Impact of Intra-Articular Local Anesthetic Injection versus Femoral Nerve Block for Post-Operative Analgesia in Total Knee Arthroplasty.

The development of joint replacement is regarded as one of the most significant advances in orthopedic surgeries. Total knee replacement is associated with significant potential perioperative morbidity. In this regard, anesthesia is of prime importance to reduce postoperative pain and morbidity. Anesthesia for total knee replacement should provide stable intraoperative conditions and rapid recuperation. Analgesia techniques should aim to provide optimal pain relief whilst minimizing side effects. There is now good evidence that well conducted regional analgesia can achieve these aims, leading to improved functional recovery facilitated by more rapid and effective joint rehabilitation. The usual choices for post-operative analgesia are epidural modes of analgesia, systemic opiates and peripheral nerve blocks. All these methods need to be complemented with NSAIDS or COX-2 selective inhibitors, paracetamol and gabapentenoids for effective management of break through high intensity pain. All these alternatives come with their own advantages and disadvantages. Statement of the problem: The comparative analgesic effect of intraarticular local anesthetic injection and femoral nerve block has not been adequately reported in patients undergoing TKA. Significance: Clinical trials investigating different modalities of administering analgesia in total knee replacement have reported comparative efficacies between single shot femoral nerve block (SSFNB) and intraarticular injections of local anesthetics with analgesic drugs. A recent retrospective study examining the pain rating, side effects and ambulation found that intraarticular injection with higher dose of local anesthetics provide comparable analgesic effect as single shot femoral nerve block after TKA and might be associated with early ambulation than femoral nerve block post-operatively.