Femoral nerve block (FNB) following total knee arthroplasty (TKA) has had mixed results with some studies reporting improvement in pain and reduced narcotic exposure while others have not shown substantial differences. The effect of a FNB on rehabilitation indices (quadriceps strength, knee flexion) is also unclear. The study purpose was to compare the effect of FNB+ a multimodal analgesic protocol (MMA) to MMA only on the 1) development of a complete quadriceps motor block and 2) knee flexion during the first two postoperative days and 3) knee flexion out to 12 weeks after primary TKA. Secondarily, we compared hospital length of stay (LOS), postoperative pain, analgesic use and the incidence of nausea/vomiting. This was a controlled clinical trial undertaken at two tertiary hospitals that do high annual TJA volumes (>200 cases). Both hospitals followed the same regional clinical pathway for preoperative, perioperative and postoperative care. The pathway started mobilization on the day of surgery with a goal for discharge home on the third postoperative day. At one site, FNB was used for the first two postoperative days in addition to MMA as needed (FNB group [n=19]) while the other site used standardized MMA (MMA group [n=20]) only. The presence of a complete quadriceps block, knee flexion, pain, analgesic use, incidence of nausea and vomiting were recorded daily in hospital. Hospital LOS was also recorded and knee flexion and pain were assessed at two, six and 12 weeks post discharge.Purpose
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