Postoperative Pain Control for Total Knee Arthroplasty: Continuous Femoral Nerve Block Versus Intravenous Patient Controlled Analgesia

Background: Purpose of this study was to compare the effects of direct, continuous adductor canal block (ACB) and ultrasonography guided, continuous femoral nerve block (FNB) on postoperative pain control, strength of the knee extensor, walking ability, and related complications after primary total knee arthroplasty. Methods: Between November 2018 and February 2019, 107 patients underwent primary total knee arthroplasty under spinal anesthesia. Forty eight patients received ACB and the other 59 received FNB for postoperative pain control. After the surgery, the patients received adductor canal or femoral nerve block via a catheter. 10 mL of 0.75% ropivacaine was administered initially, followed by continuous injection of 4 mL per hour. ACB was done before capsule repair by orthopedic surgeon and FNB was performed after the surgery. Data were prospectively collected out from these 107 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and during range of motion were recorded. To evaluate quadriceps strength, motor grade by manual muscle testing was measured. Walking ability was assessed by first weight bearing day and walking distance (steps). We also evaluated analgesic consumption using morphine equivalent and recorded related complications of peripheral nerve block. Results: No significant intergroup difference was observed in the numerical rating scale scores at rest and during range of motion on postoperative days 1, 2, 3, 4, and 5. ACB group had significantly greater quadriceps strength than did the FNB group, as evaluated by manual muscle testing on postoperative days 1. However, there was no significant difference onpostoperative days 2, 3, 4, and 5. These two groups showed no differences in walking ability in terms of first weight bearing day and walking distance. No significant intergroup difference was observed in analgesic consumption. Conclusions: The groups showed no difference in postoperative pain control. ACB showed better motor grade on postoperative day one compared with femoral nerve block, but which was similar in days after postoperative day one.

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The Effects of Single Shot versus Continuous Femoral Nerve Block on Postoperative Pain and Rehabilitation Following Total Knee Arthroplasty

Malaysian Orthopaedic Journal ◽

10.5704/moj.1003.004 ◽

2010 ◽

Vol 4 (1) ◽

pp. 19-25 ◽

Cited By ~ 3

Author(s):

R Subramaniam, ◽

SS Sathappan

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Nerve Block ◽

Knee Arthroplasty ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Single Shot ◽

Continuous Femoral Nerve Block ◽

Total Knee

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Comparative study between: Epidural bupivacaine versus Patient Controlled Analgesia for postoperative pain control in total knee arthroplasty

QJM ◽

10.1093/qjmed/hcaa039.073 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A T A Elkhouly ◽

M A Bassiony ◽

M M N Elshafey ◽

K M Khalaf ◽

A M Alansary

Keyword(s):

Total Knee Arthroplasty ◽

Stress Response ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Pain Control ◽

Patient Controlled Analgesia ◽

Postoperative Pain Control ◽

Epidural Bupivacaine ◽

Total Knee ◽

Cortisol Levels

Abstract Introduction Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization. Aim The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty. Patients Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study. Methods patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response. Results The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA. Conclusion The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.

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