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Continuous femoral nerve block after total knee arthroplasty?
Author(s) -
KADIC L.,
BOONSTRA M. C.,
DE WAAL MALEFIJT M. C.,
LAKO S. J.,
VAN EGMOND J.,
DRIESSEN J. J.
Publication year - 2009
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2009.01965.x
Subject(s) - medicine , femoral nerve block , femoral nerve , analgesic , morphine , anesthesia , osteoarthritis , surgery , regimen , arthroplasty , total knee arthroplasty , nerve block , prospective cohort study , alternative medicine , pathology
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.