Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement

Abstract

A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

“…For example, patients undergoing a total knee arthroplasty (TKA) typically experience significant postoperative pain for 1-2 months [44][45][46]. However, the most common analgesic -opioids -are associated with undesirable side effects such as nausea, vomiting, pruritis, respiratory depression, sedation, and ileus [44,46,47]. Furthermore, the threat of prescribed opioid drug abuse is persistent and growing, with the annual economic cost of nonmedical use of prescription opioids in the U.S. estimated at over $53 billion in 2011 [48].…”

Ultrasound-Guided Single-Injection Femoral Nerve Block Provides Effective Analgesia after Total Knee Arthroplasty up to 48 Hours

“…Results: Group F used significantly less morphine compared with Group P (18.7 mg vs. 39.6 mg) during the first 48 hours after surgery (p<0.001). When compared with group P, the VRS scores both at rest and during movement were significantly lower in Group F at 4,8,12, 24, and 48 hours after TKA (for all comparisons p<0.001). In addition, patient satisfaction was better in Group F than Group P. Conclusion: This study suggests that a US-guided single-injection femoral nerve block following TKA improves patient satisfaction and reduces consumption of morphine during the first 48 hours.…”

“…[8][9][10][11] In addition, femoral nerve blocks can reduce the reflex of the quadriceps muscle, thus reducing pain and muscle spasms, [12] which may provide a positive contribution in facilitating physical therapy and early ambulation, as well as reduce the length of hospitalization. [11,13] In this study, longer analgesia time may have resulted from the injection of high-volume LA tion, tourniquet time, duration of operation, and times from spinal injection to the FNB procedure between the two groups ( Table 1).…”

Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1) com ropivacaína e a analgesia subaracnóidea com morfina

“…Estudo com distribuição aleatória, examinando a infusão contínua de anestésico local no nervo femoral, demonstrou melhor analgesia, comparada ao uso sistêmico de opióides 6,39 . Outros estudos não mostraram diferença analgésica com dose simples (única) ou infusão contínua para bloqueio do nervo femoral 17,38 . Analgesia inconsistente ao bloqueio do nervo femoral pode ser explicada pela persistência da sensação da região posterior da perna, indicando que o ner- .…”

“…A área de anestesia abrangida pelo bloqueio inclui a parte anterior, medial e lateral da coxa, face medial da perna, assim como o periósteo do fêmur e do joelho 1,10,13 . É facilmente realizado, sendo indicado para procedimentos no joelho [14][15][16][17][18] , fêmur 19,20 , quadril 1, [21][22][23][24] e biópsia muscular 25 . Tem sido relatado que o bloqueio 3 em 1 proporciona analgesia satisfatória, prolongada, com baixo índice de efeitos colaterais, incluindo alterações hemodinâmicas, freqüentemente potenciais à anestesia peridural ou subaracnóidea 21,22 .…”