Reduction of leakage from insertion site during continuous femoral nerve block with catheter-through-needle versus catheter-over-needle technique for postoperative analgesia after total knee arthroplasty: a randomized controlled trial

Background Continuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A different type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare the incidence of leakage from the catheter insertion site during CFNB while using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA). Methods This prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN or CON groups. All patients in both groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine (a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 h postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups. Results The CON group had a significantly lower incidence and degree of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes. Conclusions Use of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage. Trial registration The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

The Effect of Femoral Nerve Block Versus Adductor Canal Block on the Quality of early Recovery after Revision Total Knee Arthroplasty, a retrospective Study

Background Multimodal pain analgesia strategies are common in perioperative management of total knee arthroplasty (TKA), although the role of adductor canal blocks (ACB) versus femoral nerve block on early postoperative recovery for revision knee surgery is not investigated. Aim The purpose of this study is to independently evaluate the effect of ACB on short-term postoperative outcomes including (1) length of stay (LOS), (2) postoperative narcotic utilization, and (3) function with physical therapy in revision TKA. Methods We retrospectively identified a cohort study of consecutive 40 patients from January 2021 to July 2021 who had undergone unilateral revision TKA using a single-shot ACB (19 patients) vs femoral nerve block (21 patients) under spinal anesthesia ( hyperbaric 0.5% Marcaine 2.5 ml and 20 microgram fentanyl) in addition to a standardized multimodal pain analgesia protocol. These 2 groups were compared using independent sample t-tests with primary end points of interest being distance ambulated after surgery, and inpatient narcotic use. Results Quadriceps strength was better preserved in adductor group than in femoral group. Walking meters and going upstairs were better results in adductor group. IV morphine consumption within the first 48 hours period were less in adductor group comparing to femoral group. Conclusion Adductor nerve block showed better early recovery in revision TKA when comparing to femoral nerve block (FNB).

Controlled Hypotension Combined with Femoral Nerve Block for Knee Replacement without Tourniquet

In the process of knee replacement surgery, the use of tourniquet technology for hemostasis is the most common method. But the adverse reactions of tourniquets in knee replacement surgery have become more prominent in recent years. More and more scholars have begun to advocate the optimization of the use of tourniquet technology, thereby controlling the use of tourniquet technology. In this study, 125 patient cases were randomly divided into four experimental groups for comparative analysis. The two sets of variables are whether to use tourniquet during surgery and use intravenous analgesia or nerve block analgesia. Studies have shown that when using a tourniquet for knee replacement surgery, the chance of hidden blood loss increases after use. The tourniquet was not used during the operation, the patient's thighs were swollen, and postoperative pain was reduced. Compared with intravenous analgesia, knee joint replacement with uncontrolled tourniquet combined with femoral nerve block has a better analgesic effect and can effectively relieve pain after knee replacement. Therefore, under the method of controlled hypotension combined with femoral nerve block, TKA surgery without using tourniquet technology is more conducive to early health recovery and pain relief after TKA surgery, as well as functional exercise and knee joint recovery during postoperative recovery.

Comparison of two volumes for sciatic perineural injection using 1% methylene blue in rabbit cadavers

ABSTRACT The purpose of this study was to assess the efficacy of a blind technique for sciatic and femoral nerve block in rabbit cadavers by evaluating the spread of 1% methylene blue at two different volumes. Nine recently euthanized rabbits weighing 2.5(0.3kg were used. The sciatic (SN) and femoral (FN) nerves of each limb were randomly assigned for injection with 1% methylene blue at 0.2mL/kg (G0.2) or 0.3mL/kg (G0.3). Nerves were dissected and measured for depth and extension of staining (cm). Mean comparisons were performed using paired t test. The relation between volume and nerve staining ( 2cm was assessed using chi-square test. The mean depth of SN was 1.9±0.2 and 1.6±0.3cm and staining 1.9±1.4 and 2.0±1.2cm, respectively in G0.2 and G0.3. No relation was found between depth and dye spread and there was no association between nerve staining ( 2.0cm and volume of solution. The FN failed to be stained in all subjects. In conclusion, SN injection can be successfully performed without guidance in rabbits. The lower volume (0.2mL/kg) is recommended to avoid systemic toxicity.

A guide to regional analgesia for Total Knee Arthroplasty

Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain scores, opioid use and adverse effects. Combination of regional analgesia techniques is associated with better pain management and lower side effects than single regional techniques. Adductor canal block provides good analgesia and considerably lower detrimental effect in muscular strength than femoral nerve block, enhancing surgical recovery. Infiltration techniques may have equivalent analgesic effect than epidural analgesia and peripheral nerve blocks, however there should be awareness of dose dependent toxicity. Novel long-acting local anesthetics role for regional analgesia is still to be determined, and will require larger randomized trials to support its advantage over traditional local anesthetics. Cite this article: EFORT Open Rev 2021;6:1181-1192. DOI: 10.1302/2058-5241.6.210045

Effect of Ketoprofenphonophoresis and Femoral Nerve Block in Knee Osteoarthritis

Objective: To evaluate the effect of ketoprofenphonophoresis and femoral nerve block in knee osteoarthritis. Methods: One hundred and fourteen patients with knee osteoarthritis were randomly divided into two groups. The control group consisted of 57 patients who were treated with only ketoprofenphonophoresis. The experimental group consisted of patients were treated with ketoprofenphonophoresis and femoral nerve block. The patients were followed for more than one month. The treatment effect assessed by observing their WOMAC index before and after therapy. Results: All the patients finished the follow-up. Their WOMAC indexes were reduced after therapy and one month after treatment, especially in the experimental group (P < 0.05). The effective efficiency of ketoprofenphonophoresis and femoral nerve block were higher than that in the control group after treatment and after one month of follow-up (P < 0.05). Conclusion: Compared with only ketoprofenphonophoresis, the combined treatment of ketoprofenphonophoresis and femoral nerve block was more appropriate in knee osteoarthritis.

Significantly Earlier Ambulation and Reduced Risk of Near-Falls with Continuous Infusion Nerve Blocks: A Retrospective Pilot Study of Adductor Canal Block Compared to Femoral Nerve Block in Total Knee Arthroplasty

Background: One option in total knee arthroplasty (TKA) perioperative pain management is femoral nerve block (FNB). Its association with quadriceps weakness has led to a focus on adductor canal block (ACB), with the aim of avoiding weakness in adjacent muscles. This study reviewed cases at our institution. Methods: In this pilot non-blinded study, nerve block (FNB or ACB) was performed under ultrasonic guidance after induction of general anesthesia, with an initial bolus followed by continuous levobupivacaine infusion into the perineurium as needed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who had been able to ambulate on POD 1, was investigated. Results: A total of 73 TKA cases, 37 FNB and 36 ACB, met the inclusion criteria. Episodes of near-falls in the form of knee-buckling were witnessed in 14 (38%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients were able to ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values of patients able to ambulate with parallel bars on POD 1 in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) through POD 3. Conclusion: Compared to FNB, ACB was associated with significantly less knee-buckling and earlier initiation of ambulation post-TKA, with better quadriceps muscle strength. These findings support the use of ACB as the anesthesia method of choice for TKA.

Comparison of patient and surgeon satisfaction in patients undergoing knee arthroscopy with peripheral nerve block versus spinal anesthesia

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p <0.01) and surgeon (p = 0.022; p <0.05) satisfaction rates, these being lower in the group with SFNB comparable to patients with spinal anesthesia. There was a statistically significant difference between the first analgesic requirements of the patients according to the groups (p = 0.001; p <0.01). The first analgesic requirement of the patients who received SFNB was later than in the case of patients who received spinal anesthesia. Conclusions. Patient and surgeon satisfaction with SA was significantly higher than SFNB. The peripheral nerve blocks are inadequate for patient and surgeon satisfaction for knee arthroscopy compared to SA.