| Knee Replacement: Local anesthetic infiltration in knee replacement surgery provides postoperative analgesia while preserving motor function. Concerns of toxicity, poor wound healing, and increased risk of infection associated with local anesthetic infiltration have not been demonstrated in studies. Femoral nerve blocks can achieve analgesia with reduced hypotension and use of opioids relative to epidurals and PCAs but has a negative effect on early postoperative mobilization. Hunter Canal blocks may provide analgesia for knee replacement with improved postoperative mobilization, but this has not been studied within the context of an ERAS pathway. Sciatic nerve block is not associated with improved outcomes relative to local anesthetic infiltration. Hip Replacement: Current evidence does not support local anesthetic infiltration, nerve block, or wound infusion catheter for hip replacement in the context of a multimodal and non-opioid analgesic care plan. |
