• Pierangela Pietrantoni, Tomás Cuñat, Montserrat Nuevo-Gayoso, Nuria Martín, Montserrat Tió, Misericordia Basora, Sergi Sastre, and Xavier Sala-Blanch.
• From the School of Medicine, Universitat of Barcelona (PP, TC), Department of Anesthesiology, Hospital Clínic de Barcelona (TC, NM, MT, MB, XSB), Knee Unit, Hospital CLINIC de Barcelona (MNG), Department of Orthopaedic Surgery and Traumatology, Hospital CLINIC de Barcelona (SS) and Anatomy and Embryology Department. School of Medicine. Universitat of Barcelona. Spain (XSB).
• Eur J Anaesthesiol. 2021 Aug 1; 38 (Suppl 2): S130S137S130-S137.

BackgroundStandard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis.ObjectiveTo test the noninferiority of the analgesic effect of genicular nerves block in comparison with local infiltration analgesia after 24 h of total knee arthroplasty.DesignProspective cohort study.SettingPerioperative setting.PatientsThirty-five patients scheduled for total knee arthroplasty were prospectively included in the study and compared with 35 patients in a retrospective cohort.InterventionGenicular nerve blocks in the prospective cohort were compared with local infiltration analgesia in the retrospective cohort.Main Outcome MeasuresThe pain numeric rating scale and the cumulative opioid consumption in oral morphine equivalents during the first 24 h.ResultsWe conducted propensity score-matched analyses of patients using acute postoperative pain-related risk covariates. After one-to-one propensity score matching, 21 patients were included in the local infiltration analgesia group and 21 in the genicular nerve block group. The median difference in numeric rating score at rest at 24 h was -0.99 [95% confidence interval (CI), -1.99 to 0.5, P = 0.012] on the unmatched cohort and -1.9 (95% CI, -2 to 0, P = 0.002) on the matched cohort (meeting the noninferiority criteria, Δ=1). The median difference in cumulative opioid consumption was 2.5 mg (95% CI, -13.5 to 2.5, P < 0.001) for the unmatched cohort and 4.99 mg (95% CI, -11.5 to 2.5, P < 0.001) on the matched group (meeting the noninferiority criteria, Δ = 21 mg).ConclusionLocal infiltration analgesia and genicular nerve block are comparable in terms of analgesic results. Therefore, genicular nerves block is an alternative to local infiltration analgesia in patients undergoing total knee arthroplasty.Trial RegistrationClinicaltrials.gov identifier: NCT04024319.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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