Mapping the scientific landscape of regional analgesia for total knee arthroplasty: A bibliometric study
Abhijit Sukumaran Nair, Saleh Al Sawafi, Sandesh Madi Sural, Areej Al Batrani, Tuhin MistryABSTRACT
Background:
Total knee arthroplasty (TKA) is associated with significant postoperative pain, and regional anesthesia (RA)–based analgesic strategies have evolved substantially over the past three decades. Understanding the intellectual structure, influential publications, and thematic evolution of analgesic techniques for TKA is essential to contextualize current practice and guide future research.
Methods:
A bibliometric analysis was conducted using the Scopus database. Publications related to analgesic strategies and RA for TKA published between 1998 and 2026 were retrieved and analyzed. Data were exported in BibTeX and comma-separated values (CSV) formats and analyzed using the Bibliometrix package (R-Studio: Posit PBC, Massachusetts, United States) and visualization of similarity (VOS) viewer. Bibliometric indicators included annual publication trends, citation analysis, prolific authors, institutions, countries, journals, keyword co-occurrence, thematic evolution, and co-citation networks to identify highly cited and landmark publications.
Results:
A total of 288 publications were included. Annual scientific output demonstrated a steady increase, with a marked surge after 2013. Early highly cited literature focused predominantly on neuraxial techniques and femoral nerve block–based analgesia. From 2013 onward, a distinct shift toward motor-sparing strategies was observed, coinciding with landmark publications on the adductor canal block. More recent research emphasized multimodal and anatomy-driven approaches, including adductor canal block–based bundles, posterior knee pain management strategies, and periarticular infiltration (PAI) techniques. Citation and co-citation analyses identified a small number of highly influential publications that shaped successive phases of analgesic strategy evolution in TKA.
Conclusions:
This bibliometric analysis demonstrates a clear temporal evolution of analgesic strategies for TKA, progressing from neuraxial and femoral nerve–dominant paradigms toward motor-sparing and multimodal RA techniques. A limited number of landmark publications have disproportionately influenced this transition. These findings provide a macroscopic overview of research trends, highlight foundational evidence underpinning current practice, and identify areas for future investigation in TKA analgesia.