Abstract
Total knee replacement is a painful surgical procedure. The inadequate control of postoperative pain is associated with adverse outcomes in the short and long term. Continuous femoral block has been shown to be effective and efficient as part of multimodal analgesia. This series of 48 patients who underwent total knee replacement, who received multimodal analgesic treatment including continuous femoral nerve block, documents the pain control profile during the first 48 hours. This is a successful experience of implementing regional techniques as part of perioperative pain relief, as documented in the literature. We emphasize that each institution must know its technical and human resource and characterize its patients, in order to implement multimodal analgesia protocols that include this regional technique. We also suggest to monitor and implement continuous improvement processes.
Highlights
Total knee replacement is the best available treatment for severe gonarthosis
During the post-anesthesia care unit (PACU) stay, 66.7% of the patients had adequate pain control; the average visual analogue scale (VAS) score was lower in the patients who received spinal anesthesia than in those who received general anesthesia (2.6 vs 6.1)
Due to the complexity of knee innervation and the severity of the pain associated with total knee replacement, it is not yet clear what is the ideal analgesic strategy
Summary
Total knee replacement is the best available treatment for severe gonarthosis. Despite advances in surgical technique, postoperative pain is one of the main associated problems, with a prevalence of moderate pain of 52% and of severe pain of up to 16%, at 30 days after the procedure [1,2].Optimal analgesia promotes early mobility, which accelerates functional recovery, increases the scores on satisfaction scales and decreases the length of hospital stay [3,4]. Total knee replacement is the best available treatment for severe gonarthosis. Despite advances in surgical technique, postoperative pain is one of the main associated problems, with a prevalence of moderate pain of 52% and of severe pain of up to 16%, at 30 days after the procedure [1,2]. Acute postoperative pain is associated with negative short- and long-term outcomes [5]. Non-pharmacological and pharmacological approaches, and peripheral neuroaxial and regional techniques initiated before and continued during and after the procedure, have demonstrated effectiveness in relieving postoperative pain in total knee arthroplasty [6]. Regional analgesia techniques have been proposed as strategies aimed at improving postoperative pain control, reducing opioid consumption and optimizing the patient’s rehabilitation profile
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