Effect of Combined Single-Injection Femoral Nerve Block and Patient-Controlled Epidural Analgesia in Patients Undergoing Total Knee Replacement

Abstract

PurposeTotal knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement.Materials and MethodsThirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated.ResultsMedian visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours.ConclusionThe combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.

Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries

“…On the other hand, PCEA, known as a kind of long-term anesthesia, deliver the drugs to the epidural cavity with the PCA device. It is mainly applied to the treatment of chest and back pain and the following areas, and the most commonly used analgesics are local anesthetic and opioid analgesics [18,19]. In addition, PCEA has the advantages of small dosage, reliable analgesic effect, long duration, limited range of action and relatively small systemic effects, which can be used for postoperative analgesia, cancer carbuncle of chest, abdomen and lower extremity and traumatic pain (multiple rib fractures, pelvic fractures) [20,21].…”

Comparing the Cumulative Pain Patients Experience Waiting for Knee Arthroplasty to their Postoperative Pain

“…For Query 2, nine articles [13][14][15][16][17][18][19][20][21] were returned initially and, after application of inclusion criteria, two articles [13,20] were included in the analysis. Femoral nerve blocks decreased the weighted mean knee arthroplasty pain from 4.7 (opioid group) to 2.0 cm (femoral nerve group) in the recovery room and on postoperative day #1 (Tables 3 and 4).…”

Use of a Single Injection Femoral Nerve Block in the Patients of Total Knee Replacement with Concomitant Epidural Analgesia

“…We executed a single injection femoral nerve block alone and we did not combine it with a sciatic block in our patients, to keep it as a simple and an effective mode of analgesia [11,12]. The ongoing epidural infusion will restrict the patients from shifting from the PACU and their mobilization.…”