Continuous Femoral Nerve Block Research Articles

Opioid consumption in total knee arthroplasty patients: a retrospective comparison of adductor canal and femoral nerve continuous infusions in the presence of a sciatic nerve catheter

ObjectiveTo compare opioid consumption among patients who receive a continuous adductor canal block (ACB) versus continuous femoral nerve block (FB) for total knee arthroplasty analgesia in the presence of an intermittent sciatic nerve catheter (iSB). DesignMatched cohort retrospective study. SettingMayo Clinic, Jacksonville, FL. PatientsNinety patient charts were included in this study: 45 patients with continuous ACB/iSB and 45 with continuous FB/iSB. Patients were matched according to mean preoperative opioid consumption and pain scores, BMI, age, and gender. MeasurementsThe primary outcome of the study was postoperative on-demand opioid consumption on postoperative days 0 (POD 0), 1 (POD 1), and 2 (POD 2). Secondary outcomes included postoperative Visual Analog Scale (VAS) scores for anterior and posterior knee pain, incidence of nausea and pruritus, need for intravenous rescue opioid, and need for catheter bolus by a physician. Main ResultsOn POD 0, mean opioid consumption in milligrams of oral morphine equivalent [mean±SD (95% CI)] was 43.98mg±33.36 (33.96, 54) in the ACB/iSB group vs 38.45mg±30.99 (29.14, 47.76) in the FB/iSB group, respectively (P=.42); on POD 1, 74.96mg±37.23 (63.78, 86.14) vs 72.40mg±62.34 (53.67, 91.13) (P=.81); on POD 2, 28.19mg±17.69 (22.87, 33.51) vs 31.84mg±23.09 (24.90, 38.78) (P=.40). On POD 1, median anterior knee VAS scores at rest were equivalent in both the ACB/iSB and FB/iSB groups (1 vs 1, respectively, P=.46); however, patients in the ACB/iSB group were more likely to have higher anterior knee pain scores with movement (4 vs 1, P=.002). ConclusionIn the first 2 days after a total knee arthroplasty, opioid consumption in patients with continuous ACB/iSB was not significantly different from patients receiving continuous FB/iSB. Continuous adductor canal block appears to provide adequate analgesia when compared to continuous femoral blockade.

Parecoxib Possesses Anxiolytic Properties in Patients Undergoing Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind, Placebo-Controlled, Clinical Study.

IntroductionIntravenous administration of parecoxib could provide significant pain relief in surgical operations that require additional forms of analgesia. However, very little is known about its effects on the anxiety levels of patients before a surgical procedure. The aim of this prospective study was to investigate whether intravenous parecoxib, pre-emptively administered, has an effect on anxiety levels experienced post-surgically after total knee arthroplasty (TKA) and if it influences the reported pain of the procedure itself.MethodsA total of 90 patients who underwent TKA under spinal anesthesia were included in the study. Prior to TKA, all patients received continuous femoral nerve block (CFNB) and were randomized into two groups: Group D consisted of 45 patients who received the drug parecoxib intravenously in addition to CFNB, whereas Group P consisted of 45 patients who received a placebo drug (N/S 0.9 %) intravenously instead of parecoxib. All patients were asked to fill in the questionnaires STAI1 and STAI2 in order to evaluate anxiety levels pre- and post-surgically, respectively. One of the main aims was to distinguish personality-trait anxiety from state anxiety, i.e., anxiety experience due to the actual perioperative events and the actual pain endured.ResultsThe group receiving parecoxib had statistically significant lower anxiety levels both for personality trait anxiety and state anxiety, as compared to the placebo group.ConclusionsBased on our findings, parecoxib had both analgesic and anxiolytic effects in patients undergoing TKA with CFNB.Trial RegistrationCurrent Controlled Trials: NCT02185924.

Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

Effective concentration of Ropivacaine for post-operative pain relief in Total knee replacement surgeries using ultra sound guided continuous femoral block – A randomized double blinded study

Introduction: Postoperative pain in total knee replacement surgeries is severe and needs intense analgesia. Of various analgesic techniques available, continuous femoral nerve block is safe and associated with minimal side effects. Objectives: To compare the analgesic effect of various concentrations of ropivacaine using continuous femoral nerve block for post-operative pain relief in total knee replacement surgeries. Methods: 120 patients posted for elective total knee replacement (TKR) surgeries under American Society of Anesthesiologists (ASA) physical classification I or II, under spinal anaesthesia, were randomly allocated into four groups of 30 each. Group 1, 2, 3 and 4 received ropivacaine 0.12%, 0.16%, 0.20% and 0.25% respectively at 10 mL per hour infusion, by ultrasound-guided continuous femoral nerve block. Pain relief was assessed by visual analogue scale (VAS). Analgesic requirement in the post-operative period and hemodynamic changes compared between four groups. Results: There was no statistical difference in change in hemodynamics over time between all four groups. Analgesic requirement was significantly less and VAS score was significantly low in group 3 and group 4. Conclusion: In this study, the minimum effective concentration of ropivacaine when used for pain relief in continuous femoral block in total knee replacement surgeries is found to be 0.20%. Keywords: Analgesia; Knee replacement; Nerve block; Ropivacaine; Ultrasound

In-plane three-step needle insertion technique for ultrasound-guided continuous femoral nerve block after total knee arthroplasty: a retrospective review of 488 cases.

BackgroundContinuous femoral nerve block (CFNB) improves postoperative analgesia after total knee arthroplasty (TKA). The aim of this study was to investigate the clinical efficacy and complications of our in-plane three-step needle insertion technique that was devised to reduce the risk of direct femoral nerve injury during CFNB in anesthetized patients.MethodsThis retrospective study included 488 patients who had undergone TKA. Ultrasound (US)-guided CFNB was performed under general or spinal anesthesia using an in-plane, three-step needle insertion technique. The success rate and difficulties of catheter placement, clinical efficacy of analgesia, and complications were recorded.ResultsFemoral catheters were placed with a 100% success rate. In 488 patients, real-time US imaging revealed easy separation of the fascia iliaca and the femoral nerve following injection of local anesthetic through a Tuohy needle. Verbal numerical rating scale pain scores (0–10) were 2.0 ± 1.2, 3.5 ± 1.9, 3.2 ± 1.7, 2.9 ± 1.3, and 2.5 ± 1.1 at 1, 6, 12, 24 and 48 h postoperatively. No femoral hematoma, femoral abscess, or neurologic complications, including paresthesia or neurologic deficits, were observed during the 8-week follow-up period.ConclusionsThis retrospective study suggests that an in-plane three-step needle insertion technique for CFNB may reduce the risk of femoral nerve injury in anesthetized patients.

Bloqueo de nervio femoral único vs. continuo en reconstrucción de ligamento cruzado anterior; un estudio clínico aleatorizado

Early rehabilitation is essential after anterior cruciate ligament (ACL) surgery. Femoral nerve block (FNB) is a frequently used method to control post-operative pain in arthroscopic and reconstructive knee surgery; however, it is still unknown how to apply this procedure to improve analgesia without affecting early rehabilitation. ObjectiveTo compare the effectiveness of pain management after a single dose of FNB vs a continuous FNB infusion during the first 48hours after ACL surgery. MethodologyForty-three patients older than 18 years, ASA I-II, underwent ACL reconstruction with an autograft. Patients were prospectively randomised into two separate groups: Group 1 (G1) received a single dose of FNB with bupivacaine diluted in 10mL saline solution. Group 2 (G2) received continuous FNB infusion with bupivacaine and epinephrine (1:300.000) for 48hours. Pain was assessed at rest and with controlled passive motion of the knee. Thigh hypo-aesthesia and the need for additional analgesia were evaluated at 6, 12, 24, and 48hours. Statistical analysis was performed with Fisher's exact test (%) and Mann-Whitney's test (VAS). Statistical significance with P<.05. ResultsFNB was successful in all patients, and thigh hypo-aesthesia was present in 100% of G2 vs. 17% in G1 at 24hours, declining to 74% vs. 0% at 48hours, respectively. Post-operative pain scores were low, and did not differ between the two groups. Additional analgesia was required in 33% of patients in G1 vs. 0% in G2. ConclusionFNB is a successful method for controlling pain after ACL reconstruction. No statistical significance differences were found in pain control between techniques investigated.Level of Evidence type II.

Periarticular multimodal drug injection improves post-operative pain and functional recovery after total knee arthroplasty.

This study retrospectively compared the clinical benefits of periarticular multimodal drug injection (PMDI) and continuous femoral nerve block (CFNB) after total knee arthroplasty (TKA). From 2010 to 2012, 520 primary TKAs were performed, and patients were treated with CFNB or PMDI after surgery. Patients who underwent simultaneous bilateral TKA were excluded, leaving 185 and 166 patients in the CFNB and PMDI groups, respectively. Numeric rating scale for pain (NRS) scores and analgesic consumption were evaluated to compare the effectiveness of pain control between the groups. Further, range of motion (ROM), extension lag, the time to recovery of functions, and postoperative C-reactive protein (CRP) levels were monitored. Complications such as deep infection were assessed. The PMDI group displayed a significantly smaller NRS score on postoperative day (POD) 1 and lower analgesic consumption on PODs 0 and 1. The times to functional recovery were significantly shorter and the extension lag was smaller in the PMDI group. Furthermore, CRP levels were lower in the PMDI group by POD 7. No obvious deep infections were noted. Our results indicate that PMDI induced earlier functional recovery after TKA than CFNB, partially via its analgesic effect.

Local Infiltration Analgesia Versus Continuous Femoral Nerve Block in Pain Relief After Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundAlthough both local infiltration analgesia (LIA) and continuous femoral nerve block (FNB) are common analgesic modalities for pain relief after total knee arthroplasty (TKA), we are aware of no parallel-group, randomized controlled trial that has solely compared the efficacy of LIA and continuous FNB. MethodsWe conducted a prospective, 2-arm, parallel-group, randomized controlled trial involving patients scheduled for TKA. A total of 45 patients were randomly assigned to either the LIA or the continuous FNB group. Except for the analgesic modality, perioperative managements were identical in both groups. The primary outcome was postoperative pain score at rest 1 day after surgery, measured using a 100-mm visual analog scale. ResultsPatients in the LIA group had a significantly lower visual analog scale score at rest 1 day after surgery than those in the continuous FNB group (34 ± 10 vs 42 ± 13 mm; P = .028). The opioid consumption during the initial 24 hours was significantly lower in the LIA group (12 ± 4 vs 16 ± 7 mg; P = .031). There were no differences in the rate of complications between the groups. ConclusionLIA was associated with better pain relief with a comparable complications rate for patients undergoing TKA than FNB. We recommend LIA for pain relief after TKA.

A comparison of ultrasound alone vs ultrasound with nerve stimulation guidance for continuous femoral nerve block in patients undergoing total knee arthroplasty

Study ObjectiveTo compare analgesic efficacy of ultrasound (US) guidance alone and US guidance combined with nerve stimulation (NS) for continuous femoral nerve block (CFNB) in patients undergoing total knee arthroplasty (TKA). DesignProspective, randomized double-blind trial. SettingPostanesthesia care unit and general ward. PatientsFifty American Society of Anesthesiologist physical status I to II patients undergoing TKA under spinal anesthesia. InterventionsIn group A (n = 25), an 18-gauge Tuohy needle was directed at the lower mid-part of the femoral nerve, and a nonstimulating catheter was inserted through the needle under US guidance. In group B (n = 25), an 18-gauge Tuohy needle and stimulating catheter were directed to the lower part of femoral nerve under US guidance, and quadriceps muscle contraction was checked using NS. All patients received a 20-mL loading dose of 0.2% ropivacaine, a continuous infusion of 4 mL/h, and a 4-mL bolus of 0.2% ropivacaine with a lockout time of 60 minutes for patient-controlled analgesia. MeasurementsThe primary outcome was resting and exercising pain quality assessed by numeric rating scale. Other outcomes included procedure time for correct catheter placement, block failure rate, patient satisfaction for postoperative pain control, total dose of local anesthetic, additional opioid requirement, and adverse effects postoperatively. Main ResultsThere were no significant differences between groups in resting and exercising numeric rating scale. Procedure times were longer in group B than group A (P < .05). There were no significant differences between groups in block failure rate or other outcomes. ConclusionsUS-guided CFNB was associated with similar analgesic efficacy and block failure rate and reduced procedure time compared to US with NS guidance for CFNB in patients undergoing TKA.

Peripheral Nerve Blockade for Total Knee Arthroplasty: An Evidence-Based Review

Total knee arthroplasty (TKA) is associated with significant postoperative pain. Optimization of postoperative analgesia can improve rehabilitation and functional recovery. There is much debate regarding the best peripheral nerve blocks for optimization of postoperative analgesic and functional outcomes following TKA. Continuous femoral nerve block provides excellent postoperative analgesia. In comparison, adductor canal block may provide relative preservation of quadriceps motor weakness, however, its effect on analgesia, mobilization, long-term functional outcomes, and inpatient falls remains unclear. Sciatic nerve block provides effective analgesia in addition to continuous femoral nerve block, and its clinical benefit may be greatest in patients with opioid tolerance or chronic pain. Studies comparing local infiltration analgesia to femoral nerve block are difficult to interpret due to high risk of bias and methodological flaws. Addition of obturator nerve block may improve postoperative analgesia, but the impact of this on functional outcomes remains unknown.

Effects of continuous femoral nerve block combined with infiltration anesthesia on postoperative analgesia in patients undergoing total knee arthroplasty

Objective To evaluate the effects of continuous femoral nerve block combined with infiltration anesthesia on postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Ninety patients, aged 50-80 yr, weighing 45-90 kg, of ASA physical status Ⅰ-Ⅲ, scheduled for elective unilateral total knee arthroplasty, were randomly divided into 3 groups (n=30 each) using a random number table: continuous femoral nerve block + infiltration anesthesia group (group A) ; continuous femoral nerve block group (group B) ; continuous femoral nerve block + single sciatic nerve block group (group C) . The femoral nerve was catheterized for block before induction of general anesthesia in the three groups, and then a single sciatic nerve block was performed in group C. In group A, 20 ml mixture was injected into the posterior part of the joint capsule before prosthesis implantation, and 20 ml mixture was injected around the collateral ligaments and incision sites after prosthesis implantation and before closing.The mixture included ropivacaine 2.5 mg/ml, fentanyl 2.5 μg/ml, and methylprednisolone 1 mg/ml.In group B, 40 ml of normal saline was given as the method previously described in group A. Patient-controlled analgesia with 0.2% ropivacaine 250 ml was used for postoperative analgesia, lasting for 48 h. The patient-controlled analgesia pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml/h.Tramadol was used as rescue analgesic and was given orally to maintain the VAS score ≤ 5.VAS scores at rest were recorded at 4, 8, 12, 24 and 48 h after surgery, and VAS scores during activity were recorded at 8, 12, 24 and 48 h after surgery.The total consumption of tramadol within 48 h after surgery was recorded.The motor function of the affected extremity was assessed and scored at 12, 24 and 48 h after surgery, and the sensory and motor function was evaluated at 72 h after removal of the catheter.The occurrence of bleeding or exudates from the site of catheterization and adverse effects were recorded. Results Compared with group B or C, VAS scores at rest at 4-24 h after operation, VAS scores during activity at 8-24 h after operation, and the total consumption of tramadol were significantly decreased in group A. Compared with group B, no significant changes were found in motor block score of the affected extremity in group A. Compared with group C, the motor block score of the affected extremity was significantly decreased in A and B groups.There were no significant differences in the incidence of bleeding or exudates from the site of catheterization and nausea and vomiting between the three groups. Conclusion Continuous femoral nerve block combined with infiltration anesthesia can provide sufficient analgesia without influencing the recovery of sensory and motor function, and the safety is good for the patients undergoing total knee arthroplasty. Key words: Femoral nerve; Nerve block; Anesthesia, local; Pain, postoperative; Analgesia; Arthroplasty, replacement, knee

Postoperative Analgesie nach Knie-TEP

BackgroundPostoperative pain management after total knee arthroplasty (TKA) remains a great challenge even today. In the context of new fast-track concepts, the importance of multimodal therapies for the effective treatment of pain and the reduction of side effects, as well as for the rapid ambulation of patients is increasing. Therefore, new continuous intra-articular catheter-systems (IAC) are under investigation.Materials and methodsA total of 120 patients receiving total knee replacement were included in a prospective randomized comparative study. In a standardized treatment regime 60 patients received an IAC (group A), while in 60 patients a continuous femoral nerve block (FNB) was applied (group B). All other perioperative therapy components were identical for all patients. In the first 5 days after surgery pain intensity (VAS), passive and active flexion, opioid requirements, and self-initiated or hallway ambulation were investigated and documented. The initiation time, operation time, and length of hospital stay were recorded.ResultsRegarding pain intensity no significant differences occurred (mean 5.1 ± 2.5 vs. 4.6 ± 2.6; p = 0.27). Also, additional opioid requirements and range of motion (ROM) showed no relevant distinctions of therapy. In the IAC group a much more rapid independent mobilization was achieved (p < 0.001). The mean initiation time before surgery decreased markedly compared to the FNB group by 11.9 min (p < 0.001). With respect to the operation time and duration of hospital stay there was no noticeable difference. The failure rate and the rate of dislocation of FNB appear to be increased.ConclusionThe perioperative treatment with an IAC system is an easy technique, which ensures a markedly faster ambulation following TKA compared to the treatment with continuous FNB. Hence, its usage, especially in fast-track concepts can be recommended. In this study, a comparison of pain intensity, the additional requirement of opioids and early range of motion (ROM) offers no benefits compared to FNB. Due to time savings cost reduction can be achieved.

Impact of peripheral nerve block with low dose local anesthetics on analgesia and functional outcomes following total knee arthroplasty: a retrospective study.

While the safety and efficacy of peripheral nerve blocks for postoperative pain management has been established in several well controlled prospective trials, the local anesthetic (LA) concentration and volume used in these studies was associated with a significant increase muscle weakness due to motor nerve block. The purpose of the present retrospective study of patients undergoing total knee arthroplasty was to assess the relative analgesic efficacy and functional outcomes of the low concentration, low volume of LA used in peripheral nerve blocks for postoperative pain management. Twenty-four months of deidentified patient data were extracted from an electronic medical record system. All patients received opioids with or without continuous femoral and sciatic nerve block infusions for postoperative analgesia. Pain (resting and with activity), cumulative opioid and LA use were primary endpoints, participation in physical therapy (PT), muscle strength deficits and length of hospital stay (LOS) were secondary endpoints. Postoperative pain and opioid use were significantly lower in patients with peripheral nerve blocks (n = 1,329) than those with opioids alone (n = 439). There was no detectable decrease in strength associated with nerve blocks, while a significantly greater proportion of patients with nerve blocks were able to participate in PT on postoperative day 1 (96.4% vs 57.1%). These differences were not due to the impact of the surgeon per se, but whether or not the surgeon used nerve blocks for pain management. There was a small but statistically significant decrease in the average LOS in patients with blocks. This analysis supports the use of low concentration, low volume of LA based peripheral nerve blocks for postoperative pain management.

Pooperacinio skausmo malšinimo metodų įtaka ankstyvai kelio sąnario funkcijai, lėtiniam skausmui ir gyvenimo kokybei po pilno kelio sąnario endoprotezavimo operacijos

Pilna kelio sąnario endoportezavimo (PKSE) operacija – viena iš dažniausiai pasaulyje atliekamų ortopedinių operacijų, sąlygojančių lėtinio pooperacinio skausmo išsivystymą [1-3], kuris turi įtakos pacientų gyvenimo kokybei. Skausmo malšinimas po šių operacijų yra tikras iššūkis gydančiajam personalui visame pasaulyje [1-8]. Paprastai taikoma multimodalinė analgezija, kuri apima įvairius nuskausminimo metodus, pvz.: intraveniniai opioidai, periferinių nervų blokados, epidurinė analgezija, vidusąnarinės blokados, peroraliniai analgetikai ir kt. [1, 2]. Tačiau “auksinio standarto” vis dar nėra. Mūsų tyrimo tikslas buvo išsiaiškinti ūmaus pooperacinio skausmo malšinimo metodo, taikyto po pilno kelio sąnario endoprotezavimo (PKSE) operacijos, įtaką pacientų gyvenimo kokybei bei vėlyvam pooperaciniam skausmo atsiradimui po PKSE operacijų. Buvo atliktas perspektyvinis tyrimas, į kurį įtraukti 54 pacientai, kuriems atliktos PKSE operacijos. Pagal operacijos dieną atliktą randomizaciją, pacientai buvo suskirstyti į dvi lygias grupes: I grupę (taikyta juomeninio rezginio blokada) ir II grupę (taikyta vidusąnarinė blokada). Kelio sąnario funkcija bei lėtinio skausmo (LS) įtaka gyvenimo kokybei vertinta pagal VAS skalę ir specialų KOOS (ang. Knee injury and osteoarthritis outcome score) klausimyną bei prieš operaciją pildytą Yesavage’o geriatrinės depresijos skalės anketą. Tyrimo rezultatai parodė, jog pooperacinis nuskausminimo metodas neturėjo įtakos LS išsivystymui, o depresija galėjo sąlygoti lėtinį pooperacinį skausmą. Kelio sąnario funkcija II grupės pacientams per pirmą mėnesį po PKSE operacijos gerėjo greičiau. Gyvenimo kokybė, nepaisant galimos depresijos, reikšmingai pagerėjo abiejų grupių pacientams.

Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty.

Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB). A literature search was performed in PubMed, EMBASE, the OVID database and the Cochrane Library databases. Risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included narcotic consumption, pain score, early mobilization ability, length of stay and adverse effects or events. Research identified 918 articles, of which six with a total of 284 knees, met the inclusion criteria and were eligible for the current study. Conflicting evidence was found in terms of narcotic consumption on the postoperative day 1 and early mobilization ability. Total narcotic consumption, pain score in the first 2days after surgery, length of stay and adverse effects or events showed no difference between two groups. Lower pain score on the day of surgery was detected after PAI. When compared to continuous FNB, patients in PAI group showed a tendency to achieving better ability of early mobilization. In consideration of its relatively simple practice and its potential in analgesic effects or early mobilization ability, PAI had superiority to FNB in the management of pain control after TKA. Before PAI could be widely used in clinical practice after TKAs, further investigations would be necessary to confirm or refute our observed results and to unify the protocol of PAI. I.

Effects of Postoperative Continuous Femoral Nerve Block Analgesia with Braun Continuous Peripheral Nerve Block Catheter Set versus Novel Needle-Over-Cannula after Total Knee Arthroplasty.

BackgroundThe aim of this study was to compare the novel needle-over-cannula vs. the Braun continuous peripheral nerve block catheter set (Contiplex A) in postoperative analgesics after total knee arthroplasty (TKA).Material/MethodsSixty patients undergoing total knee arthroplasty were randomly assigned to Braun continuous peripheral nerve block catheter set group (Braun Group, n=30) or the novel needle-over-cannula group (Cannula Group, n=30). All the patients in the 2 groups received continuous femoral nerve block (CFNB) for postoperative analgesics.ResultsWe found no significant difference in analgesic effect between the 2 groups. The time of catheter or cannula insertion was shorter in the Cannula Group than in the Braun Group. Four (13.32%) out of 30 patients had failed catheter insertions in the Braun Group compared to none in the Cannula Group. Twelve (46%) out of 26 patients in the Braun Group had serious local anesthetic leakage at puncture sites during 12 h compared to none in the Cannula Group.ConclusionsThe novel needle-over-cannula is effective, convenient, and safe in CFNB after TKA.

Femoral Nerve Block in Anterior Cruciate Ligament Surgery: A Prospective Randomized Trial

Early painless rehabilitation is essential after anterior cruciate ligament surgery (ACL). Postoperative main management with femoral nerve block (FNB) is a frequently used method, but it is still unknown how to administer this procedure in order to achieve faster and better analgesia. Purpose: To compare effectiveness of pain management after single shot FNB vs. continuous infusion FNB during the first 48 hours after ACL surgery. Materials and Methods: Forty-three patients older than 18 years, ASA I-II, underwent ACL reconstruction with autograft. Patients are prospectively randomized into two separate groups: Group 1 (G1) received single shot FNB with bupivacaine diluted in 10mL saline solution. Group 2 (G2) received continuous infusion FNB with bupivacaine and epinephrine (1:300.000) for 48 hours. Pain was assessed at rest and with controlled passive motion of the knee. Thigh hypoesthesia and need for additional analgesia were evaluated at 6, 12, 24 and 48 hours. Statistical analysis was performed with Fisher´s exact test (%) and Mann-Whitney´s test (VAS). Statistical significance was considered with P value <0.05. Results: FNB was successful in all patients, and thigh hypoesthesia was present in 100% of G2 vs. 17% in G1 at 24 hours, declining to 74% vs. 0% at 48 hours, respectively. Postoperative pain scores were low and did not differ between both groups. Additional analgesia was required in 33% of patients in G1 vs. 0% in G2. Neither side effects nor complications were related to both methods of FNB. Conclusion: FNB is a safe and successful method for controlling pain after ACL reconstruction, allowing early rehabilitation in both methods of local anesthesic administration. No differences in pain control were found after 48 hours, but continuous infusion FNB descreses need for additional anesthesia at 24 hours of surgery.

Continuous femoral nerve against psoas compartment block for analgesia in total knee arthroplasty

Background Total knee arthroplasty (TKA) is a surgical procedure that often demands potent analgesia. Anesthetists commonly rely on continuous epidural analgesia or psoas compartment block. After the American Society of Regional Anesthesia (ASRA) recent recommendation against the implication of deep regional blocks in the setting of perioperative anticoagulation, femoral nerve block might be a suitable alternative technique. Its effectiveness in TKA is a questionable issue. Our study is hypothesizing that continuous femoral block could provide an analgesic profile similar to continuous psoas compartment block. Patients and method Sixty patients undergoing TKA were randomly assigned into two groups to receive continuous femoral block or continuous psoas compartment block using ultrasound and nerve stimulation guidance. A bolus of 20 ml 0.25% levobupivacaine was injected through a perineural catheter in each group before surgery followed by a 5 ml bolus of 0.125%, and then 5 ml/h infusion at completion of surgery. A bolus of 5 ml 0.125% levobupivacaine was injected when numerical rating scale (NRS) was at least 5. In the first 24 h postoperatively, the median value and the interquartile range of the NRS at 1, 6, 12, and 24 h and after the first physiotherapy session were recorded as the primary end point. The total levobupivacaine and morphine consumption during the same 24-h period were the secondary end points, apart from patient's satisfaction with analgesia during hospitalization. Results The median and interquartile range of the NRS were 4.00 and 2.00 in the first hour, 4.00 and 1.5 in the sixth hour, 4.00 and 1.5 in the 12 th hour, 4.00 and 2.00 in the 24 th hour, and 4.00 and 2.00 after the first physiotherapy session, respectively, in the Fm group, and 3.00 and 3.00 in the first hour, 4.00 and 2.00 in the sixth hour, 4.00 and 1.5 in the 12 th hour, 3.00 and 2.5 in the 24 th hour, and 3.00 and 2.00 after the first physiotherapy session, respectively, in the Ps group. The total mean levobupivacaine and morphine consumption in the Fm and the Ps groups were 218. ± 7.89 vs. 216.6 ± 8.42 and 15.5 ± 4.01 vs. 13.50 ± 4.38, respectively, with no statistically significant difference between both the groups. The catheter insertion time was significantly shorter in the Fm group (8.53 ± 3.1 min) compared with (10.5 ± 3.2 min) the Ps group ( P = 0.021). Conclusion Continuous femoral nerve block provides a suitable alternative analgesic technique in patients undergoing TKA when psoas compartment block is unwarranted in the setting of perioperative anticoagulation as recommended by ASRA.

Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement

Background There are several methods for postoperative analgesia for knee surgery. The commonly utilized method is multimodal analgesia based on continuous femoral nerve block. The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block. Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group. Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group. Operations were performed under combined spinal and epidural anesthesia. After the operations, 0.2% ropivacaine was given at a speed of 5 ml/h through catheters in all patients. Visual analogue scale (VAS) pain scores at rest and while moving were noted at 4, 24, and 48 hours after the operation, and quadriceps strength was also assessed at these time-points. Secondary parameters such as doses of complementary analgesics and side effects were also recorded. Results There were no significant differences between the groups in VAS pain scores at rest or while moving, at 4, 24, or 48 hours after the operation (P &gt;0.05). At these time-points, mean quadriceps strengths in the adductor group were 3.0 (2.75-3.0), 3.0 (3.0-4.0), and 4.0 (3.0-4.0), respectively, all of which were significantly stronger than the corresponding means in the femoral group, which were 2.0 (2.0-3.0), 2.0 (2.0-3.0), and 3.0 (2.0-4.0), respectively (P &lt;0.05). There were no significant differences between the groups in doses of complementary analgesics or side effects (P &gt;0.05). X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle. Conclusions Continuous adductor canal block with 0.2% ropivacaine could be used effectively for analgesia after total knee replacement. Compared with continuous femoral nerve block, this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.

Bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio para analgesia posterior a la artroplastia total de rodilla: estudio multicéntrico, aleatorizado y controlado

Background and objectivesPostoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. Methods46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group); in 24 patients, epidural analgesia was done (PCEA group). The analgesic effects, side effects, articular recovery and complications were compared between 2 groups. ResultsAt 6h and 12h after surgery, the knee pain score (VAS score) during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. ConclusionUltrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6h and 12h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.