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Background and Aims Stiffness after total knee arthroplasty (TKA) is a complication of multifactorial nature affecting patient’s quality of life. Adequate pain control is paramount in its management along with the proposed treatment modalities.

Methods A 59 –year old, ASA II, female patient presented with stiff TKA, six weeks postoperatively, and was scheduled for manipulation under anesthesia. Immediately following the procedure, she reported a VAS score of 10. Adductor canal block (ACB) was performed, while paracetamol 1gr and dexketoprofen 50mg were administered intravenously. After explaining the procedure to the patient and obtaining informed consent, a high-frequency linear transducer, under sterile conditions, was placed at the mid thigh, just distally to the meeting point of the medial borders of sartorius and adductor longus muscles. The transducer was then moved laterally allowing visualization of the superficial femoral artery and a 70mm long needle was inserted, in plane, through the vastoadductor membrane towards the triangular hyperechoic region lateral to the artery. Once the needle tip was properly positioned, 20 ml of ropivacaine 0.2% were injected, in slow 5 ml increments, ensuring spread in both sides of the artery.

Results The patient reported immediate pain relief and a VAS score of 5, twenty minutes after the block. At the ward, 6 hours postoperatively, she had no pain and could flex the knee more than 90°, without any restriction.

Conclusions Our case provides evidence regarding the effectiveness and safety or regional anesthesia as a treatment option in patients with stiff TKA.