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Background and Aims Total knee arthroplasty (TKA) surgery induces severe pain during the postoperative period. The aim of this study is to investigate the contribution of combining anterior femoral cutaneous nerve block with distal adductor canal block to postoperative analgesia in TKA.

Methods Fifty-eight patients undergoing TKA with spinal anesthesia were divided into two groups. Group1 received adductor canal block(20ml), Group2 received anterior femoral cutaneous nerve block(10ml) in addition to distal adductor canal block(20ml). 0.25%bupivacaine was used for all blocks performed in the study. Postoperative pain was assessed using the visual analogue scale(VAS) at 3,10, and 24 hours postoperatively. Pain at the site of drain placement in the upper lateral quadrant of the knee was queried. The location of incisional pain, whether proximal or distal to the patella, was investigated. Time to first analgesic, total postoperative analgesic and opioid consumption recorded.

Results Postoperative VAS values were lower in Group2, although there was no significant difference between the groups (respectively, postoperative 3, 10, 24 hours; Group1: 2.03,2.69,3.28; Group 2:1.69,2.34,2.62). Group1; 23/29 patients reported drain site pain, Group 2, 6/29(p<0.05). Group1 and Group2 incisional pain proximal and distal to the patella numbers of patients 25 and 9; 10 and 17. Time to first analgesic consumption, the total postoperative analgesic consumption and opioid content were no statistical difference (respectively,Group1:97.59,4.79,1.69; Group2:112.24,4.66,1.59).

Conclusions That block combination did not show superiority over adductor canal block. However, the anterior femoral cutaneous nerve block reduced drain site pain and incisional pain proximal to the patella.