Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Toftdahl, Karen; Nikolajsen, Lone; Haraldsted, Viggo; Madsen, Frank; Tønnesen, Else; Søballe, Kjeld

doi:10.1080/17453670710013645

Cited by 270 publications

(315 citation statements)

References 13 publications

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“…It is also conceivable that much of the difference seen may be attributed to the FNB, which is expected to be effective during the first 24 postoperative hours. This contrasts with the findings of Toftdahl et al [18] who found analgesic benefits of local ropivacaine over a continuous FNB but can perhaps be explained by the fact that the injection was administered periarticularly in that study. This then raises the question of whether the location of the local anesthetic plays a role in its efficacy.…”

Section: Discussioncontrasting

confidence: 99%

“…In fact, we found improved pain scores during the first 24 postoperative hours with an epidural plus FNB. However, the effect size was not large, and its clinical significance may be only borderline; in fact, even the average maximum pain scores in the ropivacaine group were low and were comparable to prior studies that have supported intraarticular ropivacaine as an analgesic option after TKA [8,18]. It is also conceivable that much of the difference seen may be attributed to the FNB, which is expected to be effective during the first 24 postoperative hours.…”

Section: Discussionsupporting

confidence: 64%

“…When compared to FNB, beneficial effects of intraarticular ropivacaine have been shown. In 2007, Toftdahl et al [18] randomized 80 patients after TKA to receive either a continuous FNB or a local analgesic injection of ropivacaine, ketorolac, and epinephrine with bolus injections of ropivacaine through a knee catheter and found lower pain scores and reduced opioid consumption in the local ropivacaine group.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, an intraarticular continuous infusion of ropivacaine, in particular, has been shown to be efficacious in reducing postoperative pain and opioid requirements when compared to placebo in prior studies [8,15]. However, the superiority of a continuous intraarticular infusion of ropivacaine over other commonly used analgesic methods, such as epidural analgesia or FNB, has yet to be definitely determined [1,18]. Furthermore, no prior study has compared a continuous intraarticular infusion of ropivacaine to a combined regimen of epidural analgesia and FNB.…”

Section: Introductionmentioning

confidence: 99%

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Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Reinhardt

Duggal

Umunna

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Pain management after TKA remains challenging and the efficacy of continuously infused intraarticular anesthetics remains a controversial topic.Questions/purposes We compared the side effect profile, analgesic efficacy, and functional recovery between patients receiving a continuous intraarticular infusion of ropivacaine and patients receiving an epidural plus femoral nerve block (FNB) after TKA. Methods Ninety-four patients undergoing unilateral TKA were prospectively randomized to receive a spinal-epidural analgesic infusion plus a single-injection FNB or a spinal anesthetic plus a continuous postoperative intraarticular infusion of 0.2% ropivacaine. All patients were blinded to their treatment with placebo saline catheters. Blinded coinvestigators collected data concerning side effect profiles (nausea, hypotension), analgesic efficacy (VAS pain scores, narcotic usage), and functional recovery (timed up and go test, quadriceps strength, WOMAC scores, Knee Society scores, early postoperative ambulatory ability, in-hospital falls). All complications and adverse events were recorded. Results The frequency of nausea and hypertension was not different between the study groups. During the first 12 and 24 postoperative hours, the mean maximum VAS pain scores were higher in the ropivacaine group than in the epidural group (first 12 hours: 3.93 versus 1.14, respectively, p \ 0.0001; 12-24 hours: 3.52 versus 1.93, respectively, p = 0.008). After 24 hours, pain scores were similar between groups. Narcotic consumption was significantly higher in the ropivacaine group on the day of surgery, but overall in-hospital narcotic usage was similar between groups. There were no clinically important differences in functional recovery between groups at any time point, but patients in the epidural group were more likely to have knee buckling (32.7% versus 6.7%, p = 0.002) and delayed ambulation (16.3% versus 0.0%, p = 0.006) than patients in the ropivacaine group, though not in-hospital falls. No infections occurred in either group, and the frequency of complications was not different between groups.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Reinhardt

Duggal

Umunna

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…In a previous randomized controlled trial (RCT) evaluating PAI, we showed that mean morphine consumption was lower in the PAI group than the control group up to 40 hours postoperatively (46.7 mg compared with 68.6 mg, respectively) [27]. Other authors compared different PAI protocols versus femoral nerve block and have reported lower pain scores and consumption of opioids in their PAI group [21,26]. Carli et al [8] compared the analgesic effect of PAI versus femoral nerve block plus PAI into the posterior knee capsule and found that the femoral nerve block plus posterior PAI was associated with lower opioid consumption and better recovery at 6 weeks as measured by functional walking capacity (2-and 6-minute walk tests) than PAI alone.…”

Section: Introductionmentioning

confidence: 96%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2014

Cochrane Database of Systematic Reviews

164

112

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Background Total knee replacement (TKR) is a common and o en painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Objectives To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web of Science, dissertation abstracts and reference lists of included studies. The date of the last search was 31 January 2013. Selection criteria We included randomized controlled trials (RCTs) comparing FNB with no FNB (intravenous patient-controlled analgesia (PCA) opioid, epidural analgesia, local infiltration analgesia, and oral analgesia) in adults a er TKR. We also included RCTs that compared continuous versus single-shot FNB. Data collection and analysis Two review authors independently performed study selection and data extraction. We undertook meta-analysis (random-e ects model) and used relative risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) or standardized mean di erences (SMDs) for continuous outcomes. We interpreted SMDs according to rule of thumb where 0.2 or smaller represents a small e ect, 0.5 a moderate e ect and 0.8 or larger, a large e ect. Main results We included 45 eligible RCTs (2710 participants) from 47 publications; 20 RCTs had more than two allocation groups. A total of 29 RCTs compared FNB (with or without concurrent treatments including PCA opioid) versus PCA opioid, 10 RCTs compared FNB versus epidural, five RCTs compared FNB versus local infiltration analgesia, one RCT compared FNB versus oral analgesia and four RCTs compared continuous versus single-shot FNB. Most included RCTs were rated as low or unclear risk of bias for the aspects rated in the risk of bias Femoral nerve blocks for acute postoperative pain a er knee replacement surgery (Review)

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Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Cited by 270 publications

References 13 publications

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

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