Continuous Femoral Nerve Block Using 0.125% Bupivacaine Does Not Prevent Early Ambulation After Total Knee Arthroplasty

Beebe, Michael J.; Allen, Rachel; Anderson, Mike B.; Swenson, Jeffrey D.; Peters, Christopher L.

doi:10.1007/s11999-013-3164-7

Cited by 17 publications

(6 citation statements)

References 18 publications

(48 reference statements)

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“…But studies such as this one investigate data on anesthetic efficacy of the block for the intraoperative period, not analgesia for the postoperative period. There are studies which used 0.125% bupivacaine solution for infusion with FNB catheter and it's reported that this concentration does not prevent ambulation [15]. We believe a concentration as low as 0.125% bupivacaine for single shot FNB shows potential for early ambulation while maintaining adequate analgesia.…”

Section: Discussionmentioning

confidence: 86%

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

Kayalı

2021

Preprint

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Purpose The aim of our study is to evaluate the efficiency of femoral nerve block on recovery after primary total knee arthroplasty. Our primary goal is to provide adequate analgesia with a lower concentration of bupivacaine (0.125%) as well as the usual concentration (0.25%). Comparing the degree of motor block, side effects, postoperative pain scores, opioid consumption, and ambulation and discharge times are our secondary goals. Methods The study was conducted as randomized, controlled and double blind. Sixty three patients were randomised into three groups: G125(n:21) received FNB with 20ml of 0,125% bupivacaine, G25(n:21) received 10ml of 0,25% bupivacaine and GCont(n:21) received no block. FNB was applied with ultrasound guidance after the operation. Pain scores(NRS) at certain time intervals, total opioid consumption, motor block, knee flexion and discharge times were recorded. Results For GCont, pain scores were significantly higher at 2nd, 6th, 12th and 24th hour postoperatively, total opioid consumption was higher(G125:75mg, G25:0mg, GCont:280mg) and first opioid demand time was earlier(G125:12th hour, G25:21st hour GCont:2nd hour). First knee flexion time and mobilization time were also delayed for GCont. G25 had lower scores for quadriceps muscle strength(G25:3/5, G125:4/5, GCont:5/5, Manual Test at 6th Hour), but this did not affect mobilization compared to G125. Conclusion G125 had lower quadriceps muscle strength loss compared to the G25 and earlier mobilization and flexion times, low opioid consumption and low pain scores compared to the control group. In this respect, we believe the femoral nerve block with 0,125% bupivacaine proves to be a suitable option for analgesia with the potential of maintaining enough movement for recovery after TKA.

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Section: Discussionmentioning

confidence: 86%

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

Kayalı

2021

Preprint

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“…First, the continuous femoral nerve blocks were performed with nerve stimulation rather than with ultrasound guidance [2,6]. Second, the concentration local anesthetic in the peripheral nerve blocks was 0.2-0.5% ropivacaine, as opposed to a lower dosage like 0.25% or even 0.125%, as reported by other authors [3,7]. Both of these factors could have contributed to the high rate of dysesthesia reported in the nerve block group.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

CORR Insights®: The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Peters

2015

Clinical Orthopaedics &Amp; Related Research

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“…Femoral nerve block (FNB) has been widely used due to its ease of application and its excellent pain relief after TKA [19][20][21][22][23][24][25], while concerned with weakens quadriceps strength [26,27] due to blocking the proximal femoral nerve which contains both motor and sensory fibers [28]. As the alternative, adductor canal block (ACB) can provide equally effective pain relief preserving quadriceps strength [29][30][31][32], because the blocking the nerve distally to that of the FNB can anesthetize only the purely sensory saphenous nerve in the adductor canal [26,27,33].…”

Section: Introductionmentioning

confidence: 99%

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

Fujita

Mera

Watanabe

et al. 2022

BMC Musculoskelet Disord

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Background Near-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block. Methods Continuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated. Results A total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3. Conclusion ACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls.

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Continuous Femoral Nerve Block Using 0.125% Bupivacaine Does Not Prevent Early Ambulation After Total Knee Arthroplasty

Cited by 17 publications

References 18 publications

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

CORR Insights®: The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

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