The use of intravenous and inhaled anesthetics drugs in GA, in addition to eliminating pain and consciousness, also prevents motor repose, autonomic and cardiovascular reflexes. TKA has been performed under two main anesthetic techniques: I) GA and II) neuroaxial anesthesia. For the purpose of this review, we address anesthetic techniques as part of the intraoperative management and analgesic techniques as a component of multimodal analgesia for the perioperative care after TKA.

This review article will serve as a guide of classic and novel regional analgesic techniques used in the early postoperative period after TKA, comparing and discussing advantages and disadvantages among them in addition to present promising advances in this area. However, some techniques may reduce motor function which in turn can delay recovery times. 16 RA facilitates physical therapy by reducing postoperative pain. 15 Also, its role in decreasing risk of complications and LOS related to immobilization makes RA an ideal method for orthopaedic surgical procedures. 14 RA expanded its versatility when ultrasound improved the accuracy of LA administration. 13 Furthermore, RA can decrease opioid side effects such as urinary retention, constipation, nausea, vomiting, ventilatory depression and sedation which have resulted in lower LOS.

12 Increased interest in RA has been mainly due to its improvement of pain management with relevant reduction in opioids consumption due to its opioid-sparing effect, decrease risk of addiction and opioid crisis. 11 Most RA techniques use local anesthetics (LA), in lower concentration than anesthesia methods, to reduce pain and produce the least possible impairment in mobility. 9, 10 Regional analgesia (RA) have been used to optimize pain management during the postoperative phase of TKA. 8 On the other hand, neuroaxial anesthesia reduces nausea, vomiting, cardiovascular and pulmonary complications and overall mortality when compared to GA. GA, historically, has been associated to high rates of postoperative nausea, vomit and delirium. 6, 7ĭifferent anesthetic approaches and combinations such us general anesthesia (GA), neuroaxial anesthesia (epidural or spinal) and/or peripheral nerve blocks have been used in TKA. 5 One of the facets that continues to require improvement is the relatively high incidence of postoperative severe pain, ranging from 10 to 36%, which produce dissatisfaction among patients after TKA, and increased hospital utilization. Altogether, the safety and general feasibility of cost-effective strategies across different TKA patient populations constitutes an area of increased interest and value. Centers for Medicare & Medicaid Services (CMS) finalized the 2018 Medicare Outpatient Payment System rule that removed TKA from the Medicare inpatient-only list of procedures. 3 Among the changes in practice in the last decade, we have seen a steady decrease in hospital length of stay (LOS), and a shift towards outpatient surgery. 1- 3 Therefore, increasing value of TKA has been an area of enhanced interest. Total knee arthroplasty (TKA) is a widely used method to treat end-stage osteoarthritis and other disabling knee conditions, and its demand is expected to increase to more than 1 million procedures by the year 2030 in the United States.

Ipack block knee