reduced 48-hour opioid consumption and shortened hospital stay.

Key findings

• No significant difference in postoperative pain intensity (NRS) between eight-nerve block combination and LIA at any time point from PACU through POD1
• Eight-nerve block group had lower 48-hour opioid consumption (median 70 mg vs 96 mg OME; P=0.008)
• Hospital stay was shorter in nerve block group (median 1 day vs 2 days; P<0.001)
• Eight-nerve block combination provides motor-sparing analgesia targeting vastus medialis, vastus intermedius, anterior femoral cutaneous, adductor canal, genicular, and IPACK nerves

Why this matters at the bedside

The findings suggest that comprehensive regional anesthesia with eight-nerve blocks offers opioid-sparing benefits and reduced hospital stay without superior pain control compared to infiltration analgesia, potentially favoring regional approach for facilitating faster discharge and reducing postoperative opioid exposure in TKA patients.