Review Question - QID 213952

This patient underwent a right total knee arthroplasty (TKA). Of the above statements, the most accurate is the fact that the use of adductor canal blockade (ACB) results in earlier postoperative ambulation compared to femoral nerve blocks.

Several regional anesthetic techniques exist for TKA. ACB has been utilized as a promising alternative to femoral nerve blockade (FNB) given that it provides primarily sensory blockade without the effects of quadriceps weakness, fall risk, and delayed ambulation, which are associated with FNB. With this technique, the saphenous nerve and the nerve to the vastus medialis are targeted, both of which are distal to the quadriceps motor branches.

Kuang et al. investigated whether or not ACB is better than FNB in primary TKA. They reported that the ACB resulted in better quadriceps strength and mobilization ability. They concluded that compared to FNB, ACB showed better functional recovery without compromising analgesia, and as such may be used as an alternative analgesic method for early ambulation.

Mudumbai et al. investigated whether patients with continuous ACB exhibited decreased opioid consumption and greater total ambulation distance on the first two postoperative days after TKA compared to continuous FNB. They reported that patients undergoing ACB walked longer distances during the first two postoperative days. They concluded that ACB promotes early postoperative ambulation compared to FNB without a reduction in the analgesic effects.

Figure A demonstrates a right cemented TKA.

Incorrect Answers:
Answer 1: It has not been proven in the literature that the use of CPM postoperatively results in early ambulation.
Answer 2: Studies comparing ACB to FNB have demonstrated equivalent analgesic effects.
Answer 4: ACB results in a sensory blockade, without the quadriceps musculature weakness associated with FNB.
Answer 5: The use of a longer-acting spinal anesthetic would likely result in delayed ambulation.