{
  "abstract": "Background and Aims Peripheral nerve stimulation (PNS) is a neuromodulation technique used for pain relief, including after total knee arthroplasty (TKA). Unlike traditional nerve blocks, PNS provides analgesia without motor blockade, preserving muscle strength. Post-TKA quadriceps weakness hinders recovery, making PNS a promising alternative. This study hypothesizes that perioperative femoral nerve neuromodulation matches analgesic efficacy while enhancing quadriceps strength.Methods A single-center, controlled trial was conducted at Hospital General Universitario de Valencia. Patients scheduled for TKA were randomized in two groups. The PNS group received 20 min of femoral nerve stimulation (100 Hz for 5 min, then 2 Hz for 16 min) adjusted to patient tolerance. The shame group had the device switched off. Both interventions were applied preoperatively. Motor function (maximal voluntary isometric contraction, MVIC) was assessed at baseline, post-intervention, and 48 h post-surgery. Secondary outcomes included pain scores (NRS) and opioid consumption. This study was conceived as a proof-of-concept investigation aimed at demonstrating feasibility and gathering data to inform the design and power calculations for a subsequent clinical trial.Results 21 patients completed the study (14 PNS, 7 control). The PNS group showed a 26% increase in MVIC post-intervention (P < 0.001), while controls had no change. At 48 h, both groups experienced MVIC decline, but the PNS group’s reduction was smaller (59% vs. 74% in controls). Pain scores at 24 h were lower in the PNS group (2/10 vs. 7/10; P < 0.001), with comparable opioid use.Conclusions Perioperative femoral neuromodulation significantly improved quadriceps strength post-TKA, with sustained effects at 48 h. While all patients had strength decline, the PNS group’s reduction was less severe. PNS also provided effective analgesia, similar to nerve blocks, without motor impairment. These findings suggest PNS could enhance recovery by preserving muscle function and reducing pain. Further studies are needed to assess long-term clinical benefits.",
  "authors": [
    {
      "affiliations": [
        "Anestesiology, Hospital General de Valencia, Valencia, Spain"
      ],
      "name": "Ferran Marques Peiro"
    },
    {
      "affiliations": [
        "Anestesiology, Hospital General de Valencia, Valencia, Spain"
      ],
      "name": "Lucas Rovira Soriano"
    },
    {
      "affiliations": [
        "Anestesiology, Hospital General de Valencia, Valencia, Spain"
      ],
      "name": "Carlos Delgado Navarro"
    },
    {
      "affiliations": [
        "Anestesiology, Hospital General de Valencia, Valencia, Spain"
      ],
      "name": "Pablo Kot Baixauli"
    },
    {
      "affiliations": [
        "Anestesiology, Hospital General de Valencia, Valencia, Spain"
      ],
      "name": "Jose De Andres Ibañez"
    }
  ],
  "title": "EP089 Perioperative neuromodulation of the femoral nerve increases quadriceps strength and reduces pain after total knee arthroplasty: a pilot study",
  "uid": "e1debe8a-9170-5020-b265-5bb8abbe06a7"
}