Femoral Nerve Block vs Fascia Iliaca Block for Total Knee Arthroplasty Postoperative Pain Control

McMeniman, Timothy J.; McMeniman, P.J.; Myers, Peter; Hayes, David A.; Cavdarski, Alex; Wong, Man-Shun; Wilson, Adrian; Jones, Mark; Watts, Mark

doi:10.1016/j.arth.2009.11.018

Cited by 30 publications

(11 citation statements)

References 18 publications

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“…Overall, in this study, the 2 modalities were similar with regard to practicality, anesthetic and analgesic efficacy, and complications; this is consistent with the findings of other investigators. [8,9] In this study, we additionally demonstrated the safety and practicality of the novel cannula-over-needle set for delivering anesthesia and postoperative analgesia in hip replacement patients.…”

Section: Discussionmentioning

confidence: 83%

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Yu¹,

He²,

Cai³

et al. 2016

Medicine

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Background:Continuous femoral nerve block and fascia iliaca compartment block are 2 traditional anesthesia methods in orthopedic surgeries, but it is controversial which method is better. The objective of this study was to compare the practicality, efficacy, and complications of the 2 modalities in hip replacement surgery in the elderly and to assess the utility of a novel cannula-over-needle set.Methods:In this prospective, randomized controlled clinical investigation, 60 elderly patients undergoing hip replacement were randomly assigned to receive either continuous femoral nerve block or continuous fascia iliaca compartment block. After ultrasound-guided nerve block, all patients received general anesthesia for surgery and postoperative analgesia through an indwelling cannula. Single-factor analysis of variance was used to compare the outcome variables between the 2 groups.Results:There was a significant difference between the 2 groups in the mean visual analog scale scores (at rest) at 6 hours after surgery: 1.0 ± 1.3 in the femoral nerve block group vs 0.5 ± 0.8 in the fascia iliaca compartment block group (P < 0.05). The femoral nerve block group had better postoperative analgesia on the medial aspect of the thigh, whereas the fascia iliaca compartment block group had better analgesia on the lateral aspect of the thigh. There were no other significant differences between the groups.Conclusions:Both ultrasound-guided continuous femoral nerve block and fascia iliaca compartment block with the novel cannula-over-needle provide effective anesthesia and postoperative analgesia for elderly hip replacement patients.

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Section: Discussionmentioning

confidence: 83%

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Yu¹,

He²,

Cai³

et al. 2016

Medicine

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“…No gray literature was included. Finally, 5 RCTs [12–16] published between 2010 and 2016 were included in the present meta-analysis and all studies were published in English. These studies included 152 patients in the experimental groups and 156 patients in the control groups.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported allocation concealment was achieved by sealed opaque envelopes. Double blinding was reported in 2 RCTs, [11,12] only 1 [13] of the included articles attempted to blind the assessors. All RCTs provided complete outcome data.…”

Section: Resultsmentioning

confidence: 99%

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty

et al. 2017

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Background:This meta-analysis aimed to perform a meta-analysis to compare the efficiency and safety between femoral nerve block (FNB) and fascia iliaca block (FIB) for postoperative pain control in patients undergoing total knee and hip arthroplasties.Methods:A systematic search was performed in Medline (1966-2017.05), PubMed (1966-2017.05), Embase (1980-2017.05), ScienceDirect (1985-2017.05) and the Cochrane Library. Inclusion criteria (1) Participants: Only published articles enrolling adult participants that with a diagnosis of end-stage of osteoarthritis and prepared for unilateral TKA or THA; (2) Interventions: The intervention group received FIB for postoperative pain management; (3) Comparisons: The control group was received FNB for postoperative pain control; (4) Outcomes: Visual analogue scale (VAS) scores in different periods, opioids consumption, length of stay and postoperative complications; (5) Study design: clinical randomized control trials (RCTs) were regarded as eligible in our study. Cochrane Hand book for Systematic Reviews of Interventions was used for assessment of the included studies and risk of bias was shown. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software.Results:Five RCTs including 308 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.080, 95% CI: −0.306 to 0.145, P = .485), 24 hours (SMD = 0.098, 95% CI: −0.127 to 0.323, P = .393), and 48 hours (SMD = −0.001, 95% CI: −0.227 to 0.225, P = .993). No significant differences were found regarding opioid consumption at 12 hours (SMD = 0.026, 95% CI: −0.224 to 0.275, P = .840), 24 hours (SMD = 0.037, 95% CI: −0.212 to 0.286, P = .771), and 48 hours (SMD = −0.016, 95% CI: −0.265 to 0.233, P = .900). In addition, no significant increase of complications was identified between groups.Conclusion:There is no significant differences of VAS scores at 12-48 hour and opioids consumption at 12-48 hour between two groups following total joint arthroplasty. No increased risk of nausea, vomiting and pruritus was observed in both groups. More high-quality large RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of FNB with FIB. The present meta-analysis exists some limitations that should be noted: (1) Only five articles were included in present meta-analysis, although all of them are recently published RCTs, the sample size are relatively small; (2) Functional outcome is an important parameter, due to the insufficiency of relevant data, we cannot perform a meta-analysis. (3) Dose and types of local anesthetics are varied, which may influence the results; (4) The duration of follow up is relatively short which leads to underestimating complications. (5) Publication bias in present meta-analysis ...

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“…FIB was considered an alternative choice for pain control. Brisbane et al [18] found that there is no significant difference in pain scores and opioids consumption in different periods between FIB and FNB in patients undergoing TKA; thus, FIB is as effective as FNB as part of a multimodal anesthetic regimen for TKA. The present meta-analysis indicated that FIB could significantly reduce VAS scores at 12 and 24 hours following total knee and hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

The efficiency and safety of fascia iliaca block for pain control after total joint arthroplasty

Zhang

Li²,

Song³

et al. 2017

Medicine

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Background:This meta-analysis aimed to perform a meta-analysis including randomized controlled trials (RCTs) to assess the efficiency and safety of fascia iliaca block (FIB) for pain control in patients undergoing total joint arthroplasty (TJA).Methods:A systematic search was performed in Medline (1966–2017.03), PubMed (1966–2017.03), Embase (1980–2017.03), ScienceDirect (1985–2017.03) and the Cochrane Library. Study evaluated the efficiency and safety of FIB in TJA was selected. Meta-analysis was performed using Stata 11.0 software.Results:Five randomized controlled trials (RCTs) including 270 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.544, 95% CI: −0.806 to −0.281, P = .000) and 24 hours (SMD = −0.519, 95% CI: −0.764 to −0.273, P = .000), morphine equivalent consumption at 12 hours (SMD = −0.895, 95% CI: −1.164 to −0.626, P = .000) and 24 hours (SMD = −0.548, 95% CI:−0.793 to −0.303, P = .000). In addition, fewer adverse side effect was identified in FIB groups (RD = −0.139, 95% CI: −0.243 to −0.034, P = .009).Conclusion:The application of fascia iliaca block could significantly reduce VAS scores and morphine consumption at 12 and 24 hours following total knee and hip arthroplasty. In addition, there were fewer adverse effects in FIB groups. Due to the limited quality of the evidence currently available, higher quality RCTs are required.

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Femoral Nerve Block vs Fascia Iliaca Block for Total Knee Arthroplasty Postoperative Pain Control

Cited by 30 publications

References 18 publications

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty

The efficiency and safety of fascia iliaca block for pain control after total joint arthroplasty

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