For people post knee replacement surgery, how does femoral nerve block (FNB) compare with opioids, epidural, or local infiltration analgesia?

2020 ◽  
Author(s):  
Jane Burch ◽  
Jaimo Ahn
Keyword(s):  
Nerve Block ◽  
Knee Replacement ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Infiltration Analgesia

scholarly journals Comparison of continuous femoral nerve block with local infiltration for postoperative analgesia in unilateral total knee arthroplasty- a randomized controlled trial

2019 ◽  
pp. 268-273
Author(s):  
Rohit Kumar Varshney ◽  
Mukesh Kumar Prasad ◽  
Megha Garg
Keyword(s):  
Nerve Block ◽  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Femoral Nerve ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Total Knee ◽  
Infiltration Analgesia

Background & Objective: Local infiltration of knee joints during knee joint surgery has been used for postoperative analgesia with preservation of motor function of quadriceps muscle, which helps in early mobilization. Femoral nerve block has been incriminated with paralyses of vastus medialis muscle. We aimed to compare postoperative analgesia between femoral nerve block and local infiltration in patients undergoing unilateral total knee arthroplasty (TKA).Methodology: After obtaining institutional ethical approval and written informed consent from the patients, this randomized controlled trial was conducted at Department of Anesthesia at Teerthankar Mahaveer Medical College & Research Centre between July - December 2018. The study was conducted on 60 patients of ASA I and II, undergoing unilateral total TKA. Patients were randomly divided into two groups: Group FB patients underwent femoral nerve block, and Group LI patients underwent local infiltration analgesia. Sedation score, numeric rating scale, motor power and frequency of nausea/vomiting were recorded and statistical analysis done.Results: We observed better pain relief in patients which received femoral nerve block as compared to local infiltration analgesia (p < 0.001). Sedation score was higher in Group LI and was statistically significant between the two groups at 4th, 12th, and 48th hour (p < 0.05). Group FB patients were associated with higher muscle power grades (p < 0.001) as compared to local infiltration analgesia patients. Fentanyl demand was observed to be lesser in Group FB as compared to Group LI (p < 0.001).Conclusion: The study concludes that femoral nerve block produces better pain reliefin patients posted for unilateral knee arthroplasty as compared to local infiltration ofthe local anesthetic solution. However, there is gross reduction in range of motion withfemoral nerve block.Citation: Varshney RK, Prasad MK, Garg M. Comparison of continuous femoral nerve block with local infiltration for postoperative analgesia in unilateral total knee arthroplasty - a randomized controlled trial. Anaesth pain & intensive care 2019;23(3):268-273

Local infiltration analgesia or femoral nerve block for postoperative pain management in patients undergoing total hip arthroplasty. A randomized, double-blind study

2017 ◽  
Vol 16 (1) ◽  
pp. 223-230 ◽  
Author(s):  
Ján Kuchálik ◽  
Anders Magnuson ◽  
Anders Lundin ◽  
Anil Gupta
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Postoperative Pain Management ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Infiltration Analgesia

AbstractBackground and aimsSeveral methods for pain management following total hip arthroplasty (THA) have been described but the best postoperative pain management technique remains uncertain. We compared surgeon applied local infiltration analgesia (LIA) with anaesthesiologist performed femoral nerve block (FNB) using ultrasound. The primary aim was to assess pain intensity 24 h after THA.MethodsIn this randomized, double-blind study, 56 patients (ASA I-III) undergoing THA consented to participate. In Group FNB, patients received an ultrasound-guided femoral nerve block using 30 ml of ropivacaine 7.5 mg/ml (225 mg) while Group LIA received a similar volume of saline. Spinal anaesthesia was then performed and bupivacaine heavy, 3–3.5 ml injected depending on patient characteristics. During surgery, patients in Group LIA received a mixture of 300 mg (150 ml) ropivacaine, ketorolac 30 mg (1 ml) and adrenaline 0.5 mg (0.5 ml) (total volume 151.5 ml) peri-articularly and subcutaneously while Group FNB received 151.5 ml of saline peri-articularly in a systematic way by the surgeon. A multi-hole catheter was placed with the tip placed intra-articularly at the end of surgery in both groups. After 23 h, the LIA mixture consisting of 20 ml ropivacaine (7.5 mg/ml), ketorolac 30 mg (1 ml), adrenaline 0.1 mg (1 ml) (total volume 22 ml) was injected in Group LIA and the same volume of saline in Group FNB. Postoperative pain, analgesic consumption (postoperative and post-discharge), side effects, home discharge, quality of life and hip function were recorded, the latter up to 6 months after surgery.ResultsPostoperative pain intensity was significantly lower in Group LIA compared to Group FNB during mobilization at 24 h (primary endpoint), mean difference 1.8 NRS units (95% CI 0.7–2.9) (P = 0.006), at rest after 4 h (P = 0.029) and on standing after 24 (P = 0.0003) and 48 h (P = 0.043). Rescue morphine consumption was also significantly lower in Group LIA during 0–24, mean difference 13.5 mg (95% CI, 6.1–20.9) (P = 0.002) postoperatively. Motor block was greater at 6 h (P = 0.029) postoperatively in Group FNB. Two patients (one in each group) had persistent post-surgical pain (NRS > 3) at 3 months (3.6%) but none at 6 month. No other differences were found between the groups.ConclusionLocal infiltration analgesia significantly reduces pain intensity on standing and mobilization, and rescue analgesic consumption compared to femoral nerve block without causing significant side effects. The superior analgesia in the LIA group may result from the secondary injection at 23 h postoperatively and needs to be furtherevaluated in future studies. No differences were found in home discharge, quality of life and hip dysfunction between the groups.ImplicationLocal infiltration analgesia is the preferred method for postoperative pain management following THA compared to single-shot femoral nerve block.© 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

scholarly journals Controlled Hypotension Combined with Femoral Nerve Block for Knee Replacement without Tourniquet

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Liangming Wang ◽  
Yiqiang Zheng ◽  
Xiaolu Zhang ◽  
Qingfeng Ke
Keyword(s):  
Knee Joint ◽  
Nerve Block ◽  
Knee Replacement ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Postoperative Recovery ◽  
Controlled Hypotension ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Intravenous Analgesia

In the process of knee replacement surgery, the use of tourniquet technology for hemostasis is the most common method. But the adverse reactions of tourniquets in knee replacement surgery have become more prominent in recent years. More and more scholars have begun to advocate the optimization of the use of tourniquet technology, thereby controlling the use of tourniquet technology. In this study, 125 patient cases were randomly divided into four experimental groups for comparative analysis. The two sets of variables are whether to use tourniquet during surgery and use intravenous analgesia or nerve block analgesia. Studies have shown that when using a tourniquet for knee replacement surgery, the chance of hidden blood loss increases after use. The tourniquet was not used during the operation, the patient's thighs were swollen, and postoperative pain was reduced. Compared with intravenous analgesia, knee joint replacement with uncontrolled tourniquet combined with femoral nerve block has a better analgesic effect and can effectively relieve pain after knee replacement. Therefore, under the method of controlled hypotension combined with femoral nerve block, TKA surgery without using tourniquet technology is more conducive to early health recovery and pain relief after TKA surgery, as well as functional exercise and knee joint recovery during postoperative recovery.

scholarly journals Helyi infiltrációs érzéstelenítés alkalmazása nagyízületi endoprotézisek beültetése során

2017 ◽  
Vol 158 (9) ◽  
pp. 352-357 ◽  
Author(s):  
Tamás de Jonge ◽  
Szabolcs Görgényi ◽  
Gabriella Szabó ◽  
Miklós Bulcsú Torkos
Keyword(s):  
Postoperative Pain ◽  
Knee Replacement ◽  
Control Group ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Knee Replacement Surgery ◽  
Total Hip ◽  
Replacement Surgery ◽  
The Cost ◽  
Infiltration Analgesia

Abstract: Introduction: Total hip and knee replacment surgeries are characterized by severe postoperative pain. Local infiltration analgesia is proved to be very effective. However this method has not been widely used in Hungary. Aim: To evaluate the efficacy of the local infiltration analgesia with modified components in patients underwent total hip or knee replacement surgery. Method: Data of 99 consecutive patients underwent primary total hip or knee replacement surgery were evaluated prospectively. In all the 99 surgeries modified local infiltration analgesia was applied. Postoperative pain reported on a visual analog scale was recorded as well as the need for further analgetics during the first 18 hours after surgery. The cost of the analgetic drugs was calculated. The control group comprised 97 consecutive patients underwent total hip or knee replacement, where local infiltration analgesia was not applied. Statistical analysis was done. Results: Patients received local infiltration analgesia reported significantly less pain (p<0.001). The need for postoperatively given analgetics was almost 50% less, and the cost of all postoperative analgetics was 47% less than in the control group. Conclusion: In total hip and knee replacement surgeries the modified local infiltration analgesia decreases postoperative pain effectively and contribute to the early mobilization of the patients. Orv. Hetil., 2017, 158(9), 352–357.

Sign in / Sign up

Export Citation Format

Share Document