In this Pro-Con commentary article, we debate the importance of anterior thigh block locations for analgesia following total knee arthroplasty. The debate is based on the current literature, our understanding of the relevant anatomy, and a clinical perspective. We review the anatomy of the different fascial compartments, the course of different nerves with respect to the fascia, and the anatomy of the nerve supply to the knee joint. The Pro side of the debate supports the view that more distal block locations in the anterior thigh increase the risk of excluding the medial and intermediate cutaneous nerves of the thigh and the nerve to the vastus medialis, while increasing the risk of spread to the popliteal fossa, making distal femoral triangle block the preferred location. The Con side of the debate adopts the view that while the exact location of local anesthetic injection appears anatomically important, it has not been proven to be clinically relevant.
- Question: Is there an optimal location for performing anterior thigh nerve blocks for perioperative analgesia of the knee to provide perioperative analgesia following total knee arthroplasty?
- Findings: Although cadaveric studies and the anatomy suggest that different locations for local anesthetic injection during true adductor canal or distal femoral triangle block could produce different effects, the limited available clinical evidence does not clearly support a clinically meaningful difference.
- Meaning: Further research is required to clarify the optimal location of a peripheral nerve block for perioperative analgesia following total knee arthroplasty.