Comparison of fast track after total knee replacement surgery with continuous femoral nerve block analgesia and intravenous analgesia

Abstract

Objective Comparing fast track after total knee arthroplasty(TKA) with continuous femoral nerve block(CFNB) analgesia and intravenous analgesia. Methods Sixty ASAⅠor Ⅱpatients, aged 45-78 years, undergoing unilateral TKA were randomly divided into 2 groups(n=30): patient controlled nerve block analgesia(PCNA) group and patient controlled intravenous analgesia(PCIA) group. All patients received spinal anesthesia combined with epidural anesthesia. In the postoperative period, the VAS in resting and exercise were recorded to evaluate the degree of postoperative pain, the numbers of patient-controlled analgesia(PCA) pressing and meperidine using, muscle strength of limb, the active movement angle, adverse reactions and analgesic associated complications were observed and recorded. Results In 6, 12, 24, 48 h postoperative resting state, there was no significant differences in pain score between CFNB group and PCIA group(P<0.05). There was significantly less VAS scores in the PCNA group comparing the PCIA group during the continuous passive movement of knee postoperatively at 24 h and 48 h[(3.6±0.5) vs(4.7±0.6), (3.4±0.5) vs (4.5±0.4)](P<0.05). The numbers of PCA pressing and meperidine using of PCNA group were significantly lower than that of PCIA group after surgery(P<0.05). Angle of knee active movement postoperatively at 24 h and 48 h in the PCNA group was larger than PCIA group(P<0.05). Blood glucose level of PCNA group was lower than that of PCIA group after surgery(P<0.05). Postoperative complications such as deep vein thrombosis, adverse reactions such as lethargy, respiratory depression were fewer in the PCNA group(P<0.05). Patients satisfaction scores in the PCNA group was higher than the PCIA group [(9.6±1.4) vs (7.9±1.2)](P<0.05). Conclusions CFNB has superior early analgesic effect to PCIA in total knee replacement surgery, as well as fewer adverse reactions, better knee function recovery, shorter hospital time and higher patient satisfaction. CFNB is in accordance with fast track surgery concept and it is a safe, practical and effective method for analgesia after TKA. Key words: Femoral nerve block; Intravenous analgesia; Total knee arthroplasty; Fast track