A Comparative Study between Femoral Nerve Block and Saphenous Nerve Block in Enhanced Recovery after Knee Replacement Surgery under Spinal Anesthesia

Abstract

Total knee arthroplasty (TKA) is one of the most commonly performed operations in our daily practice. It is indicated in all patients with severe osteoarthritis and it needs early postoperative ambulation to improve postoperative outcomes and to reduce immobility related complications. Providing adequate analgesic control is very important to achieve functional recovery, facilitates rehabilitation and attenuates the progression from acute to chronic postsurgical pain, aiming to maximize non-opioid analgesics in addition to regional analgesic techniques. It is estimated that the majority of patients experience either severe pain (60% of patients) or moderate pain (30% of patients) following TKA surgeries. With the emergence of enhanced recovery after surgery ERAS clinical pathways, many surgical specialties are adopting multimodal analgesic regimens to improve patient outcomes. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuraxial or peripheral nerve blocks were employed. An ideal nerve block that targets the sensory nerves and spares the motor function, can facilitate early ambulation and rehabilitation, which is a major goal for patients undergoing total knee replacement Femoral nerve block is known to provide superior pain control and shortens the time of functional recovery and the length of hospital stay without associated side effects, in comparison with epidural or intravenous patient-controlled analgesia. However, it reduces quadriceps muscle strength and results in an increased risk of falls. Saphenous nerve block in the adductor canal finds the balance between optimal analgesia and minimal motor weakness and it continues to be an active area of research. it produces a primarily sensory block.