scholarly journals The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block in total knee arthroplasty: a randomized control trial

2021 ◽  
Author(s):  
Wirinaree Kampitak ◽  
Aree Tanavalee ◽  
Tanvaa Tansatit ◽  
Srihatach Ngarmukos ◽  
Nattaporn Songborassamee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Randomized Control Trial ◽  
Analgesic Efficacy ◽  
Cutaneous Nerve ◽  
Femoral Cutaneous Nerve ◽  
Total Knee ◽  
Randomized Control ◽  
Femoral Triangle

Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

2019 ◽  
Vol 45 (2) ◽  
pp. 107-116
Author(s):  
Siska Bjørn ◽  
Thomas Dahl Nielsen ◽  
Bernhard Moriggl ◽  
Romed Hoermann ◽  
Thomas Fichtner Bendtsen
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Nerve ◽  
Cutaneous Nerve ◽  
Sartorius Muscle ◽  
Midline Incision ◽  
Femoral Cutaneous Nerve ◽  
Volunteer Study ◽  
Total Knee ◽  
Femoral Triangle

Background and objectives For pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior femoral cutaneous nerves (intermediate femoral cutaneous nerve (IFCN) and medial femoral cutaneous nerve (MFCN)) are not anesthetized. The IFCN can be selectively anesthetized in the subcutaneous tissue above the sartorius muscle and the MFCN by an injection in the proximal part of the femoral triangle (FT). The primary aim was to investigate the area of cutaneous anesthesia in relation to the surgical incision for TKA and anteromedial knee area after intermediate femoral cutaneous nerve blockade (IFCNB) in combination with an injection in the proximal or distal part of the FT (proximal vs distal femoral triangle block (FTB)). Methods The study was carried out as two separate investigations: first, dissection of nine cadaver sides to verify a technique for IFCNB; second, a volunteer study with 40 healthy volunteers. The surgical midline incision for TKA was drawn bilaterally. All volunteers received an active distal FTB combined with a placebo proximal FTB on one side and vice versa on the other side. All volunteers were randomized to an active IFCNB on one side and placebo IFCNB on the contralateral side. Results Identification of IFCN was successful in all cadaver sides. Fifteen out of 20 volunteers had complete anesthesia of the incision line after IFCNB combined with proximal FTB, which was significantly higher compared with proximal FTB alone and with distal FTB+IFCNB. A gap at the anteromedial knee area was present in 2/20 volunteers with proximal FTB compared with 17/20 with distal FTB when all volunteers had active IFCNB. Conclusion Ultrasound-guided blockade of the IFCN and MFCN anesthetize the surgical midline incision and the anteromedial area of the knee relevant for TKA. In contrast, an injection at the midthigh level produces insufficient cutaneous anesthesia not covering the areas of interest. Trial registration number EudraCT: 2018-004986-15.

scholarly journals Incidence of Suture-Method Catheter Dislocation with Femoral Nerve Block and Femoral Triangle Block after Total Knee Arthroplasty

2021 ◽  
Vol 18 (13) ◽  
pp. 6687
Author(s):  
Bulat Tuyakov ◽  
Mateusz Kruszewski ◽  
Lidia Glinka ◽  
Oksana Klonowska ◽  
Michal Borys ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Opioid Consumption ◽  
Total Knee ◽  
Group 2 ◽  
Femoral Triangle ◽  
Group 1

Catheter dislocation with continuous peripheral nerve blocks represents a major problem in clinical settings. There is a range of factors affecting the incidence of catheter dislocation, including catheter type. This study aimed to assess the incidence of suture-method catheter (SMC) dislocation 24 h after total knee arthroplasty (TKA), with continuous femoral nerve block (CFNB) and continuous femoral triangle block (CFTB), respectively. In the prospective randomized trial, 40 patients qualified for TKA with SMC and were divided into two groups, those who received CFNB (Group 1, n = 20) and those who received CFTB (Group 2, n = 20). After 24 h, the degree of catheter displacement (cm), pain intensity (NRS) and opioid consumption (mg) was assessed. The catheter dislocation rates were found to be 15% in Group 1 versus 5% in Group 2, with the catheter dislocated by 0.83 cm (SD = ±0.87) and 0.43 cm (SD = ±0.67), respectively. There were no differences in NRS score (p = 0.86) or opioid consumption (p = 0.16) between the groups. In each case, a displaced catheter was successfully repositioned by pulling, which clinically resulted in a lower NRS score. The results of the study suggest that CFTB with SMC may be used after TKA with a good effect, as it is associated with low catheter dislocation rates and an adequate analgesic effect.

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