Increased local anesthesia volume may not improve pain control in popliteal plexus block following total knee arthroplasty

For popliteal plexus block after total knee arthroplasty, 10 mL of local anesthetic appears sufficient, as 20 mL offers no added benefit in pain control or early functional recovery.

Evidence Rating Level: 1 (Excellent)

In this single-center, blinded randomized controlled trial, investigators evaluated whether a larger volume of local anesthetic improves outcomes for popliteal plexus block after primary unilateral total knee arthroplasty. A total of 120 adults undergoing surgery under spinal anesthesia were randomized to receive either 10 mL or 20 mL of bupivacaine for the popliteal plexus block, in addition to a standardized multimodal analgesic regimen that included a femoral triangle block. The primary outcome was 24-hour postoperative opioid consumption, while secondary outcomes included opioid-free analgesia, pain scores, early functional recovery, motor impairment, ambulation with crutches, and Quality of Recovery-15 scores. The study found no statistically significant or clinically meaningful differences between groups in 24-hour opioid use, likelihood of remaining opioid-free, pain at rest or with walking, functional mobility, motor function, or patient-reported recovery. These findings suggest that increasing the block volume from 10 mL to 20 mL does not improve analgesia or early recovery after total knee arthroplasty.

Click here to read this study in Regional Anesthesia & Pain Medicine

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.