Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

ISOKINETIC STRENGTH IS COMPARABLE AMONG ADOLESCENT PATIENTS WHO HAD EITHER A SINGLE INJECTION FEMORAL NERVE BLOCK OR CONTINUOUS FEMORAL NERVE CATHETER DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background: Single injection femoral nerve blocks or continuous femoral nerve catheters are commonly used during anterior cruciate ligament reconstruction (ACLR). However, both single injection and continuous femoral nerve catheters have been associated with decreased quadriceps strength and function up to 6 months postoperative compared to no regional anesthesia Purpose/Hypothesis: We compared isokinetic limb asymmetry 5-10 months post-surgery between patients who received either single injection or continuous femoral nerve block during ACLR. We also assessed patient characteristics potentially associated with strength deficits. We hypothesized that patients with continuous femoral nerve catheters would demonstrate decreased quadriceps function due to increased local anesthetic. Methods: We reviewed medical records of patients ages 10-19 years who completed isokinetic testing 5-10 months following quadricep tendon ACLR by a single surgeon. Patients were excluded for previous lower limb surgery. We grouped patients based on whether they received a single injection femoral nerve block (FNB group) or a continuous femoral nerve catheter (FNC group) intraoperatively. Using isokinetic data at 60, 180, and 300 degrees per second, we calculated maximum torque percent deficit of the involved compared to the uninvolved leg, as well as compared peak torque extensor and flexor deficits (% difference between operative/non-operative sides) between groups. Results: Sixty-two patients were included: 50 who received FNC and 12 who received FNB (Table 1). There were no significant differences between continuous femoral nerve block and single-shot femoral nerve block groups for extensor deficits at any speed (Figure 1) or for flexor deficits at any speed (Figure 2). At 60 degrees/s (p=0.006) and 180 degrees/s (p=0.017), longer time since surgery was associated with smaller extensor deficits (Table 2). At 180 degrees/s (p=0.008) older age was associated with greater extensor deficits (Table 2). At 60 degrees/s (p=0.017) skeletal maturity was associated with greater extensor deficits (Table 2). At all speeds, an injured dominant limb was associated with smaller flexor deficits (Table 3). Older age was associated with greater flexor deficits at 60 deg/s (Table 3). Conclusion: No apparent significant isokinetic strength differences were found between groups 5-10 months postoperatively. Longer time from surgery was significantly associated with decreased extensor deficits among both groups at slower isokinetic test speeds. Our data suggest increased isokinetic strength recovery over the 5-10-month timeframe. The surgeon, anesthesia team, and patient should choose the pain management protocol based on resource and patient factors. Tables and Figures: [Table: see text][Table: see text][Table: see text][Figure: see text][Figure: see text]

Continuous Epidural Analgesia and Continuous Femoral Nerve Block for Postoperative Pain after Unilateral Total Knee Arthroplasty: A Prospective Cohort Study

Introduction: Total Knee Arthroplasty (TKA) surgeries are associated with moderate to severe postoperative pain. Inadequate analgesia leads to patient distress, suboptimal knee mobilisation and complications due to delayed rehabilitation. Peripheral nerve blocks and central neuraxial techniques are in the vanguard of various analgesic strategies to minimise pain after TKA. Aim: To compare the effects of Continuous Epidural Analgesia (CEA) and Continuous Femoral Nerve Block (CFNB) on postoperative analgesia, knee rehabilitation and adverse effects after TKA surgeries. Materials and Methods: A prospective cohort study was conducted among 90 patients undergoing unilateral TKA at the Government Medical College, Kozhikode, Kerala, India. They were divided into two groups of 45 each. CEA (Group E) and CFNB (Group F) were given for postoperative pain management. Effectiveness of postoperative analgesia was measured by Numerical Rating Scale (NRS) scores at 6, 12, 24, 48 and 72 hours and also by need for rescue analgesics during the first 48 hours. Postoperative knee rehabilitation indices were measured on 1st, 2nd and 3rd Postoperative Days (POD). Incidence of adverse effects in each group was also noted. Continuous variables were analysed using students t-test, categorical variables using Chi-square test and NRS scores using Mann Whitney U test. Results: NRS scores were similar in both CEA (E) and CFNB (F) groups. On POD 1, 75.6% of group E and 71.1% of group F (p=0.630), on POD 2, 71.1% of group E and 68.9% of group F (p=0.818) and on POD 3, 62.2% of group E and 66.7% of group F (p=0.66) achieved specific rehabilitation indices. There was no statistically significant difference in pain scores, rescue analgesic requirement and rehabilitation indices between the two groups. No significant adverse effects were noted in either group. Conclusion: CFNB is as effective as continuous epidural block for postoperative analgesia and knee rehabilitation after TKA without any significant side-effects.

Comparison of Continuous Epidural Blockade and Continuous Femoral Nerve Block on Postoperative Pain in Total Knee Replacement Surgeries: A Prospective Randomised Controlled Study

Background: The use of epidural analgesia in the management of postoperative pain following orthopedic surgeries has evolved as a critical component of a multimodal approach to achieve the goal of pain relief, early mobilization, and improved compliance with physiotherapy resulting in overall improved outcomes. Aim: The aim of this study is to compare continuous femoral nerve block with continuous epidural block technique for postoperative analgesia in patients undergoing elective total knee replacement surgery.Subjects and Methods:The patients belonging to the ASA I to III scheduled for various knee surgeries under spinal anesthesia were enrolled in this study. They were randomly divided into two equal groups of thirty-three patients each. The Group F patients received continuous femoral nerve blockade and in the Group E patients continuous epidural blocked preoperatively.Results:The analgesic efficacy of both continuous femoral nerve block and continuous epidural nerve block was equal as measured by the visual analogue scores. The incidence of Hypotension was more in the Epidural group. The adverse effects due to the Continuous Femoral Nerve block were lower in comparison with the Continuous Epidural block technique.Conclusion:Continuous femoral nerve blockade provides postoperative analgesia equivalent to that obtained with a continuous epidural blocked but with lesser side effects.

Analgesic effect of ropivacaine with fentanyl in comparison with ropivacaine alone for continuous femoral nerve block after knee replacement arthroplasty: a prospective, randomized, double-blinded study

Background: The analgesic effect of perineural opioid in clinical practice are still controversial. This randomized controlled trial compared analgesic effect of ropivacaine with fentanyl or ropivacaine alone for continuous femoral nerve block following unilateral total knee arthroplasty. Methods: Fourty patients of ASA PS Ⅰ or Ⅱ receiving total knee arthroplasty with spinal anesthesia were enlisted and randomly allocated into two groups. Group R; bolus injection of 0.375% ropivacaine, 30 ml and an infusion of 0.2% ropivacaine at 8 ml/h (n = 20). Group RF; 0.375% ropivacaine, 29 ml added with 50 μg of fentanyl as a bolus and an infusion of 0.2% ropivacaine mixed with 1 μg/ml of fentanyl at 8 ml/h (n = 20). Local anesthetic infusion via a femoral nerve catheter was started at the end of operation and continued for 48 h. Intravenous patient-controlled analgesia with hydromorphone (0.15 mg/ml, 0-1-10) were used for adjuvant analgesics. Position of catheter tip and contrast distribution, visual analog scale of pain, hydromorphone consumption, side effects were recorded for 48 h after operation. Patient satisfaction for the pain control received were noted. Results: The pain visual analogue scale, incidences of side effects and satisfaction were not different between the two groups (P > 0.05), but the hydromorphone usage at 48 h after operation were lower in the Group RF than in the Group R (P = 0.047). Conclusions: The analgesic effect of ropivacaine with fentanyl for continuous femoral nerve block after knee replacement arthroplasty was not superior to that of the ropivacaine alone.