Ultrasound-Guided Single-Injection Femoral Nerve Block Provides Effective Analgesia after Total Knee Arthroplasty up to 48 Hours

Şahin, Levent; Korkmaz, Halil Fatih; Şahin, Mehrican; Atalan, Güneri

doi:10.5505/agri.2014.83788

Cited by 20 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Urinary retention was registered in four trials [ 17 , 19 , 21 , 22 ], deep venous thrombosis (DVT) in two [ 17 , 21 ], soreness/pain in the back in two [ 18 , 23 ], hypotension in one [ 25 ], numbness around the knee in one [ 16 ], and infection around the site of injection in one [ 26 ]. No significant differences between active and control groups were reported.…”

Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

View full text Add to dashboard Cite

IntroductionThe aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA).MethodsThis PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis.ResultsThe included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low.ConclusionA low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

show abstract

Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…There are a limited number of studies regarding FNB use in TKA in our country. Sahin et al [ 15 ] performed US-guided FNB using 40 mL of 0.5% bupivacaine after T12 regression of spinal anesthesia. Their study reported significant decrease in opioid consumption with sufficient and effective analgesia for up to 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of analgesic regimens in total knee artroplasty, retrospective study

Tulgar

Selvi

Şentürk

et al. 2017

North Clin Istanbul

View full text Add to dashboard Cite

OBJECTIVE:Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA).METHODS:The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB.RESULTS:The average age of the patients was 64.3±14.9 years and average body mass index (BMI) was 32.5±5.3 kg/m2. There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3.CONCLUSION:This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.

show abstract

“… 21 The lateral femoral cutaneous nerve is involved in innervation to the lateral knee skin and in pain syndrome 17 , 21 , 22 following TKA, and this nerve should be blocked along with the other three nerves. This study compared the efficacy of ultrasound (US)-guided preoperative femoral nerve block (FNB) alone 1 – 6 to that of US-guided multiple preoperative nerve block (MNB) of all four nerves (femoral, sciatic, obturator, and lateral femoral cutaneous), since, to the best of our knowledge, such a comparison has not yet been performed or published.…”

Section: Introductionmentioning

confidence: 99%

Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

Stav¹,

Reytman²,

Sevi³

et al. 2017

Rambam Maimonides Med J

View full text Add to dashboard Cite

BackgroundThe PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone.MethodsThis is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days.ResultsA total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the “blocks” groups versus the control group. Morphine consumption was significantly higher in the control group.ConclusionsPain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120)

show abstract

Ultrasound-Guided Single-Injection Femoral Nerve Block Provides Effective Analgesia after Total Knee Arthroplasty up to 48 Hours

Cited by 20 publications

References 17 publications

Postoperative pain treatment after total knee arthroplasty: A systematic review

Postoperative pain treatment after total knee arthroplasty: A systematic review

Evaluation of analgesic regimens in total knee artroplasty, retrospective study

Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

Contact Info

Product

Resources

About