Recent studies have shown the efficacy of local anesthetic injection into the interspace between the popliteal artery and posterior capsule of the knee (iPACK) and popliteal plexus block (PPB) to block the ABTN, common peroneal, and/or obturator nerves in the popliteal region as part of the multimodal regimens for posterior knee analgesia after TKA. Hence, blockade of the ABTN that forms a popliteal plexus can be used to provide posterior knee analgesia without motor weakness. These branches are delineated as a plexus, which is closely associated with the popliteal vessels at the level of the popliteal fossa. The sensory innervations of the posterior aspect of the knee are by the articular branch of the tibial nerve (ABTN), with variable contributions from the posterior branch of the obturator nerve. On the other hand, several studies found that the blockade of the common peroneal nerve remains to be determined and could result in delayed rehabilitation. Tibial nerve block (TNB) may provide sensory analgesia in the posterior aspect of the knee, similar to that of the SCB, without resulting in dorsiflexion motor deficits from common peroneal nerve paralysis. However, both femoral and SCB may result in muscle weakness and delayed ambulation. Therefore, blockade of peripheral nerves that only innervate some parts of the knee does not provide sufficient analgesia in TKA. A recent study found that multiple PNBs, especially when combined with femoral and sciatic nerve blocks (SCB), were more effective in pain relief and physical performance than single PNBs. It can be a challenge to administer peripheral nerve blocks (PNBs) with other multimodal analgesia methods to provide effective pain relief, while preserving muscle strength for rehabilitation. The aim of the postoperative analgesics prescribed for total knee arthroplasty (TKA) is to provide adequate pain relief, as well as minimize opioid consumption and enhance rehabilitation.
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