Skip to main content

Acute Pain Management Protocol for Distal Femur, Proximal Tibia/Fibula and Knee Procedures

  • Chapter
  • First Online:
First Aid Perioperative Ultrasound
  • 652 Accesses

Abstract

Early recovery after surgery (ERAS) consisting of balanced and focused platforms of multimodal analgesia, regional anesthesia, and local infiltration analgesia can optimize perioperative outcomes for patients undergoing lower extremity orthopedic procedures. Regional analgesia for total knee arthroplasty has evolved to more distal and selective peripheral nerve blocks such as adductor canal block and IPACK block to allow for earlier postoperative ambulation and improved patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016;116(2):163–76. https://doi.org/10.1093/bja/aev455.

    Article  CAS  PubMed  Google Scholar 

  2. Wilson JM, Farley KX, Erens GA, Guild GN III. General vs spinal anesthesia for revision total knee arthroplasty: do complication rates differ? J Arthroplast. 2019;34(7):1417–22. https://doi.org/10.1016/j.arth.2019.03.048.

    Article  Google Scholar 

  3. Johnson RL, Kopp SL. Optimizing perioperative management of total joint arthroplasty. Anesthesiol Clin. 2014;32(4):865–80. https://doi.org/10.1016/j.anclin.2014.08.006.

    Article  PubMed  Google Scholar 

  4. Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, Kroin JS. The incidence and severity of postoperative pain following inpatient surgery. Pain Med. 2015;16(12):2277–83. https://doi.org/10.1111/pme.12751.

    Article  PubMed  Google Scholar 

  5. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286–93. https://doi.org/10.1001/jamainternmed.2016.3298.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kopp SL, Børglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG, et al. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2017;42(6):683–97. https://doi.org/10.1097/AAP.0000000000000673.

    Article  PubMed  Google Scholar 

  7. Jaffe RA, Schmiesing CA, Golianu B, editors. Anesthesiologist’s manual of surgical procedures. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.

    Google Scholar 

  8. Ilfeld BM, Le LT, Meyer RS, Mariano ER, Vandenborne K, Duncan PW, et al. Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2008;108(4):703–13. https://doi.org/10.1097/ALN.0b013e318167af46.

    Article  CAS  PubMed  Google Scholar 

  9. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904–25. https://doi.org/10.1213/ANE.0b013e3182285e01.

    Article  PubMed  Google Scholar 

  10. Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;2014(5):CD009941. https://doi.org/10.1002/14651858.CD009941.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. J Pain. 2016;17(2):131–57.

    Article  PubMed  Google Scholar 

  12. Dixit V, Fathima S, Walsh SM, Seviciu A, Schwendt I, Spittler KH, et al. Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: a double blinded, randomized trial. Knee. 2018;25(4):623–30. https://doi.org/10.1016/j.knee.2018.04.001.

    Article  PubMed  Google Scholar 

  13. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines. Reg Anesth Pain Med. 2010;35(1):64–101.

    Article  CAS  PubMed  Google Scholar 

  14. Memtsoudis SG, Poeran J, Cozowicz C, Zubizarreta N, Ozbek U, Mazumdar M. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study. Pain. 2016;157(10):2341–9. https://doi.org/10.1097/j.pain.0000000000000654.

    Article  PubMed  Google Scholar 

  15. Webb CAJ, Madison S, Goodman SB, Mariano ER, Horn JL. Perioperative pain management for total knee arthroplasty: need more focus on the forest and less on the trees. Anesthesiology. 2018;128(2):420–1. https://doi.org/10.1097/ALN.0000000000001992.

    Article  PubMed  Google Scholar 

  16. Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010;111(6):1552–4. https://doi.org/10.1213/ANE.0b013e3181fb9507.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Park JH, Restrepo C, Norton R, Mandel S, Sharkey PF, Parvizi J. Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery. J Arthroplast. 2013;28(9):1538–42. https://doi.org/10.1016/j.arth.2013.02.025.

    Article  Google Scholar 

  18. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplast. 2014;29(11):2224–9. https://doi.org/10.1016/j.arth.2014.06.010.

    Article  Google Scholar 

  19. D’Souza RS, Langford BJ, Olsen DA, Johnson RL. Ultrasound-guided local anesthetic infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block for primary total knee arthroplasty: a systematic review of randomized controlled trials. Local Reg Anesth. 2021;14:85–98. https://doi.org/10.2147/LRA.S303827.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hussain N, Brull R, Sheehy B, Dasu M, Weaver T, Abdallah FW. Does the addition of iPACK to adductor canal block in the presence or absence of periarticular local anesthetic infiltration improve analgesic and functional outcomes following total knee arthroplasty? A systematic review and meta-analysis. Reg Anesth Pain Med. 2021;46(8):713–21. https://doi.org/10.1136/rapm-2021-102705.

    Article  PubMed  Google Scholar 

  21. Uesugi K, Kitano N, Kikuchi T, Sekiguchi M, Konno S. Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized, controlled study. Knee. 2014;21(4):848–52. https://doi.org/10.1016/j.knee.2014.04.008.

    Article  PubMed  Google Scholar 

  22. Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334–9. https://doi.org/10.1097/AAP.0b013e318296b6a0.

    Article  PubMed  Google Scholar 

  23. Neal JM, Bernards CM, Hadzic A, Hebl JR, Hogan QH, Horlocker TT, et al. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med. 2008;33(5):404–15. https://doi.org/10.1016/j.rapm.2008.07.527.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jæger P, Jenstrup MT, Lund J, Siersma V, Brøndum V, Hilsted KL, et al. Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95. Br J Anaesth. 2015;115(6):920–6. https://doi.org/10.1093/bja/aev362.

    Article  CAS  PubMed  Google Scholar 

  25. Gautier PE, Hadzic A, Lecoq JP, Brichant JF, Kuroda MM, Vandepitte C. Distribution of injectate and sensory-motor blockade after adductor canal block. Anesth Analg. 2016;122(1):279–82. https://doi.org/10.1213/ANE.0000000000001025.

    Article  CAS  PubMed  Google Scholar 

  26. Chen J, Kim JH, Rosenblatt MA, Lesser JB, Lai YH. Delayed onset of foot drop after the insertion of a mid-thigh adductor canal catheter. J Clin Anesth. 2019;54:59–60. https://doi.org/10.1016/j.jclinane.2018.10.038.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yan H. Lai .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hong, J., Lai, Y.H. (2023). Acute Pain Management Protocol for Distal Femur, Proximal Tibia/Fibula and Knee Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-21291-8_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics