Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement

Harsha Shanthanna, Medha Huilgol, Vinay Kumar Manivackam, Amjad Maniar, Harsha Shanthanna, Medha Huilgol, Vinay Kumar Manivackam, Amjad Maniar

Abstract

Background: Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.

Aims: Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.

Settings and design: Randomised, controlled, non-blinded study done in a tertiary care private hospital.

Methods: Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.

Statistical analysis: Mean VAS score at 6, 6-24, 24-48 and 48-72 h were considered. Significance was assessed at the 5% level.

Results and conclusion: VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.

Keywords: Continuous femoral catheter; epidural; regional analgesia; total knee replacement; ultrasound.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Graphical representation of post-operative pain scores; all values are mean+SD. P value obtained by Student's t test shows a highly significant difference at 6 h
Figure 2
Figure 2
Graphical representation of the side-effects observed; depicted as % values

References

    1. Evans H, Steele SM, Nielsen KC, Tucker MS, Klein SM. Peripheral nerve blocks and continuous catheter techniques. Anesthesiol Clin North Am. 2005;23:141–62.
    1. Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: A systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008;100:154–64.
    1. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis Anesth Analg. 2006;102:248–57.
    1. Liu SS, Ngeow J, John RS. Evidence Basis for Ultrasound-Guided Block Characteristics: Onset, Quality, and Duration. Reg Anesth Pain Med. 2010;35:S26–36.
    1. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous Femoral Nerve Blockade or Epidural Analgesia After Total Knee Replacement: A Prospective Randomized Controlled Trial. Anesth Analg. 2005;101:1824–9.
    1. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92.
    1. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15.
    1. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001;16:436–45.
    1. Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous, femoral blockade? Anesth Analg. 2004;98:747–9.
    1. Weber A, Fournier R, Van Gessel E, Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement. Eur J Anaesthesiol. 2002;19:834–6.
    1. Tarkkila P, Tuominen M, Huhtala J, Lindgren L. Comparison of intrathecal morphine and continuous femoral 3-in-1 block for pain after major knee surgery under spinal anaesthesia. Eur J Anaesthesiol. 1998;15:6–9.
    1. Tierney E, Lewis G, Hurtig JB, Johnson D. Femoral nerve block with bupivacaine 0.25% for postoperative analgesia after open knee surgery. Can J Anaesth. 1987;34:455–8.
    1. Mansour NY, Bennetts FE. An observational study of combined continuous lumbar plexus and single-shot sciatic nerve blocks for post-knee surgery analgesia. Reg Anesth. 1996;21:287–91.
    1. Pham-Dang C, Gautheron E, Guilley J, Fernandez M, Waast D, Volteau C, et al. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005;30:128–33.
    1. Levesque S, Delbos A. Sciatic nerve block for total-knee replacement: Is it really necessary in all patients? Reg Anesth Pain Med. 2005;30:410–1.
    1. Schug SA. Peripheral nerve blockade carries only a minimal risk of permanent neurological complications. Anaesth Intensive Care. 2007;35:11–2.
    1. Fischer HB. Regional anaesthesia before or after general anaesthesia. Anaesthesia. 1998;53:727–9.
    1. Horlocker TT. Regional anesthesia survey. ASRA News. 1997;3:1–3.
    1. Watts SA, Sharma DJ. Long-term neurological complications associated with surgery and peripheral nerve blockade: Outcomes after 1065 consecutive blocks. Anaesth Intensive Care. 2007;35:24–31.
    1. Sawyer RJ, Richmond MN, Hickey JD, Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia. 2000;55:980–91.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere