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. 2012 May;56(3):270-5.
doi: 10.4103/0019-5049.98776.

Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement

Harsha Shanthanna  1 , Medha Huilgol, Vinay Kumar Manivackam, Amjad Maniar
Affiliations

Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement

Harsha Shanthanna et al. Indian J Anaesth. 2012 May.

Abstract

Background: Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.

Aims: Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.

Settings and design: Randomised, controlled, non-blinded study done in a tertiary care private hospital.

Methods: Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.

Statistical analysis: Mean VAS score at 6, 6-24, 24-48 and 48-72 h were considered. Significance was assessed at the 5% level.

Results and conclusion: VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.

Keywords: Continuous femoral catheter; epidural; regional analgesia; total knee replacement; ultrasound.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Graphical representation of post-operative pain scores; all values are mean+SD. P value obtained by Student's t test shows a highly significant difference at 6 h
Figure 2
Figure 2
Graphical representation of the side-effects observed; depicted as % values
See this image and copyright information in PMC

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