Editorial Commentary: Femoral Nerve Block: Don’t Kill the Motor Branch

doi:10.1016/j.arthro.2020.05.020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 36, Issue 7, July 2020, Pages 1981-1982

https://doi.org/10.1016/j.arthro.2020.05.020 Get rights and content

Abstract

Femoral nerve block is commonly used for pain control after knee surgery and helps to reduce the need for opioids in the early postoperative period. The potential disadvantage is blockage of the motor branch of the femoral nerve, resulting in quadriceps weakness and reduced strength by up to 50%. Adductor canal nerve block is a possible alternative resulting in less muscle weakness. The rationale behind adductor canal nerve block is blockage of the saphenous nerve and part of the obturator nerve, providing reliable and adequate pain relief.

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There are more references available in the full text version of this article.

Cited by (4)

Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury
2021, Knee
Citation Excerpt :
The extent to which FNB impacts the neuromuscular system and outcomes following ACL-R still remains an issue of debate. As such, some authors have concluded that FNB may not be appropriate for use in patients already at high risk of ACL re-injury and instead, other analgesic alternatives should be considered [95,103], Previous reports contend FNB may prevent the timely restoration of maximal strength and function, as well as increase the risk of re-injury [104,105].
Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked.
This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation)
Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation.
Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.
Analgesic effect of cocktail therapy combined with femoral nerve block in unicompartmental knee arthroplasty
2024, Chinese Journal of Tissue Engineering Research
Progress in extension lag after knee surgery
2023, Chinese Journal of Orthopaedics
Choice of Anesthesia for Orthopedic Surgery in Elderly and Senile Patients (Review)
2022, Obshchaya Reanimatologiya

: See related article on page 1973

: The author reports the following potential conflicts of interest or sources of funding: Associate Editor of Arthroscopy Journal. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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Editorial CommentaryEditorial Commentary: Femoral Nerve Block: Don’t Kill the Motor Branch

Abstract

Knee

J Orthop Res

Knee

J Clin Anesth

Arthroscopy

Complications of femoral nerve block for total knee arthroplasty

Clin Orthop Relat Res

Editorial Commentary
Editorial Commentary: Femoral Nerve Block: Don’t Kill the Motor Branch