Authors: KADIC, L.¹; BOONSTRA, M. C.²; DE WAAL MALEFIJT, M. C.³; LAKO, S. J.¹; VAN EGMOND, J.¹; DRIESSEN, J. J.¹

Source: Acta Anaesthesiologica Scandinavica, Volume 53, Number 7, August 2009 , pp. 914-920(7)

Publisher: Wiley-Blackwell

Abstract:

Background:

A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. Methods:

In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. Results:

The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90° flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. Conclusion:

A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90° knee flexion after 6 days. However, after 3 months, no significant functional benefits were found.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2009.01965.x

Affiliations: 1: Department of Anesthesiology, 2: Orthopaedic Research Laboratory and 3: Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Publication date: 2009-08-01

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