Comparison between Ultrasound Guided Continuous Femoral Nerve Block with Continuous Epidural Analgesia for Post Operative Pain Relief in Major Knee Surgeries

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

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A Comparative Study between Continuous Epidural Infusion and Continuous Femoral Nerve Block for Post-Operative Pain Relief in Total Knee Replacement Surgeries

Indian Journal of Anaesthesia and Analgesia ◽

10.21088/ijaa.2349.8471.4417.24 ◽

2017 ◽

Vol 4 (4 (Part-1)) ◽

pp. 1057-1063

Author(s):

R. Brindha ◽

◽

Senthil M ◽

B. Arun Kumar ◽

Shehzad Parveen ◽

...

Keyword(s):

Pain Relief ◽

Total Knee Replacement ◽

Comparative Study ◽

Nerve Block ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Continuous Epidural Infusion ◽

Post Operative Pain ◽

Continuous Femoral Nerve Block ◽

Total Knee

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Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty

Medical Principles and Practice ◽

10.1159/000500261 ◽

2019 ◽

Vol 28 (5) ◽

pp. 457-462 ◽

Cited By ~ 2

Author(s):

Xiao-Ying Zhao ◽

Er-Fei Zhang ◽

Xiao-Li Bai ◽

Zi-Jian Cheng ◽

Peng-Yun Jia ◽

...

Keyword(s):

Elderly Patients ◽

Nerve Block ◽

Knee Arthroplasty ◽

Postoperative Analgesia ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Low Concentrations ◽

Functional Exercise ◽

Continuous Femoral Nerve Block

Objectives: This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). Materials and Methods: Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg–1 × h–1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg–1 × h–1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. Results: The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. Conclusion: The protocol of 0.05 μg × kg–1 × h–1 of DEX combined with 0.15% ropivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance.

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Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47654.14723 ◽

2021 ◽

Author(s):

Shiv Shanker Tripathi ◽

Suruchi Ambasta ◽

Swagat Mahapatra ◽

Anurag Agarwal ◽

Shivani Rastogi

Keyword(s):

Emergency Department ◽

Pain Relief ◽

Nerve Block ◽

Distal Femur ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Vas Score ◽

The Mean ◽

Fractures Of The Femur

Introduction: Fractures around the hip and fractures of the femur are commonly encountered in the Emergency Department (ED). Effective control of pain in these fractures is of critical importance for proper radiography, reduction and splintage. Traditionally, systemic analgesics have been used for pain relief which had its own limitations both in terms of pain relief and relaxation. Use of Femoral Nerve Block (FNB) in acute fractures around the hip and femur has been a challenge and, evaluation of this procedure has been the subject of research recently in ED. Aim: To evaluate the efficacy of FNB in decreasing pain and anxiety in acute fractures of the femur. Materials and Methods: Prospective interventional study was conducted at a tertiary care centre with well-defined inclusion and exclusion criteria. Eighty four patients with fractures around the hip, fractures of the shaft and distal femur underwent ultrasound guided FNB for performance of retrieval procedures. Visual analog scale (VAS) score for pain and Hamilton Anxiety Score (HAM-A) score for anxiety were used as parameter both for pre and postblock to assess the effectiveness. Subjective assessment of the patients comfort level was also done. Statistical analysis of all data obtained was done using SPSS 21.0. Results: Study group (n=84) included in the evaluation were homogenous in terms of age and sex distribution. The mean±SD VAS score preoperatively was 72.93±10.91. At 30 minutes and 4 hours postblock,the mean±SD VAS scores were 18.65±5.25 and 13.88±6.05, respectively. There was statistically significant difference in VAS score at 30 minutes (p=0.004) and 4 hours (p=0.015). The mean Hamilton Anxiety score at preblock and 4 hour postblock was 27.05±5.94 and 8.07±3.7, respectively. The overall HAM-A score comparison showed that there was statistically significant change after 4 hours postblock (p=0.013) showing significant decrease in anxiety levels. All patients were satisfied by the comfort and ease of shifting after block. Intergroup analysis of fractures around the hip (Neck femur, Trochanter) and fractures of the shaft (Shaft femur and distal femur) revealed equal efficacy of the femoral block. Conclusion: Ultrasound guided FNB is an easy and safe means of providing pain and anxiety relief to patients with the fracture of the femur (neck femur, per-trochanteric femur, shaft femur or distal femur) in the ED. At the same time, it decreases the need of systemic analgesia.

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