Continuous Femoral Nerve Block versus Patient-Controlled Intravenous Analgesia for Patients Undergoing Unilateral Total Knee Arthroplasty: A Cost-Effectiveness Analysis and Cost-Utility Analysis

Abstract

Background: In order to relieve pain following total knee arthroplasty (TKA), patient-controlled intravenous analgesia (PCIA) and continuous femoral nerve block (CFNB) are commonly used for postoperative analgesia. Nowadays, anesthesiologists are more and more interested in reducing patients’ financial burden while providing effective analgesia. Therefore, this study investigated the cost-effectiveness and cost-utility of CFNB versus PCIA for patients undergoing unilateral TKA.Methods: Patients were randomly divided into CFNB group and PCIA group. Ultrasound-guided femoral nerve block was performed for CFNB group, and PCIA was used in the other group. The effects of analgesia during hospital stay, pain intensity and knee function at 6 months after discharge were evaluated. The cost of analgesia, direct medical cost, indirect cost, total cost, cost-effectiveness ratio, cost-utility ratio, and incremental cost-effectiveness ratio were calculated.Results: Compared with the PCIA group, the rate of incomplete analgesia, mean frequency of rescue treatment, mean dose of drugs used for rescue treatment, and mean length of postoperative hospital stay decreased in the CFNB group (PCIA: N=123, CFNB: N=127). In the CFNB group, pain score decreased, knee function improved (PCIA: N=123, CFNB: N=127), and the quality of life score increased at 6 months after surgery (PCIA: N=102, CFNB: N=109). Analysis of economic outcomes showed that the mean cost of analgesia in the CFNB group was higher than that of the PCIA group (PCIA: N=123, CFNB: N=127), but the mean direct cost and total cost in the CFNB group were lower at 6 months after surgery (PCIA: N=102, CFNB: N=109).Conclusions: Compared with PCIA, CFNB reduced acute and chronic pain after TKA, improved short-term and long-term function of knee, and improved patients’ quality of life with better cost-effectiveness and cost-utility. Citation: Pei-Pei Qin, Su Min, Li-Hua Peng, Li Ren. Continuous femoral nerve block versus patient-controlled intravenous analgesia for patients undergoing unilateral total knee arthroplasty: a cost-effectiveness analysis and cost-utility analysis. J Anesth Perioper Med 2016; 3: 160-170. doi: 10.24015/JAPM.2016.0021This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.