Distal Femoral Triangle Combined With Distal Adductor Canal Block Offers Superior Analgesia and Functional Recovery After Total Knee Arthroplasty Compared to Adductor Canal Block and iPACK: A Randomized Clinical Trial.

Study Summary

70 patients undergoing primary total knee arthroplasty (TKA) were randomized to receive distal femoral triangle block and distal adductor canal block (dFdA) or an adductor canal block plus infiltration between the popliteal artery and posterior capsule of the knee (ACB+iPACK). The primary outcomes of interest were anterior and posterior knee pain measured using the numerical rating scale (NRS) at rest and during movement, and total morphine consumption. Secondary outcomes included the timed up and go (TUG) test, 2-minute walk test (2MWT), active knee flexion, five-times sit-to-stand test (FTSST), patient satisfaction, and length of hospital stay. Outcomes were assessed at 6, 12, 18, 24, and 48 hours after surgery. Overall, the results of the study revealed lower anterior knee pain through 48 hours and lower posterior knee pain through 18 hours with dFdA, along with reduced morphine consumption and better early TUG and 2MWT performance. These findings suggested that dFdA may provide a simpler and more effective motor-sparing analgesic strategy than ACB+iPACK for early recovery following TKA.