Multimodal pain management with peripheral nerve blocks for total knee arthroplasty.

Multimodal pain management techniques using femoral and sciatic nerve blocks can dramatically improve a patient's experience after total knee arthroplasty. Nerve blocks reduce postoperative pain and the need for parenteral opioids and result in fewer medical complications associated with opioid use. Peripheral nerve blocks have traditionally been underutilized in lower extremity surgery; however, more modern techniques now allow for safe, efficient, and reliable femoral and sciatic blocks. Peripheral nerve blocks are now routinely used in both primary and revision total knee arthroplasty. Although it is difficult to isolate the added benefit of sciatic nerve blocks, there is a growing body of evidence for using femoral and/or sciatic nerve blocks as part of a multimodal approach to pain management. With many years of experience and published results on thousands of patients, it is clear that the risks of peripheral nerve blocks are minimal, whereas the benefits are substantial.