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. 2011 Jan;52(1):145-50.
doi: 10.3349/ymj.2011.52.1.145.

Effect of combined single-injection femoral nerve block and patient-controlled epidural analgesia in patients undergoing total knee replacement

Ae-Ryung Lee  1 , Duck-Hwan Choi, Justin Sangwook Ko, Soo-Joo Choi, Tae-Soo Hahm, Ga-Hyun Kim, Young-Hwan Moon
Affiliations

Effect of combined single-injection femoral nerve block and patient-controlled epidural analgesia in patients undergoing total knee replacement

Ae-Ryung Lee et al. Yonsei Med J. 2011 Jan.

Abstract

Purpose: Total knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement.

Materials and methods: Thirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated.

Results: Median visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours.

Conclusion: The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Temporal pain visual analog scale (VAS) at rest and with movement (flexion of knee). The box depicts the 25th and 75th percentiles. Horizontal lines represent the median (50th percentile), and bars depict the 10th and the 90th percentiles. *p < 0.05 compared with the control group.
Fig. 2
Fig. 2
Volume of patient-controlled epidural analgesia medication. Values are expressed as mean ± standard deviation. *p < 0.05 compared with the control group. PCEA, patient-controlled epidural analgesia.
See this image and copyright information in PMC

References

    1. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493. - PMC - PubMed
    1. Williams-Russo P, Sharrock NE, Haas SB, Insall J, Windsor RE, Laskin RS, et al. Randomized trial of epidural versus general anesthesia: outcomes after primary total knee replacement. Clin Orthop Relat Res. 1996;(331):199–208. - PubMed
    1. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized controlled trial. Anesth Analg. 2005;101:1824–1829. - PubMed
    1. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001;16:436–445. - PubMed
    1. Hirst GC, Lang SA, Dust WN, Cassidy JD, Yip RW. Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty. Reg Anesth. 1996;21:292–297. - PubMed