Effectiveness of 3-in-1 Continuous Femoral Block of Differing Concentrations Compared to Patient Controlled Intravenous Morphine for Post Total Knee Arthroplasty Analgesia and Knee Rehabilitation

Abstract

We assessed the effectiveness of the 3-in-1 continuous femoral block as a form of postoperative pain relief for unilateral total knee arthroplasty (TKA). Sixty patients undergoing elective unilateral TKA under subarachnoid block were randomized into three groups. Postoperative analgesia was provided with a continuous 3-in-1 femoral nerve catheter with 0.15% ropivacaine in group A, a continuous 3-in-1 femoral nerve catheter with 0.2% ropivacaine in group B, or patient controlled intravenous morphine in group C (control group). Groups A and B received patient controlled intravenous morphine pumps for rescue analgesia. Patients in each group were followed for 72 hours postoperatively. Five patients were excluded after randomization. In the remaining 55 patients there was no statistical difference in pain score between the groups. Total morphine use was highest in group C (P< 0.05). No appreciable difference could be found with sensorimotor blockade, morphine usage and satisfaction scores when comparing groups A and B. Femoral catheter dislodgement rate was 7.9%. There was no statistical difference between the groups when comparing the day of first ambulation and the time to discharge from the hospital. Satisfaction scores were higher in group A (P = 0.028) and group B (P = 0.002) compared to group C. We conclude that a continuous 3-in-1 femoral nerve block with ropivacaine 0.15% or 0.2% for elective unilateral TKA has an opioid-sparing effect.

Postoperative pain treatment after total knee arthroplasty: A systematic review

“…One study demonstrated a significant increase in obturator motor blockade at 6 hours postoperatively [33]. Urinary retention was registered in one trial [35], cardiac events in one [38] and hypotension in two [35, 37]. No significant differences between active and control groups were reported.…”

The effect of pregabalin and s-ketamine in total knee arthroplasty patients: A randomized trial

“…[3] Analgesic benefits of peripheral nerve blocks are well described. [45678910] Femoral nerve block, single shot or continuous (CFNB), also in combination with sciatic and/or obturator block is proven to provide superior analgesia to opioids alone. [111213] The main problems with these peripheral nerve blocks are prolonged muscle weakness, the risk of falling during exercise, and decubitus on pressure points, as described after sciatic nerve block.…”

“…[3] Epidural analgesia and peripheral nerve blocks are frequently being used. They provide superior analgesia than opioids,[45678910111213] but cause muscle weakness, and risk of falling,[1415] postponing the physiotherapy exercises, and prolonging the hospital stay. Local infiltration analgesia (LIA) has lately gained popularity.…”

Schmerztherapie mit Stimulationskathetern bei Kniegelenkersatz

“…Die Notwendigkeit einer zusätzlichen Blockade des N. ischiadicus zur Komplettierung der Analgesie wird kontrovers diskutiert [1,3,5,9,21,25].…”

“…In einer Arbeit von Neuburger et al [19] wird für kontinuierlich anteriore Ischiadikuskatheter eine Dislokationsrate von 1,4% beschrieben, in anderen Arbeiten für Femoraliskatheter 2,8% [11] bis 7,9% [25].…”