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.

Background: The distal femoral triangle block may provide better coverage of the saphenous nerve and the nerve to vastus medialis compared to the adductor canal block (ACB). Furthermore, anesthetic injection into the distal ACB may spread into the popliteal fossa, potentially alleviating posterior knee pain. Therefore, we aimed to evaluate the efficacy of the combined distal femoral triangle block and distal ACB (dFdA) for pain management following total knee arthroplasty (TKA). Methods: Patients (N = 70) were randomized to dFdA or ACB+iPACK groups. Primary outcomes were the numerical rating scale (NRS) for post-TKA pain during rest and movement, and total morphine consumption (TMC). Secondary outcomes included the timed up and go test (TUG), two-minute walk test (2MWT), active knee flexion, and five-times sit-to-stand test. Results: The dFdA group demonstrated significantly lower NRS for anterior knee pain during 6-48 hours and posterior knee pain during 6-18 hours post-TKA, both at rest and during movement, compared with the ACB+iPACK group. The dFdA group exhibited significantly reduced TMC at 24 ([interquartile range 4-6] vs [interquartile range 6-15], Conclusions: The dFdA demonstrates superior analgesic efficacy and could be a good alternative approach to enhance recovery for current clinical pathways of TKA.