Continuous femoral nerve block after total knee arthroplasty?

Abstract

A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90 degrees knee flexion after 6 days. However, after 3 months, no significant functional benefits were found.

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

“…Regional anesthesia is a well-established technique for total knee arthroplasty to provide a bridge to early postoperative analgesia, reduce opioid consumption, and improve mobility and rehabilitation. 3,4 The most widely used techniques are femoral nerve block (FNB), with or without sciatic nerve block (SNB), together with intrathecal anesthesia. 5 Several strategies involving regional anesthesia for joint arthroplasty have been designed to contain the cost of the surgery and secondary treatments and to decrease the economic burden on the health care system.…”

Postoperative Pain Control for Total Knee Arthroplasty: Continuous Femoral Nerve Block Versus Intravenous Patient Controlled Analgesia

“…Various studies have demonstrated the effectiveness of femoral nerve blocks in reducing pain post-total knee arthroplasty compared with intravenous PCA (3,7,8,(11)(12)(13)(14)(15)(16)(17). A systematic review of 112 studies between 1996 and 2005 by the PROSPECT working group supports the use of femoral nerve blocks for postoperative analgesia for primary TKA, based on the reduction in pain scores and supplemental analgesia (10).…”

Regional analgesia for improvement of long-term functional outcome after elective large joint replacement

“…We also requested additional data for three studies (Kadic 2009;Nader 2012;Wu 2014). Kadic 2009 gave the knee flexion results only as mean (range) and reported only the components of the WOMAC score but not the global score.…”

“…Design: Three of the six studies were only single-blinded (Kadic 2009;Tammachote 2013;Zhang 2011), while three were unblinded (Nader 2012;Singelyn 1998;Wu 2014). Due to the nature of the interventions and their obvious numbing effect (participants received either a continuous femoral nerve block, an epidural catheter, or no regional technique), blinding of participants or personnel would have been difficult.…”

“…Included studies-We identified six RCTs studying the effect of regional analgesia on functional outcome for total knee replacement (Kadic 2009;Nader 2012;Singelyn 1998;Tammachote 2013;Wu 2014;Zhang 2011) at least three months after surgery (Characteristics of included studies table), with a total of 350 participants. We did not find any study on the effect of regional anaesthesia for longterm function after shoulder replacement.…”