Strong evidence supports that peripheral nerve blockade for total knee arthroplasty (TKA) decreases postoperative pain and opioid requirements.

Rationale
There were seven high-quality (McNamee 2001, Good 2007, Kadic 2009, Xie 2012, Chan 2012, Moghtadaei 2014, Liu 2014) and three low-quality (Lau 1998, Beaupre 2012, Kim 2012) studies evaluating whether the use of peripheral nerve blockade reduces complications or improves outcomes in adult patients undergoing knee arthroplasty compared to no peripheral nerve block use.
 
Three high-quality studies (Chan 2012, Moghtadaei 2014, Liu 2014) demonstrated significantly lower VAS pain scores and opioid requirements during the postoperative period when peripheral nerve blockade was compared to parenteral opioids alone. 
 
One high-quality study (Chan 2012) demonstrated improvement in overall range-of-motion and a reduction in opioid-related side effects with the use of peripheral nerve blockade when compared to no peripheral nerve block use.  Another high-quality study (Liu 2014) demonstrated that peripheral nerve block use improved the Quality of Recovery (e.g., Emotive, Nociceptive and Cognitive domains) during the immediate postoperative period.
 
  1. Beaupre,L.A., Johnston,D.B., Dieleman,S., Tsui,B. Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: a controlled clinical pilot study. ScientificWorldJournal. 2012; 0: 273821-
  2. Chan,M.H., Chen,W.H., Tung,Y.W., Liu,K., Tan,P.H., Chia,Y.Y. Single-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol.Taiwan 2012/6; 2: 54-58
  3. Good,R.P., Snedden,M.H., Schieber,F.C., Polachek,A. Effects of a preoperative femoral nerve block on pain management and rehabilitation after total knee arthroplasty. Am J Orthop (Belle.Mead NJ) 2007/10; 10: 554-557
  4. Kadic,L., Boonstra,M.C., DE Waal Malefijt,M.C., Lako,S.J., VAN,Egmond J., Driessen,J.J. Continuous femoral nerve block after total knee arthroplasty?. Acta Anaesthesiol.Scand. 2009/8; 7: 914-920
  5. Kim,J.H., Cho,M.R., Kim,S.O., Kim,J.E., Lee,D.K., Roh,W.S. A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty. Korean J Anesthesiol. 2012/5; 5: 448-453
  6. Lau,H.P., Yip,K.M., Jiang,C.C. Regional nerve block for total knee arthroplasty. J Formos.Med Assoc 1998/6; 6: 428-430
  7. Liu,J., Yuan,W., Wang,X., Royse,C.F., Gong,M., Zhao,Y., Zhang,H. Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery. Clin Interv Aging 2014; 0: 341-350
  8. McNamee,D.A., Convery,P.N., Milligan,K.R. Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block. Acta Anaesthesiol.Scand. 2001/4; 4: 477-481
  9. Moghtadaei,M., Farahini,H., Faiz,S.H.-R., Mokarami,F., Safari,S. Pain management for total knee arthroplasty: Single-injection femoral nerve block versus local infiltration analgesia. Iranian Red Crescent Medical Journal 2014/1; 1: -
  10. Xie,Z., Hussain,W., Cutter,T.W., Apfelbaum,J.L., Drum,M.L., Manning,D.W. Three-in-one nerve block with different concentrations of bupivacaine in total knee arthroplasty: randomized, placebo-controlled, double-blind trial. J Arthroplasty 2012/5; 5: 673-678