Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia

90 patients scheduled for total knee arthroplasty were randomized to one of three nerve block combinations for postoperative analgesia: an obturator nerve block (ONB) plus continuous adductor canal block (cACB), a tibial nerve block (TNB) plus cACB, or an ONB and TNB plus cACB. Patients were assessed primarily for patient-controlled analgesia consumption, time to first analgesia request, and pain scores postoperatively. Results for morphine consumption demonstrated significantly lower cumulative consumption over the first 48 hours after surgery in the groups administered a TNB - either with or without a combined ONB - in comparison to the group administered an ONB plus cACB alone.