Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty

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

doi:10.1097/aln.0b013e3181f4b18

Cited by 406 publications

(271 citation statements)

References 39 publications

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“…We did not find significant differences in any of the other performance-based ambulation measures during the early and later postoperative period, or the self-reported WOMAC physical function score, between either of the FNB groups and the PCA opioid alone group. A past systematic review of randomized clinical trials comparing the effect of FNB and PCA opioid on knee flexion at postoperative day 2 failed to find any difference (7). Our findings extend the results of this review by suggesting that the patients given FNB were more likely to achieve knee flexion 90°before discharge or day 6, compared to patients given PCA opioid alone.…”

Section: Discussionsupporting

confidence: 77%

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Functional Discharge Readiness and Mobility Following Total Knee Arthroplasty for Osteoarthritis: A Comparison of Analgesic Techniques

Chan

Teo

Assam

et al. 2014

Arthritis Care & Research

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Objective. To determine if functional discharge readiness and mobility following total knee arthroplasty (TKA) for osteoarthritis is delayed after femoral nerve block (FNB) with or without patient-controlled analgesia (PCA) opioid compared with PCA opioid alone. Methods. We analyzed secondary outcomes from a randomized controlled trial with 200 patients undergoing unilateral TKA. Experimental group 1 received single-injection FNB with intravenous PCA opioid, experimental group 2 received continuous FNB, and the control group received PCA opioid alone. FNB was administered using bupivacaine. Patients followed a structured TKA pathway. Discharge readiness outcomes included achievement of 90°knee flexion, independent walking, and stair climbing, and were assessed daily before discharge or day 6, whichever came first. Mobility outcomes included the Timed Up and Go (TUG) test, the 6-Minute Walk Distance (6MWD), and self-reported physical function, and were assessed at weeks 2 and 12. TUG was also assessed on days 3 to 6, postoperation. Results. Both FNB groups (77%) were more likely to achieve 90°knee flexion compared with the control group (59%); odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.1, 4.8 for single-injection FNB, and OR 2.3, 95% CI 1.1, 4.9 for continuous FNB. There were no significant differences in independent walking and stair-climbing ability before discharge, TUG, 6MWD, or self-reported physical function, between the FNB groups compared with the control group. Conclusion. After TKA, FNB (single-injection with PCA opioid or continuous) does not delay achievement of 90°knee flexion or other measures of functional discharge readiness and mobility compared with PCA opioid alone.

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Section: Discussionsupporting

confidence: 77%

“…Generally, FNBs provide better pain relief and less opioid consumption compared to intravenous PCA opioid (7). However, blockade of the femoral nerve impairs quadriceps muscle function and may limit functional recovery or mobility.…”

Section: Introductionmentioning

confidence: 99%

Functional Discharge Readiness and Mobility Following Total Knee Arthroplasty for Osteoarthritis: A Comparison of Analgesic Techniques

Chan

Teo

Assam

et al. 2014

Arthritis Care & Research

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“…Discomfort during the postoperative period could hinder the rehabilitation process and cause a reduction in knee ROM [37]. Minimizing trauma to the extensor mechanism during arthrotomy may influence pain relief or function.…”

mentioning

confidence: 99%

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

Laffosse

Potapov

Malo

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.Questions/purposes We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort. Patients and Methods We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively.

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“…This approach was reported in a recent meta-analysis of femoral nerve blocks highlighting morphine reductions from a single-shot femoral nerve block (20-mg reduction), a single-shot femoral nerve block with a sciatic block (31-mg reduction), and a continuous femoral nerve block (15-mg reduction). 19 The decrease in morphine use in the dexmedetomidine group in the first 24 hr is clinically relevant for a number of reasons. Total knee arthroplasty is an operation associated with significant postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

Chan

Maslany

Gorman

et al. 2016

Can J Anesth/J Can Anesth

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Background It remains unclear whether the opioidsparing effects of dexmedetomidine seen in patients undergoing general anesthesia are reproducible in patients undergoing spinal anesthesia. We hypothesized that the administration of intravenous dexmedetomidine for sedation during total knee arthroplasty under spinal anesthesia would decrease postoperative morphine consumption in the first 24 hr following surgery. Methods We conducted this prospective double-blind randomized-controlled trial in 40 patients (American Society of Anesthesiologists physical status I-III) undergoing total knee arthroplasty with a standardized spinal anesthetic. Patients were randomized to receive either a dexmedetomidine loading dose of 0.5 lgÁkg -1 over ten minutes, followed by an infusion of 0.5 lgÁkgÁhr -1 for the duration of the surgery, or a normal saline loading dose and an infusion of an equivalent volume. The primary outcome was the consumption of morphine delivered via patientcontrolled analgesia in the first 24 hr following surgery. Results The mean (SD) cumulative morphine at 24 hr in the dexmedetomidine group was 29.2 (11.2) mg compared with 61.2 (17.2) mg in the placebo group (mean difference, 32.0 mg; 95% confidence interval, 22.7 to 41.2; P \ 0.001). In the dexmedetomidine group, there was a delay in the time to first analgesic request (P = 0.003) and a reduction in the mean morphine use at six and 12 hr following surgery (both P \ 0.001).Conclusions Dexmedetomidine was associated with a significant decrease in morphine use in the first 24 hr following total knee arthroplasty. Our study shows that an intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce postoperative analgesic effects. This offers another potential adjunct in the multimodal pain management of these patients. This trial was registered at ClinicalTrials.gov (identifier NCT02026141).

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Femoral Nerve Block Improves Analgesia Outcomes after Total Knee Arthroplasty

Abstract: SSFNB or continuous FNB (plus PCA) was found to be superior to PCA alone for postoperative analgesia for patients having total knee arthroplasty. The impact of adding a sciatic block or continuous FNB to a SSFNB needs to be studied further.

Cited by 406 publications

References 39 publications

Functional Discharge Readiness and Mobility Following Total Knee Arthroplasty for Osteoarthritis: A Comparison of Analgesic Techniques

Functional Discharge Readiness and Mobility Following Total Knee Arthroplasty for Osteoarthritis: A Comparison of Analgesic Techniques

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

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