Case study: Total knee arthroplasty - NYSORA

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Case study: Total knee arthroplasty

January 9, 2024

Case presentation

A 65-year-old male patient with severe osteoarthritis of the right knee was scheduled for elective total knee arthroplasty. The patient had a history of chronic knee pain and limited mobility and was keen on exploring options for effective pain relief. As part of the comprehensive pain management plan, an ultrasound-guided femoral nerve block was planned to provide targeted analgesia for improved pain control.

Nerve block technique

The patient was positioned supine with the lower extremity fully extended and slightly rotated externally. A high-frequency linear transducer was placed in a transverse orientation over the femoral crease to identify the femoral nerve.

Femoral nerve block; transducer position and sonoanatomy. FA, femoral artery; FV, femoral vein; FN, femoral nerve.

A 22-gauge needle was inserted in-plane, in a lateral-to-medial direction, to pierce the fascia iliaca lateral to the femoral nerve. A total of 12 mL of bupivacaine 0.5% was injected ensuring proper spread around the femoral nerve.

Femoral nerve block; Reverse Ultrasound Anatomy with needle insertion in-plane and local anesthetic spread (blue). FA, femoral artery; FV, femoral vein; FN, femoral nerve.

Patient outcome

Following the ultrasound-guided femoral nerve block, the patient experienced significant pain relief within minutes. The patient reported improved comfort, allowing for early mobilization and participation in physical therapy. The need for systemic opioids was greatly reduced, thereby minimizing associated side effects such as sedation and nausea. The patient did not experience any immediate or delayed complications related to the nerve block.

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