DOI: 10.1097/SA.0b013e31802f8c83
,
Issn Print: 0039-6206
Publication Date: 2007/02/01
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Excerpt
Francis V. Salinas, Spencer S. Liu, and Michael F. Mulroy
(Anesth Analg, 102:1234-1239, 2006)
Department of Anesthesiology, Virginia Mason Medical Center and Department of Anesthesiology, University of Washington, Seattle, WA.
Single-injection femoral nerve blocks (SFNBs) are superior to systemic opioid therapy in reducing pain after total knee arthroplasty (TKA). Improved analgesia can increase a patient's ability to participate in early intensive physical therapy and may reduce hospital length of stay (LOS). The potential advantages of continuous femoral nerve blocks (CFNBs) over SFNB were examined in a randomized study of 36 adult patients undergoing TKA within an established clinical pathway.
Patients in the SFNB group received a femoral nerve block in the postanesthesia care unit upon resolution of the spinal anesthetic to the T12 dermatome. Those in the CFNB group had a continuous femoral stimulating catheter placed while in the postanesthesia care unit and received a femoral nerve block via the catheter, followed by a continuous infusion of local anesthetic until the morning of the second day after surgery. All patients were treated with warfarin, had a standardized spinal anesthetic (bupivacaine and fentanyl), and received an intravenous morphine patient-controlled analgesia device and oral ibuprofen postoperatively. Discharge occurred when predetermined criteria had been met.
Measures of pain relief, including mean visual analog scale resting scores, mean maximal visual analog scale scores during physical therapy, and mean oxycodone consumption, indicated that analgesia for TKA was improved in the CFNB group compared with the SFNB group. The 2 groups did not differ importantly in number of antiemetic requests, hospital LOS, or 6- and 12-week knee flexion. At 12 weeks postoperatively, all patients were judged functionally independent.
Analgesia after TKA was more effective with CFNB than with SFNB, but hospital LOS was not reduced. The benefits to the patient achieved with CFNB, however, may justify the additional time, effort, and cost to place and manage continuous femoral nerve catheters.
