However, qualitative analyses of studies on singleshot or continuous femoral nerve block consistently demonstrate a significant reduction in postoperative pain and opioid consumption for both types of blocks compared to controls. Inconsistencies in the reporting of outcomes and timepoint for reporting of outcomes frequently resulted in substantial heterogeneity in the metaanalyses. Despite the numerous high and moderate quality studies on single-shot or continuous femoral nerve blocks, the meta-analyses related to pain and opioid consumption were omitted from consideration in the recommendations due to the presence of substantial heterogeneity. Similar to prior clinical practice guidelines on postoperative analgesia, only a limited number of meta-analyses were capable of being performed to support the recommendations. For instance, a combined femoral and sciatic nerve block effectively provides total analgesia of the lower extremity, but it causes significant motor weakness not conducive to early postoperative mobilization.
Among the included studies comparing a regional nerve block to control, thirteen studies investigated a single-shot femoral nerve block, eight studies investigated a continuous femoral nerve block, six studies investigated a single-shot adductor canal block, four studies investigated a continuous adductor canal block, and one study investigated iPACK. Although additional regional nerve blocks have been studied with randomized clinical trials following primary TKA, the workgroup excluded these alternative regional nerve blocks because of limited evidence or lack of clinical relevance.
We reviewed twenty-nine randomized clinical trials, which represented the best available evidence, including twenty high quality and nine moderate quality studies to evaluate the effectiveness of a single-shot or continuous femoral nerve block or adductor canal block or infiltration between Popliteal Artery and Capsule of Knee (iPACK) to reduce pain and/or opioid consumption following primary TKA.
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