Single-Shot vs. Continuous ACB: Which Nerve Block Truly Optimizes TKA Recovery?

Unpacking the direct meta-analysis that shows no significant difference in opioid consumption between single-shot adductor canal blocks and standard local infiltration.

Total knee arthroplasty (TKA) is among the most common orthopedic procedures performed in the United States, which improves a patient’s quality of life and functional status. Despite the long-term clinical success of the procedure, more than 80% of TKA patients experience moderate to severe pain during the postoperative period, making TKA among the most painful orthopedic procedures. Multimodal analgesia protocols have been widely adopted by orthopedic surgeons and anesthesiologists to provide better postoperative pain control and reduce the side effects of opioid medications.

Regional nerve blocks and peri-articular local anesthetic infiltration (PAI) provide analgesia through the administration of local anesthetics to reduce the transmission of neuropathic pain signals. When regional nerve blocks were introduced to improve pain management after TKA, it was more common to use a combined femoral and sciatic nerve block. Although the combination of femoral and sciatic nerve blocks resulted in total analgesia of the lower extremity, it was accompanied by significant motor blockade.