Genicular Nerve Block During Intraoperative Total Knee Arthroplasty: A Randomized Controlled Clinical Trial
F.C.J. Neto, E.S. Yoshida, J.S.E.L. Schleder, J.C. Schleder, J.F. Stoco, A.L.V. De FariaObjectives:
To evaluate the effectiveness of intraoperative genicular nerve block in reducing postoperative pain after total knee arthroplasty (TKA).
Methods:
This study was a single-center randomized controlled clinical trial. Patients who underwent primary total knee arthroplasty (TKA) for gonarthrosis were randomized to genicular nerve block or standard care. The primary outcome was to evaluate Visual Analogue Scale (VAS, 0-10) at 24 hours. Secondary outcomes included pain evolution at 21 days, length of hospital stay, tramadol consumption, and satisfaction at 3 months. The Mann-Whitney U test and Fisher's exact test were used.
Results:
Fifty-one patients were analyzed (28 intervention group and 23 control). The median VAS score at 24h was lower in the block group (5 [IQR 3-8] vs 7 [IQR 4-9]; p=0.28), but without statistical significance. On day 3, a trend towards less pain was observed in the intervention group (3.5±2.3 vs 4.9±2.5; p=0.07), with a difference of 1.4 points approaching the minimum clinically important difference. There was no difference in 24h hospital discharge (100% vs 95%; p=0.48) or tramadol consumption (764 vs 765mg; p=0.90). Satisfaction was higher in the intervention group (96% vs 83%; p=0.17).
Conclusion:
Genicular nerve block did not significantly reduce pain 24 hours after total knee arthroplasty (TKA). However, the trend toward better pain control on D3 suggests potential benefit in the acute phase of recovery. Studies in larger groups are needed to consolidate these findings.