Effects of Intravenous Patient-Controlled Analgesia with Morphine, Continuous Epidural Analgesia, and Continuous Three-in-One Block on Postoperative Pain and Knee Rehabilitation After Unilateral Total Knee Arthroplasty

Abstract

In this study, we determined that, after total knee arthroplasty, loco-regional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabilitation than i.v. patient-controlled analgesia with morphine. Because it causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice.

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

“…Two prospective randomized studies examined 3 different modes of analgesia: continuous femoral nerve block, epidural analgesia, and intravenous narcotic therapy after TKA. 47,48 These studies showed improvement in perioperative rehabilitation scores and a decreased duration of stay in a rehabilitation center for patients receiving the regional anesthesia techniques. Continuous femoral nerve block was shown to have equivalent analgesia with fewer side effects than epidural analgesia in both of these studies.…”

“…Continuous femoral nerve block has been shown to improve outcome after major knee and vascular surgery of the lower extremity compared with intravenous narcotic therapy or continuous infusion or injection of analgesics. [44][45][46][47][48][49][50] Chelly et al 46 showed a 20% reduction in hospital length of stay in patients receiving continuous femoral nerve block analgesia compared with patients receiving intravenous patient-controlled analgesia narcotics after major knee surgery. Two prospective randomized studies examined 3 different modes of analgesia: continuous femoral nerve block, epidural analgesia, and intravenous narcotic therapy after TKA.…”

“…Continuous femoral nerve block was shown to have equivalent analgesia with fewer side effects than epidural analgesia in both of these studies. 47,48 However, not all investigators have been able to show these improvements in outcome with continuous femoral nerve blocks. Hirst et al 51 found no differences in narcotic consumption or pain scores between patients receiving a single-injection femoral nerve block and patients receiving a continuous femoral nerve block after TKA.…”

Location, location, location: Continuous peripheral nerve blocks and stimulating catheters

“…1 Continuous peripheral nerve blocks provide superior analgesia compared with intravenous patient-controlled analgesia and a lower incidence of side effects compared with either intravenous patient-controlled analgesia or continuous lumbar epidural analgesia. [2][3][4][5] Prospective, randomized clinical studies have demonstrated the effectiveness of ambulatory continuous peripheral blocks after painful orthopedic procedures. 6,7 A major concern with the use of continuous peripheral nerve block is placement of the catheter close enough to the nerve to allow effective analgesia with the small amounts of dilute local anesthetic solutions utilized for the "secondary analgesic block" after the initial primary anesthetic block has resolved.…”

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery

“…160,161 Most studies comparing this method directly to intravenous patient-controlled analgesia (PCA) have demonstrated superior pain relief at rest and with movement, better postoperative knee flexion, and earlier discharge. 162,163 Unfortunately, the increased cost of this technique and lack of expertise in placing peripheral nerve catheters often limits their use. Whenever peripheral nerve techniques (either single shots or catheters) are used, it is very important that anaesthesiologists and physiotherapists engage in dialogue in order to reach rehabilitation goals and avoid the delay in functional recovery that can be caused by dense motor blockade.…”