Peripheral Nerve Blockade (PNB)
Strong evidence supports that peripheral nerve blockade for total knee arthroplasty (TKA) decreases postoperative pain and opioid requirements.
Surgical Management of Osteoarthritis of the Knee
Endorsed by: The Knee Society, SOMOS, AAHKS, ACR, AGS, AANA

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.
 

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