Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

Anatoli Stav, Leonid Reytman, Roger Sevi, Michael Yohay Stav, Devorah Powell, Yanai Dor, Mickey Dudkiewicz, Fuaz Bayadse, Ahud Sternberg, Michael Soudry, Anatoli Stav, Leonid Reytman, Roger Sevi, Michael Yohay Stav, Devorah Powell, Yanai Dor, Mickey Dudkiewicz, Fuaz Bayadse, Ahud Sternberg, Michael Soudry

Abstract

Background: The PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone.

Methods: This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days.

Results: A total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the "blocks" groups versus the control group. Morphine consumption was significantly higher in the control group.

Conclusions: Pain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120).

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Clinical Trials (CONSORT) Flow Chart of Included and Excluded Patients. The inclusion criteria were: physical status of I–III based on the American Society of Anesthesiologists criteria; and scheduled to undergo elective TKA due to osteoarthritis. * The exclusion criteria were: previous TKA, revision of TKA, TKA due to trauma or etiology other than osteoarthritis, age

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