200 Motor sparing nerve blocks for total knee arthropalsty (TKA)- is it worth the effort?

Background and Aims Anaesthesia and post-operative analgesia for patients undergoing total knee arthroplasty (TKA) has evolved over the last 20 years. Our aim was to carry out a quality improvement project to assess the benefit of motor sparing nerve blocks which includes the IPACK and low femoral triangle blocks1. We aimed to assess post-operative pain scores and analgesic requirements2. Methods We carried out a retrospective analysis of patients undergoing TKA including 46 patients after seeking approval from the local audit committee. We used medical notes to obtain patient characteristics, method of anaesthesia and analgesia provision, opiate consumption, and pain scores. Results 100% of patients had a spinal anaesthetic with 1 patient requiring conversion to GA. 41% of patients had a combined IPACK and low femoral triangle block. The remainder received LAI by the surgeon. The mean request for first opiate dose was earlier by 20 min in the block group. Opiate consumption was significantly lower in the first 24 hours by 21 mg OME. 90% had no to mild pain at 24 hours in the block group compared to 63% in the LIA group. Pain scores at 48 hours were similar in both groups. A multimodal approach to analgesia was used for all patients. Conclusions Motor sparing nerve blocks for patients undergoing TKA is beneficial in the first 24 hours with improved pain scores, reduced opiate consumption as well as surgeon satisfaction. We have implemented recommendations to add these to our ERAS pathway and aim to train anaesthetists in performing these blocks for all TKA patients.