In-plane three-step needle insertion technique for ultrasound-guided continuous femoral nerve block after total knee arthroplasty: a retrospective review of 488 cases

Abstract

BackgroundContinuous femoral nerve block (CFNB) improves postoperative analgesia after total knee arthroplasty (TKA). The aim of this study was to investigate the clinical efficacy and complications of our in-plane three-step needle insertion technique that was devised to reduce the risk of direct femoral nerve injury during CFNB in anesthetized patients.MethodsThis retrospective study included 488 patients who had undergone TKA. Ultrasound (US)-guided CFNB was performed under general or spinal anesthesia using an in-plane, three-step needle insertion technique. The success rate and difficulties of catheter placement, clinical efficacy of analgesia, and complications were recorded.ResultsFemoral catheters were placed with a 100% success rate. In 488 patients, real-time US imaging revealed easy separation of the fascia iliaca and the femoral nerve following injection of local anesthetic through a Tuohy needle. Verbal numerical rating scale pain scores (0–10) were 2.0 ± 1.2, 3.5 ± 1.9, 3.2 ± 1.7, 2.9 ± 1.3, and 2.5 ± 1.1 at 1, 6, 12, 24 and 48 h postoperatively. No femoral hematoma, femoral abscess, or neurologic complications, including paresthesia or neurologic deficits, were observed during the 8-week follow-up period.ConclusionsThis retrospective study suggests that an in-plane three-step needle insertion technique for CFNB may reduce the risk of femoral nerve injury in anesthetized patients.

Evaluation of analgesic regimens in total knee artroplasty, retrospective study

“…Many studies have evaluated the effectiveness of FNB or have compared it with another analgesia method in TKA. A large majority of these studies have reported the use of 0.25% bupivacaine for single dose FNB [ 3 , 8 , 15 , 23 , 24 ]. When the catheter was placed near the femoral nerve, bolus of 0.25% bupivacaine was followed by 0.125% concentration as a continuous infusion [ 20 , 25 – 27 ].…”

Comparison of periarticular anesthesia with liposomal bupivacaine with femoral nerve block for pain control after total knee arthroplasty

“…[1–3] Postoperative pain control management after TKA is still a concern as it relates to patients satisfaction and functional recovery. [4,5] Adequate postoperative pain management, enhances patient comfort and rapid return to expected functionality, was the current goal for TKA surgeons. [6] Numerous trials have estimated that inappropriate pain control after TKA was associated with a wide range of preventable and undesirable side effects.…”