Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty

Paul, James; Arya, Aman; Hurlburt, Lindsay; Cheng, Jin; Thabane, Lehana; Tidy, Antonella; Murthy, Yamini

doi:10.1097/aln.0b013e3181f4b418

Cited by 19 publications

(28 citation statements)

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“…At least 1 reason for the relative unpopularity of SNB may be the ambiguity of the available evidence and inconsistent recommendations regarding the addition of SNB to FNB for postoperative analgesia following TKA. 19Y21 Indeed, two recently published metaanalyses 20,22 and one systematic review 19 concluded that SNB does not provide any analgesic advantage when added to FNB, but these conclusions were drawn exclusively from one small randomized trial. 2 The goal of this systematic literature review was to evaluate the effect of adding SNB to FNB for postoperative analgesia following TKA.…”

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confidence: 97%

Is Sciatic Nerve Block Advantageous When Combined With Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty?

Abdallah

Brull

2011

Regional Anesthesia and Pain Medicine

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Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). This systematic review examines the effects of adding SNB to FNB for TKA compared with FNB alone on acute pain and related outcomes. Four intermediate-quality randomized and 3 observational trials, including a total of 391 patients, were identified. Three of 4 trials investigating the addition of single-shot SNB and 2 of 3 trials investigating continuous SNB reported improved early analgesia at rest and reduced early opioid consumption. Only 2 trials specifically assessed posterior knee pain. We were unable to uncover any clinically important analgesic advantages for SNB beyond 24 hours postoperatively. At present, there is inconclusive evidence in the literature to define the effect of adding SNB to FNB on acute pain and related outcomes compared with FNB alone for TKA.

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confidence: 97%

Is Sciatic Nerve Block Advantageous When Combined With Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty?

Abdallah

Brull

2011

Regional Anesthesia and Pain Medicine

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“…Similarly, a recent meta-analysis by Paul et al (6) found that single-shot and continuous FNB was superior (lower opioid consumption) to PCA alone. In particular, continuous FNB with intravenous PCA was clearly superior to PCA alone with regard to reduced morphine consumption at 24 and 48 hours, pain scores, and nausea.…”

Section: Discussionmentioning

confidence: 99%

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

2012

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In total knee arthroplasty, postoperative pain control is imperative in facilitating physical therapy and rehabilitation. Our study promotes use of continuous femoral nerve blocks for pain relief post total knee arthroplasty. ambulation, which hastens recovery and reduces hospital length of stay (5). The risk of postoperative complications, such as venous thromboembolism and nosocomial infections (6), has also been shown to decrease with early mobilization.Pain control modalities for post-TKA include intravenous patient-controlled analgesia (PCA), peripheral nerve blockade, and continuous epidural analgesic techniques. All methods have been shown to be efficacious in relieving postoperative pain. However, conventional techniques that use intravenous PCA with morphine and fentanyl are associated with side effects, such as respiratory depression, sedation, pruritus, nausea and vomiting, hypotension, constipation, and urinary retention (7); epidural analgesia is associated with hypotension and bilateral motor blockade if local anesthetics are used (8, 9).

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“…However, placement of an epidural catheter carries a definite risk for neurological complications. Alternative techniques such as FNB combined with PCA or local anesthetic wound infiltration have been advocated for pain therapy after TKA [5].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are little data on efficacy and adverse effects of pain therapy after converting an established protocol (EA) to a modified protocol (FNB) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Kozian¹

2017

SDRP-JAS

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Background:Combined epidural analgesia (EA) and patient controlled analgesia (PCA) for postoperative pain control after total knee arthroplasty (TKA) is well established. Previous studies demonstrated the effectiveness of femoral nerve block (FNB) in combination with PCA. This study compares clinical efficiency and adverse events of pain therapy of an established (EA+PCA) and a modified (FNB+PCA) protocol. Methods:A retrospective, single-center cohort study analyzing TKA patients after subarachnoid anesthesia. Matched pair analysis was performed using filters for American Society of Anesthesiologists (ASA) classification, age, gender, height, weight, comorbidities and prior use of analgesics. Surgical technique and postoperative medication protocol were similar in both groups. Primary outcome was postoperative pain on movement assessed by a visual analog scale (VAS) and use of analgesics within 72 hours after surgery. Secondary, incidence of adverse events (postoperative nausea and vomiting, pruritus, urinary retention and hypotension) was examined.Results: From a total of 846 patients, 104 matched pairs were built and analyzed within 72 hours after surgery. Mean VAS scores were similar in patients receiving EA+PCA (2.7 ± 1.1) or FNB+PCA (2.8 ± 1.2). Supplemental opioid administration was higher in EA+PCA patients. Hypotension was more frequent in EA+PCA as in FNB+PCA patients (36 % vs. 12 %). Combined adverse events were more frequent in EA+PCA as in FNB+PCA patients (75 % vs. 58 %). Conclusion: Both FNB+PCA and EA+PCA results in equivalent degrees of analgesia after TKA. Converting an established mode of pain therapy to a modified protocol may decrease incidence of adverse events rather than improve quality of analgesia. EPIDURAL ANALGESIA COMPARED WITH FEMORAL NERVE BLOCK FOR POSTOPERATIVE PAIN THERAPY AFTER TOTAL KNEE ARTHROPLASTY -A MATCHED PAIR ANALYSIS

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Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty

Cited by 19 publications

References 0 publications

Is Sciatic Nerve Block Advantageous When Combined With Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty?

Is Sciatic Nerve Block Advantageous When Combined With Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty?

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

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

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