Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan, Ee‐Yuee; Fransen, Marlene; Parker, David; Assam, Pryseley Nkouibert; Chua, Nelson

doi:10.1002/14651858.cd009941

Cited by 28 publications

(43 citation statements)

References 32 publications

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“…5,6,20 Other benefits associated with the utilization of PNBs include intraoperative hemodynamic stability, reduced opioid consumption, lower risk of nausea and vomiting, improved ambulation, and higher patient satisfaction. 5,[20][21][22][23][24][25] Given the amount of evidence in favor of NA and PNBs, it is intriguing that the majority of patients in our study received neither intervention. Thus, our data confirm that regional anesthesia remains underutilized even among orthopedic patients who are highly amenable to regional anesthetic approaches.…”

Section: Discussionmentioning

confidence: 92%

“…[40][41][42] However, neuraxial techniques are not a viable option for surgeries of the upper extremity, and even for the lower extremity, some authors have reported advantages with the use of PNBs. 24 In contrast to NA, there is a wide variety of PNB technology, techniques, and equipment, leading to significant heterogeneity in terms of expertise among physicians. 41 Institutional resources play a critical role not only with regard to equipment acquisition but also in providing fundamental training to instill procedural competencies.…”

Section: Discussionmentioning

confidence: 99%

“…One of the reasons could be that knee arthroplasties are particularly associated with severe postoperative pain and have been reported to be one of the most painful surgeries. 19,24 Furthermore, the more distal location of TKA procedures may provide more alternatives for the performance of PNBs compared with THA procedures.…”

Section: Discussionmentioning

confidence: 99%

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Trends in the Use of Regional Anesthesia

Cozowicz

Poeran

Zubizarreta

et al. 2016

Regional Anesthesia and Pain Medicine

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Our findings provide important insight into the dynamics of the adoption of regional anesthetic techniques. Whereas PNB utilization is significantly increasing, overall, NA and PNBs are performed in the minority of cases. With accumulating evidence in favor of regional anesthesia, promoting the use of NA and a further increase in PNB utilization could have far-reaching medical and economic implications.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Trends in the Use of Regional Anesthesia

Cozowicz

Poeran

Zubizarreta

et al. 2016

Regional Anesthesia and Pain Medicine

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“…Continuous FNBs have been shown to provide a longer duration of analgesia than single-injection FNB. 3 The quests for fast-track surgery, younger patients undergoing TKA, and early patient mobilization have been drivers for change in the management of postoperative pain. Years ago, as regional anesthesia was gaining popularity, it was common to combine a posterior lumbar plexus block (psoas) with a sciatic block to provide complete unilateral analgesia for patients undergoing TKA.…”

Section: Peripheral Nerve Blocksmentioning

confidence: 99%

“…1 Patients undergoing TKA report improved healthrelated quality of life and functional status. [2][3][4] Unfortunately, it is known to cause moderate to severe pain in most patients and is therefore regarded as one of the most painful orthopedic procedures. 5 In addition, patients who are identified as at risk of chronic pain may benefit from aggressive perioperative pain management in an attempt to prevent central sensitization.…”

mentioning

confidence: 99%

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

Kopp

Børglum

Buvanendran

et al. 2017

Regional Anesthesia and Pain Medicine

165

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In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual settings.

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2014

Cochrane Database of Systematic Reviews

164

112

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Background Total knee replacement (TKR) is a common and o en painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Objectives To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web of Science, dissertation abstracts and reference lists of included studies. The date of the last search was 31 January 2013. Selection criteria We included randomized controlled trials (RCTs) comparing FNB with no FNB (intravenous patient-controlled analgesia (PCA) opioid, epidural analgesia, local infiltration analgesia, and oral analgesia) in adults a er TKR. We also included RCTs that compared continuous versus single-shot FNB. Data collection and analysis Two review authors independently performed study selection and data extraction. We undertook meta-analysis (random-e ects model) and used relative risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) or standardized mean di erences (SMDs) for continuous outcomes. We interpreted SMDs according to rule of thumb where 0.2 or smaller represents a small e ect, 0.5 a moderate e ect and 0.8 or larger, a large e ect. Main results We included 45 eligible RCTs (2710 participants) from 47 publications; 20 RCTs had more than two allocation groups. A total of 29 RCTs compared FNB (with or without concurrent treatments including PCA opioid) versus PCA opioid, 10 RCTs compared FNB versus epidural, five RCTs compared FNB versus local infiltration analgesia, one RCT compared FNB versus oral analgesia and four RCTs compared continuous versus single-shot FNB. Most included RCTs were rated as low or unclear risk of bias for the aspects rated in the risk of bias Femoral nerve blocks for acute postoperative pain a er knee replacement surgery (Review)

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Cited by 28 publications

References 32 publications

Trends in the Use of Regional Anesthesia

Trends in the Use of Regional Anesthesia

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

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