Day zero ambulation under modified femoral nerve block after minimally invasive surgery for total knee arthroplasty: preliminary report

Introduction: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not. Methods: A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB. Results: Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05). Discussion: When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction. Conclusion: We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

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Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Clinics ◽

10.6061/clinics/2015(09)09 ◽

2015 ◽

Vol 70 (9) ◽

pp. 648-653 ◽

Cited By ~ 14

Author(s):

S Mei ◽

S Jin ◽

Z Chen ◽

X Ding ◽

X Zhao ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Nerve Block ◽

Knee Arthroplasty ◽

Femoral Nerve Block ◽

Meta Analysis ◽

Femoral Nerve ◽

Local Infiltration ◽

Total Knee

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Ultrasound Guided Femoral Nerve Block with Bupivacaine versus Bupivacaine and Tramadol for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty under Spinal Anesthesia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2131130 ◽

2021 ◽

pp. 23-32

Author(s):

Mohammad Mostafa Abo Farrag ◽

Laila Elahwal ◽

Hesham Mohammad Maroof ElDomairy ◽

Mohammad Ibrahem Okab

Keyword(s):

Total Knee Arthroplasty ◽

Spinal Anesthesia ◽

Nerve Block ◽

Knee Arthroplasty ◽

Postoperative Analgesia ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Group I ◽

Total Knee

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol. Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups. Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

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