This prospective, randomised controlled trial offers valuable insights into optimising postoperative pain control for patients undergoing total knee arthroplasty (TKA). The study directly compared two common regional anaesthesia techniques—the femoral nerve block (FNB) and the fascia iliaca block (FIB)—to determine their respective efficacy in a modern multimodal pain management setting. The findings help surgeons and anaesthetists make informed decisions that can improve patient comfort and aid in early rehabilitation.
Study Design and Key Findings
The trial involved 98 patients undergoing primary unilateral TKA, who were randomly assigned to receive either an FNB or an FIB for pain relief after surgery. Researchers assessed several key metrics to measure the effectiveness of each approach, including opioid consumption (fentanyl and tramadol), pain levels, nausea, and knee function and range of motion.
The results demonstrated that both blocks were effective. The study found no significant differences between the FNB and FIB groups for analgesic use at 12 and 36 hours post-surgery, pain scores, or incidence of nausea and impact on range of motion. A noteworthy observation was a case of paraesthesia in the femoral nerve in the FNB group, highlighting a potential complication of that technique.
Implications for Postoperative Care
Given that both nerve blocks provided comparable pain control, the findings suggest that the FIB is a safe and effective alternative to the FNB as part of a multimodal anaesthetic regimen for TKA. In broader orthopaedic literature, a key advantage of the fascia iliaca block is its potential to offer effective analgesia with a reduced risk of quadriceps muscle weakness compared to a more direct femoral nerve block. This can facilitate faster patient mobilisation and reduce the risk of postoperative falls, making it a compelling option for enhanced recovery protocols.
Ultimately, this study contributes to the growing body of evidence supporting the use of regional anaesthesia in TKA, suggesting that the choice between FNB and FIB can be guided by patient-specific factors and the desire to prioritise early functional recovery.
Professor Wilson’s Comments
“As part of our commitment to patient care, we always strive to ensure our patients are as comfortable as possible. Anaesthetic management—before, during, and after surgery—is a key area of focus for us.
This paper explores the differences between femoral nerve blocks and the so-called fascia iliaca block. It was carried out by our fellow, Hamid, who has since gone on to achieve great things in Singapore; not only as a leading joint preservation surgeon but also as a candidate for government. This was a lovely piece of work by one of my favourite fellows, and it remains a paper we are very proud to have produced as a team.”
For a deeper dive into the full data, methodology, and analysis, the complete research paper is available for your review.
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/20178889/
- https://www.nysora.com/techniques/crash-course-with-dr-hadzic-best-nerve-block-for-total-knee-replacement-pain/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10916633/
