Adductor canal nerve block (ACB), infiltration between the popliteal artery and the
posterior knee capsule (IPACK), with or without peri-articular infiltration of local
anesthetics (PAI), is the current standard of practice for analgesia coverage after total
knee arthroplasty at the Hospital for Special Surgery. However, we frequently see
patients with moderate post-operative knee pain, particularly on the anterior, middle,
and lateral sides of the knee. There is limited clinical research on if adding a
genicular nerve block could offer TKA patients a more complete analgesia. This study will
test if the addition of genicular nerve block (including superolateral genicular nerve,
superomedial genicular nerve, inferomedial genicular nerve, and nerve to vastus
intermedius) and anterior femoral cutaneous nerve block could offer TKA patients a more
complete analgesia. Participants will be randomly assigned to receive the genicular nerve
block and anterior femoral cutaneous nerve block in addition to standard of care
(intervention group), or not receive the nerve blocks (control group).
The main questions it aims to answer are:
Does incorporating genicular nerve block and anterior femoral cutaneous nerve block
to our current standard of care reduce patients' total opioid consumption in the
first 24 hours after total knee arthroplasty (TKA) surgery?
Does incorporating genicular nerve block and anterior femoral cutaneous nerve block
to our current standard of care reduce patients' worst numeric rating scale (NRS)
pain score in the post-anesthesia care unit (PACU)?
Does incorporating genicular nerve block and anterior femoral cutaneous nerve block
to our current standard of care result in earlier discharge from the post-anesthesia
care unit (PACU)?
Does incorporating genicular nerve block and anterior femoral cutaneous nerve block
to our current standard of care reduce patients' total opioid consumption in the
first 7 days after total knee arthroplasty (TKA) surgery?
Does incorporating genicular nerve block and anterior femoral cutaneous nerve block
to our current standard of care reduce patients' numerical rating scale (NRS) pain
(both at rest and during movement) in the first 24 and 48 hours after surgery?
Participants will be randomly assigned to receive the genicular nerve block and anterior
femoral cutaneous nerve block in addition to standard of care (intervention group), or
not receive the nerve blocks (control group).
Comparing the intervention group to the control group, the researcher's primary outcomes
are numerical pain in the post-anesthesia care unit and cumulative opioid consumption
during the first 24 hours.