Continuous Femoral Nerve Block Research Articles

Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty

BackgroundMultiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24 h compared with end-hole catheter.MethodsEighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses.ResultsThere was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24 h (4(2–7) vs. 4(2–8) in six-hole and end-hole groups, respectively; P = 0.832) or median ropivacaine consumption at 48 h (365(295–418) vs. 387(323–466); P = 0.452).No significant differences were recorded between the groups at 24 h regarding median average verbal rate pain scale (2(0–3) vs. 2(0–4); P = 0.486) or morphine consumption (0(0–20) vs. 0(0–20); P = 0.749). Quadriceps muscle strength declined to 7% (0–20) and 10% (0–28) in the six-hole and end-hole groups, respectively, at 24 h after surgery (P = 0.733).ConclusionsIn this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness.Trial registrationRetrospectively registered at (NCT03376178). Date: 21 November 2017.

Periarticular Knee Injection With Liposomal Bupivacaine and Continuous Femoral Nerve Block for Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundLocal periarticular infiltration (PAI) analgesia has emerged as an important component of multimodal approaches to treat total knee arthroplasty postoperative pain. Liposomal bupivacaine may provide prolonged analgesic duration when injected into the surrounding tissues. The purpose of this study was to compare the analgesic efficacy and serum bupivacaine levels of a continuous femoral nerve block (CFNB) with bupivacaine to PAI with liposomal bupivacaine. MethodsSixty-five patients undergoing primary unilateral total knee arthroplasty were randomized into 2 groups: (1) CFNB and PAI with bupivacaine (CFNB group) or (2) PAI with bupivacaine:liposomal bupivacaine mixture at the end of surgery (LB group). The primary outcome was pain intensity at maximum knee flexion 24 hours following surgery. Secondary outcomes included pain intensities at rest and movement at timed intervals and serum bupivacaine levels. ResultsPatients in the CFNB group experienced lower pain scores at maximum knee flexion at 24 hours (7.91; 95% confidence interval, 7.19-8.61) compared to the LB group (8.95; 95% confidence interval, 8.42-9.48; P = .02). The mean peak serum bupivacaine level in the LB group up to 72 hours was 0.55 μg/mL versus 1.4 μg/mL for CFNB group (P = .0008) with one patient in the CFNB group exceeding the reported minimum serum bupivacaine threshold for toxicity. ConclusionWhile similar pain control was observed on the day of surgery for both groups, patients with a CFNB experienced lower pain intensities during maximum knee flexion at 24 hours. Total serum concentrations in LB group remained below the toxicity threshold over the study period.

Low concentration continuous femoral nerve block improves analgesia and functional outcomes after total knee arthroplasty in spinal anesthesia

Low concentration continuous femoral nerve block improves analgesia and functional outcomes after total knee arthroplasty in spinal anesthesia

Analysis of Inpatient Falls After Total Knee Arthroplasty in Patients With Continuous Femoral Nerve Block.

Continuous femoral nerve block (cFNB) is thought to increase the risk of falls after total knee arthroplasty (TKA). Previous studies have failed to consider the timing of cFNB removal in relation to inpatient falls. We investigated all inpatient falls after TKA over a 3-year period using our institutional safety report database. Ninety-five falls were reported from a total of 3745 patients. The frequency of falls after TKA persisted at a similar rate despite removal of cFNB and likely regression of femoral nerve block. Other modifiable risk factors may play a more prominent role in falls risk after TKA.

Effects of palonosetron for prophylaxis of postoperative nausea and vomiting in high-risk patients undergoing total knee arthroplasty: A prospective, randomized, double-blind, placebo-controlled study.

BackgroundThe preemptive multimodal pain protocols used in total knee arthroplasty (TKA) often cause emesis postoperatively. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA.MethodsWe randomized 120 female patients undergoing TKA to receive either palonosetron (0.075 mg, intravenous) or no antiemetic prophylaxis (0.9% saline, control group). All patients were given spinal anesthesia, a continuous femoral nerve block, and fentanyl-based intravenous patient controlled analgesia. Patients undergoing staged bilateral TKA were assigned to one group for the first knee and the other group for the second knee. The overall incidence of PONV, the incidences of both nausea and vomiting, severity of nausea, complete response, requirement for rescue antiemetics, pain level, opioid consumption, and satisfaction scores were evaluated during three periods: 0–2, 2–24, and 24–48 h postoperatively. We also compared PONV and pain between the first and second TKA.ResultsThe incidence of PONV during the first 48 h was lower in the palonosetron group compared with the controls (22 vs. 41%, p = 0.028), especially 2–24 h after surgery, as was the nausea and vomiting respectively. The severity of nausea was lower in the palonosetron group (p = 0.010). The complete response rate (93 vs. 73%, p = 0.016) and satisfaction score (84 ± 12 vs. 79 ± 15, p = 0.032) were higher in the palonosetron group during 2–24 h after surgery. Patients who underwent a second operation complained of more severe pain, and consumed more opioids than those of the first operation. There was no difference in the incidence of PONV between the first and second operations.ConclusionsPalonosetron prophylaxis reduced the incidence and severity of PONV in high-risk patients managed with multimodal pain protocol for 48 h, notably 2–24 h after TKA.

Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: A double blinded, randomized trial

BackgroundEffective analgesia following total knee arthroplasty (TKA) is important for maximizing patient satisfaction, early participation in physical therapy and reducing the hospital stay. This trial compared continuous catheter femoral nerve block (cFNB) to single injection femoral nerve block (sFNB) in terms of analgesia, opioid consumption, and participation in physical therapy and associated side effects. MethodsThis randomized, double blinded trial was conducted in a non-university hospital setting, without major changes to anesthesia or surgical clinical pathways. A total of 85 patients scheduled for primary TKA were randomized to receive either cFNB (n=44) or sFNB (n=41). All patients had FNB with 0.5% ropivacaine bolus followed by subarachnoid block for surgery. Postoperatively, 0.2% ropivacaine infusion was commenced in cFNB group and a sham catheter was taped to the skin in sFNB group. All patients received a structured multimodal analgesia regimen throughout hospital stay. The primary outcomes were peak resting visual analogue scale (VAS) scores and morphine consumption at 48h postoperatively. ResultsVAS scores (Mean difference 0.25, 95% Confidence Interval (CI) −0.56 to 1.06; [P=0.196]) and morphine consumption (Mean difference 0.95mg, 95% CI −9.99 to 11.89; [P=0.863]) were not significantly different among patients who received cFNB versus sFNB at 48h. There was no difference in hospital stay (P=0.517) or long-term functional recovery between the two groups (P=0.385). ConclusionssFNB block provides equal pain relief compared with cFNB, after TKA with no significant difference in opioid consumption, hospital stay, physical therapy outcomes or associated side effects.

Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial

ObjectiveFractured neck of femur is a severely painful condition with significant mortality and morbidity. We investigated whether early and continuous use of femoral nerve block can improve pain on movement...

Sublingual sufentanil tablet system Zalviso\xae for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study

BackgroundCurrently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA IV opioids do not provide optimal results with fast track rehabilitation protocols.MethodsThe present is a retrospective study comparing the novel sublingual sufentanil PCA system (SSTS) to our standard of care foreseeing continuous femoral nerve block (cFNB) within a multimodal analgesic in a TKA fast-track protocol. The study evaluated 95 patients on SSTS (SSTS group) and 87 on cFNB (cFNB/control group) and collected data on numeric rating scores for pain from day 1–3 after surgery (T1, T2, T3), both at rest (NRS) and during movement (mNRS), patient’s ability to walk, need for supplementary analgesia (rescue dose), occurrence of adverse effects, length of hospital stay, and usability rating for SSTS by both patients and hospital staff.ResultsNRS at rest was lower in the cFNB than in the SSTS group for all 3 days after surgery, whereas mNRS scores were lower in the SSTS group at all time points measured. Adverse effects were significantly fewer among patients of the SSTS group (6% patients) than those of the cFNB (74% patients) (p < 0.001). Rescue doses were needed by 5% of SSTS patients vs 60% of cFNB. The fewer adverse events and lower pain scores for the SSTS group were associated to a notably better ability to ambulate, with all patients (100%) of the SSTS group being able to stand and walk for 10 m from T1 on; patients in the cFNB group showed a slower recovery with only 40% being able to stand and walk on T1, 70% on T2 and 85% on T3. All patients of the SSTS group had a length of stay of 4 days (day of surgery plus 3 after) as foreseen by the fast track protocol, in comparison only 36% of cFNB. Lastly, patient and nursing staff judged SSTS easy to use.ConclusionOur experience suggests that SSTS is a valuable strategy for routine postoperative analgesia following TKA in the context of a multimodal analgesic approach within the fast-track setting.

Dexmedetomidine combined with ropivacaine for continuous femoral nerve block improved postoperative sleep quality in elderly patients after total knee arthroplasty

Objective: To investigate the effect of dexmedetomidine adding to ropivacaine for continuous femoral nerve block on the improvement of postoperative sleep quality in elderly patients after total knee arthroplasty. Methods: One hundred and sixty patients aged 60 years or older in Jishuitan Hospital scheduled for single total knee arthroplasty between Nov. 2016 and Jun. 2017 were recruited. All patients received spinal anesthesia and were randomized to receive either combined ropivacaine and dexmedetomidine (0.2% ropivacaine 250 ml and 5 μg/kg dexmedetomidine, at a rate of 5 ml/h or 0.1 μg·kg-1·h-1 dexmedetomidine, dexmedetomidine group) or only ropivacaine (0.2% ropivacaine, at a rate of 5 ml/h, controlled group) for continuous femoral nerve block as postoperative analgesia after surgery. The severity of postoperative pain was assessed with numeric rating scale at 4, 24, and 48 hours after surgery both at rest and with movement. Subjective sleep quality and delirium were evaluated daily during the first 3 days postoperatively. Results: The subjective sleep quality scores were 2(1-4), 2(1-4) and 4(2-8), 4(2-7) in dexmedetomidine group and controlled group respectively on the 1st and 2nd days after surgery. The scores of dexmedetomidine group were much better than those of controlled group (Z=-4.597, -4.183, both P<0.05). The difference was statistically significant. The NRS pain scores at rest were 2(1-2), 2(1-4), and 3(2-5), 3(2-6) in dexmedetomidine group and controlled group respectively at 24 and 48 hours after surgery. The scores of dexmedetomidine group were lower than those of controlled group (Z=-6.671, -4.010, both P<0.05). The difference was statistically significant. The NRS pain scores with movement were 1(1-2), 3(2-4), 3(2-3) and 3(2-4), 5(3-6), 5(4-7)in dexmedetomidine group and controlled group respectively at 4, 24 and 48 hours after surgery. The scores of dexmedetomidine group were lower than those of controlled group (Z=-7.167, -6.824, -7.473, all P<0.05). The difference was statistically significant. The incidence of 3-day delirium was lower in dexmedetomidine group (5%) than that in controlled group (15%) (χ2=4.444, P<0.05). The difference was statistically significant. There were no significant differences between groups regarding the incidences of adverse events. Conclusion: Dexmedetomidine combined with ropivacaine for continuous femoral nerve block may improve subjective sleep quality, postoperative analgesia, and reduce delirium in the elderly after total knee arthroplasty.

Effect of perioperative continuous femoral nerve block on postoperative cognitive dysfunction in elderly patients with femoral neck fractures

Objective To evaluate the effect of perioperative continuous femoral nerve block on postoperative cognitive dysfunction(POCD)in elderly patients with femoral neck fractures. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-90 yr, scheduled for femoral head replacement under combined spinal-epidural anesthesia, were divided into 2 groups(n=30 each)using a random number table: patient-controlled femoral nerve block for analgesia(PCNA)group and patient-controlled intravenous analgesia(PCIA)group.When the patients were diagnosed with femoral neck fractures after admission to hospital in two groups, patients received continuous PCNA under nerve stimulator guidance until 48 h after operation in group PCNA, and fentanyl was continuously injected for analgesia until 48 h after operation in group PCIA.Neuraxial anesthesia was performed at L3, 4 interspace, 2 ml cerebrospinal fluid was extracted after successful subarachnoid puncture to detect the concentrations of Aβ-42 and tau, and the ratio of Aβ-42 to tau was calculated.The patient′s cognitive function was assessed using Mini-Mental State Examination before analgesia and at 7 days after operation, and the occurrence of POCD was recorded. Results The ratio of Aβ-42 to tau in cerebrospinal fluid was significantly lower, and the incidence of POCD was higher at 7 days after operation in group PCIA than in group PCNA(P<0.05). Conclusion Perioperative continuous femoral nerve block can decrease the development of POCD in elderly patients with femoral neck fractures. Key words: Nerve block; Femoral nerve; Cognition disorders; Aged

Rehabilitation Outcomes for Total Knee Arthroplasties: Continuous Adductor Canal Block Versus Continuous Femoral Nerve Block.

Objective:To determine whether any strength, range of motion (ROM), or functional improvement exists in the adductor canal block (ACB) group after completion of inpatient rehabilitation and following the removal of the continuous block.Design:Retrospective cohort.Setting:Inpatient rehabilitation at discharge and outpatient orthopedic clinic for follow-up.Participants:Two hundred forty-six consecutive primary total knee arthroplasties (TKAs; N = 221 patients) performed by a single surgeon in a single institution between July 2013 and August 2015 for a diagnosis of osteoarthritis.Interventions:All TKA cases received a continuous femoral nerve block (FNB) from July 2013 to August 2014 for postoperative pain control. From August 2014 through August 2015, all TKAs received a continuous ACB.Main Outcome Measures:Manual muscle tests (MMTs; 0-5 scale) of the quadriceps and passive ROM of the knee were assessed at 3 time periods (hospital discharge [HD], 1-2 weeks, and 1 month). Patient-oriented outcomes and clinical knee scores were examined preoperatively and postoperatively at 3 and 6 months.Results:63.6% of FNB cases had an MMT less than 3 at HD and 36.4% of FNB cases had an MMT of 3 or greater at HD. Conversely, 46% of ACB cases had an MMT less than 3 at HD and 54% had an MMT of 3 or greater at HD. There were no statistically significant differences in all postoperative variables at all tested time periods.Conclusions:This study showed no short-term postoperative advantages in the ACB group after catheter removal. The superior inpatient rehabilitation course in the continuous ACB group is likely not long enough to translate into any maintained benefit following catheter removal. Nevertheless, the trend toward greater strength in the ACB group in the immediate short term at HD warrants further investigation.

Effects of continuous femoral nerve block with selective tibial nerve block after total knee arthroplasty

Effects of continuous femoral nerve block with selective tibial nerve block after total knee arthroplasty

Early Experience with Bilateral Continuous Femoral Nerve Block and Single-Injection Spinal Anesthesia for Bilateral Total Knee Arthroplasty: A Case Series.

Total knee arthroplasty (TKA) is a commonly performed surgery in the United States, with demand for unilateral and simultaneous bilateral TKAs (BTKAs) expected to increase significantly over the coming decades. This study reports the authors' early experience in a consecutive series of simultaneous BTKAs performed under regional anesthesia and mild sedation. In this retrospective case series, the authors examined all simultaneous BTKAs performed over two years by a single surgeon. Only patients receiving bilateral continuous femoral nerve blockade (CFNB) and single-injection sciatic nerve blockade in combination with single-injection subarachnoid block were included in the study. Of the 32 patients who underwent BTKAs during this period, 25 met the inclusion criteria. The patient's anesthesia records, physician notes, nursing notes, pharmacy records, and physical therapy records were then reviewed systematically to create a database of information. Only one of 25 patients required conversion to general anesthesia during surgery. There were no major perioperative complications. The average Defense and Veterans Pain Rating Scale score immediately postoperation was 0.6/10, and the average daily score remained below 3.5/10 throughout the hospital stay. The use of bilateral CFNB did not prevent patients from ambulating during physiotherapy. This early retrospective case series suggests that it is feasible to effectively manage the postoperative pain associated with BTKA with staged bilateral CFNB and single-injection sciatic nerve blockage in combination with single-injection subarachnoid block as the sole anesthetic technique without negatively influencing early ambulation.

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block

Abstract Background Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. Methods We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score > 2 in a [0–10] scale after 15 min, and time required to perform it. Results We analyze data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12 min, however all the AR who did more than 20 blocks (4/4) achieved it. Conclusions The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programmes to allow early interventions in case of repeated failures, and develop competence-based curriculum.

Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial

Continuous femoral nerve block (CFNB) has been used to prevent the breakthrough pain after total knee arthroplasty (TKA). Multimodal drug injection (PMDI) has also been shown to decrease opioid consumption and pain. We investigated whether the use of PMDI further improves analgesic and rehabilitation outcomes when used in conjunction with CFNB. This is a prospective randomized controlled study of 44 patients undergoing primary TKA. The treatment group (n=23) received a PMDI of combined ropivacaine, epinephrine, ketorolac and morphine, and the controlled group (n=21) received saline at wound closure. Total opioid consumption, pain scores, knee range of motion (ROM) outcomes, length of stay, and patient satisfaction were measured and compared. The total consumption of morphine is similar between the two groups (52.6±40.6 vs. 41.5±32.9, p=0.325). The mean morphine consumption of the treatment group was significantly lower than the control at 4h after surgery (4.2±5.5 vs. 11.3±8.1, p=0.002) but comparable on POD1, POD2, and POD3. The mean pain scores were significantly higher in the treatment group than the control group at POD2 (at rest: 47.3±29.1 vs. 23.8±20.6, p=0.004; after PT: 57.7±25.4 vs. 35.2±26.8, p=0.007) and POD3 (at rest: 30.9±30.3 vs. 14.8±20.9, p=0.045; after PT: 50.2±30.6 vs. 29.0±32.1, p=0.035), and not significantly different at 4h after surgery or at POD1. Mean maximal knee flexion ROM in degrees during active and active assisted mobilization showed no significant difference between the control and the treatment groups on POD2 and POD3. The mean length of stay of the treatment group is significantly longer than the control group (5.1±2.1 vs. 3.8±1.6, p=0.032). At discharge, no significant difference exists between the two groups for mean patient satisfaction. The addition of PMDI led to a decrease in opioid consumption in the immediate postoperative period but with no significant difference in the total consumption within the first three days postoperatively. This finding provides an opportunity for appropriate preoperative treatment and education for both patients and caregivers.

Comparisons between perioperative continuous femoral nerve block and patient controlled analgesia for analgesia in primary total knee arthroplasty: a Meta-analysis

Objective To evaluate the efficacy and safety of continuous femoral nerve block (CFNB) versus patient controlled analgesia (PCA) for analgesia in primary total knee arthroplasty (TKA) through a Meta-analysis. Methods All randomized controlled trials (RCTs) which compared about the efficacy and safety of CFNB versus PCA for analgesia in primary TKA, were searched from Cochrane Library, Embase, PubMed, CBM, VIP, Wang Fang database and CNKI. At the same time, conference papers were identified manually. A quality assessment of the included literature was evaluated by Cochrane system evaluation manually. Revman 5.3 software was used for the Meta-analysis to compare visual analogue scale(VAS), hospital for special surgery knee score (HSS), western Ontario and McMaster university of orthopedic index (WOMAC), patient satisfactory degree, and incidences of complications (nausea, vomit, dizziness, somnolence, itch of skin, etc). Results Twenty-four RCTs involving 1896 patients were identified including CFNB (946 cases) and PCA (950 cases) application of TKA. The pooled results illustrated that CFNB could reduce VAS in rest (MD=-1.28, 95%CI-1.56, -1.00, P<0.05) and VAS in movement (MD=-0.98, 95%CI-1.38, -0.58, P<0.05), increase HSS (MD=2.13, 95%CI 0.12, 4.14, P<0.05), reduce WOMAC(MD=-0.97, 95%CI-1.83, -0.11, P<0.05), increase patient satisfactory degree (RR=1.27, 95%CI 1.10, 1.46, P<0.05) and at the same time reduce the incidences of nausea, vomit, dizziness, somnolence and itch of skin (RR=0.32, 95%CI 0.24, 0.43, P<0.05). Conclusion Compared with PCA, CFNB analgesia can reduce VAS, WOMAC score, improve the postoperative HSS and patient satisfaction degree, and decrease the risk of complications. Key words: Arthroplasty, replacement, knee; Randomized controlled trial; Analgesia; Meta-analysis

A comparative study of Ultrasound Guided Continuous Femoral Nerve Block Versus Local Infiltration Analgesia for management of postoperative Pain in Unilateral Total Knee Arthroplasty in an Indian scenario

A comparative study of Ultrasound Guided Continuous Femoral Nerve Block Versus Local Infiltration Analgesia for management of postoperative Pain in Unilateral Total Knee Arthroplasty in an Indian scenario

Effect of continuous adductor canal or femoral nerve block on pain relief and early rehabilitation following total knee arthroplasty

Objective To compare the analgesic effect of continuous adductor canal block(ACB) and continuous femoral nerve block(FNB) after total knee arthroplasty(TKA). Methods Sixty patients scheduled for unilateral TKA were randomly assigned into two groups, receiving continuous ACB(group A) or continuous FNB(group F). Intravenous anesthesia was applied throughout the operation. The adductor canal and the femoral nerve were catheterized for block under the guidance of sonography before induction of general anesthesia. Patient-controlled analgesia was provided immediately after surgery with 0.2% ropivacaine through the perineural catheter. The pain severity at rest and upon movement (passive knee flexion of 45 degrees) with a 0-10 numeric rating scale (NRS), the Lovett score of muscle strength of the quadriceps femoris, and the modified Bromage score of the motor block of the affected extremity were assessed 4, 8, 12, 24, 48 h after surgery. The maximal range of active/passive motion of the knee joint was recorded 1, 2, 3, 14 d after surgery. The number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue within 48 h after surgery, the first time of out-of-bed activity, the time of active knee flexion reaching 90 degrees, and the hospital for special surgery(HSS) score of knee function 14 d after surgery were also recorded. Results There was no difference between group A and group F in terms of the NRS scores at rest and upon movement, the number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue (P>0.05). Patients in group A had a higher Lovett score of muscle strength of the quadriceps femoris and a lower modified Bromage score of the motor block than those in group F within 12 h after surgery (P 0.05). Conclusions An equal postoperative analgesic efficacy was observed in patients receiving continuous ACB and continuous FNB. Furthermore, continuous ACB did not provide a superior effect on early rehabilitation than continuous FNB. Key words: Adductor canal block; Femoral nerve block; Total knee arthroplasty; Postoperative analgesia; Rehabilitation

Comparison of Continuous Femoral Nerve Block with and Without Combined Sciatic Nerve Block after Total Hip Arthroplasty: A Prospective Randomized Study.

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement