The Use of Anterior Femoral Cutaneous Nerve Blocks in Total Knee

Arthroplasty: A Quality Improvement Project

James Tautkus, MD; Andrew Kehrer, DO; William Perillo, DO; Haleh Saadat, MD, FAAP; Vlad Frenk, MD, FASA

Introduction Key Findings

Discussion

Discussion

Problem: Many patients experience anterior distal knee pain following

total knee arthroplasty (TKA), commonly associated with the anterior

femoral cutaneous nerve (AFCN) distribution.

Current Practice:

• IV diazepam is used as first-line treatment to relieve muscle spasms.

• Opioids and rescue blocks are used for additional pain management.

Objective:

• Incorporate AFCN block into the preoperative nerve block protocol.

Hypothesis:

• We hypothesize that incorporating AFCN block will reduce the need for

postoperative pain medications and interventions

Methods

Standard Analgesia Care:

• Femoral Triangle Block (FTB) and Injection between the Popliteal Artery

and the Capsule of the Knee (IPACK) are administered preoperatively.

Intervention:

• AFCN block was added to the standard analgesia protocol.

Data Collection:

• A retrospective review of medical records for 105 patients who

received the AFCN block as part of the protocol and 100 patients who

did not receive the block

Exclusion Criteria:

• None of the patients were chronic opioid users.

Primary Outcome:

• Postanesthesia care unit (PACU) diazepam use.

US images

Key Findings:

• The addition of anterior femoral cutaneous nerve (AFCN) block to

the total knee arthroplasty protocol significantly reduced the

need for postoperative diazepam.

Literature Review:

• Evidence suggests that AFCN block provides more effective

analgesia and reduces opioid requirements compared to femoral

triangle block (FTB) after TKA, enhancing immediate post-op

functional recovery.

• A single FTB injection lacks cutaneous anesthesia covering the

anterior knee, which AFCN block addresses.

Recommendations for Practice:

• Continue incorporating AFCN blocks in the total knee protocol.

• Ongoing data collection is recommended to assess the

continued effectiveness and potential for scaling this

intervention.

• Formal IRB approval is pending for further research

References

⦁ 1. Kampitak, W., Tanavalee, A., Tansatit, T., Ngarmukos, S., Songborassamee, N., & Vichainarong, C. (2021).

The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block

in total knee arthroplasty: a randomized controlled trial. Korean journal of anesthesiology, 74(6), 496–505.

https://doi.org/10.4097/kja.21120

⦁ 2. Bjørn, S., Nielsen, T. D., Moriggl, B., Hoermann, R., & Bendtsen, T. F. (2019). Anesthesia of the anterior

femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial. Regional

anesthesia and pain medicine, rapm-2019-100904. Advance online publication.

https://doi.org/10.1136/rapm-2019-100904