Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial

Abstract

Purpose: Total knee replacement (TKR) is associated with post-operative pain. Femoral nerve block can relieve the pain but also affects the post-operative mobility. Saphenous nerve block (SNB) can improve analgesia without interfering mobilisation. However, there is no consensus on the ideal mode of administration of SNB. We aim to compare the effects of single shot versus continuous SNB on patients undergoing TKR. Methods: Patients were randomised into two groups: single shot and continuous SNB groups. Post-operative rehabilitation and mobilisation were assessed by blinded physiotherapists, and preoperative and post-operative American knee scores were recorded by blinded specialised nurse. Post-operative analgesics usage was recorded by blinded pain nurses and anaesthetists. Results: Sixty-four patients were recruited; 6 patients withdrew with 29 patients in each group. There is no significant difference in early mobilisation and rehabilitation comparing both groups. The mean of the range gained on day 2 when compared to day 1 in single-shot SNB group was 17.41 ± 19.67° versus continuous SNB group was 23.45 ± 19.18° ( p = 0.149). The mean of the range gained on day 3 when compared to day 1 in single-shot group was 27.24 ± 22.66° versus continuous SNB group was 29.31 ± 21.57° ( p = 0.6). The mean of maximum flexion achieved by day 3 in single-shot SNB group was 92.41 ± 9.6° versus continuous SNB was 91.90 ± 7.95° ( p = 0.84). The day of reaching maximum flexion and the goal of 40 m showed no significant difference. Length of stay (LOS), difference in post-operative American Knee Society knee score at 3 months and analgesics usage showed no significant difference. Conclusion: There is no significant difference in comparing the effect on mobilisation, LOS, early clinical outcome, analgesics usage in the single-shot group and the continuous SNB group.

Effect of Oral Tranexamic Acid on the Blood Transfusion Rate and the Incidence of Deep Vein Thromboembolism in Patients after TKA

“…In order to reduce the perioperative blood loss and the side events caused by blood transfusion, a tourniquet is frequently used in clinical TKA treatment. However, a small number of patients experience abnormal blood coagulation after the tourniquet is released, and the vulnerability to postoperative complications is high [20,21]. On top of this, some patients are susceptible to ischemiareperfusion injury after the release of the tourniquet, seriously compromising the prognosis of the patients.…”

Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty: a systemic review and meta-analysis of randomized trials

“…Two additional trials25 26 were identified by clinical trials registry hand search; but data were unavailable for these trials. Thus, a total of 11 randomized trials27–37 were included from the full-text search strategy. Of the 11 trials included, 6 were prospectively registered,28 29 31 33 35 36 and the remaining 5 were either completed or published prior to 2019 27 30 32 34 37.…”

“…Thus, a total of 11 randomized trials27–37 were included from the full-text search strategy. Of the 11 trials included, 6 were prospectively registered,28 29 31 33 35 36 and the remaining 5 were either completed or published prior to 2019 27 30 32 34 37. The full-flow diagram for study inclusion can be viewed in figure 1.…”

“…The characteristics and outcomes of the 11 trials included in this review are presented in tables 1 and 2 27–37. Studies were conducted across a variety of centers worldwide, including Canada, China, Denmark, India, South Korea, Turkey, and USA.…”

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

“…These added advantages of remnant preservation led to better functional results than remnant sacrificing ACL reconstruction despite comparable mechanical stability. 1 , 6 , 11 , 13 …”