What is the recommended regional block for meniscus repair?

Recommended Regional Block for Meniscus Repair

The adductor canal block is the recommended regional anesthetic technique for arthroscopic meniscus repair due to its effective pain control, reduced opioid consumption, and minimal impact on quadriceps strength which facilitates earlier mobilization. 1, 2

Primary Regional Anesthetic Options

• Adductor canal block provides superior postoperative analgesia while preserving quadriceps strength, making it ideal for early rehabilitation after meniscus repair 1, 2
• Ultrasound-guided adductor canal block significantly reduces pain scores in the post-anesthesia care unit and decreases 24-hour opioid consumption compared to sham injections 1
• Adductor canal block targets the saphenous nerve (a branch of the femoral nerve) which provides sensory innervation to the medial aspect of the knee without affecting motor function 1, 2

Alternative Regional Techniques

• Femoral nerve block is effective for pain control but causes significant quadriceps weakness that may delay mobilization and rehabilitation 3, 2
• Combined femoral and sciatic nerve blocks are necessary for complete pain relief during knee arthroscopy, particularly when managing medial meniscus tears 3
• Adding an obturator nerve block may be beneficial when valgus positioning of the knee is required during surgical management of medial meniscus tears 3

Multimodal Analgesia Approach

• Regional anesthetic techniques should be used as part of a multimodal analgesic regimen including:
  • Regular paracetamol (acetaminophen) as baseline treatment 4
  • NSAIDs or COX-2 selective inhibitors unless contraindicated 4
  • Limited use of opioids for breakthrough pain 4

Practical Considerations

• Ultrasound guidance is recommended for accurate placement of the adductor canal block 1
• Use of 0.5% ropivacaine (20-30ml) provides effective analgesia for meniscus repair procedures 1, 2
• The block should be performed at an anatomical site distant from any active infection to minimize risk of spreading infection 5
• Early mobilization is critical following meniscus repair, making preservation of motor function particularly important 2, 6

Clinical Pearls and Pitfalls

• Avoid femoral nerve block as a first-line option due to its significant impact on quadriceps strength and potential to delay rehabilitation 2
• Consider the addition of sciatic nerve block for complete analgesia, especially when working on the posterior aspect of the meniscus 3
• When using regional techniques, ensure patients receive regular multimodal analgesia to prevent rebound pain after block resolution 4
• Be aware that meniscus repair (versus meniscectomy) requires longer rehabilitation and more robust pain management strategy 7, 6