Evaluation of analgesic regimens in total knee artroplasty, retrospective study

Abstract

OBJECTIVE:Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA).METHODS:The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB.RESULTS:The average age of the patients was 64.3±14.9 years and average body mass index (BMI) was 32.5±5.3 kg/m2. There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3.CONCLUSION:This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.

Multimodal neural block analgesia versus morphine analgesia after elective knee surgery

“…Reduction in the pain intensity, judged according to the lower scores on the NPS in comparison with the opioid group, found in the FNB group was in accordance with the results of several other clinical trials. [29][30][31][32][33][34][35][36] Publications on the postoperative efficacy of FICNB are less abundant, but a meta-analysis unequivocally confirms the results of the present study. 37 One of the rare available clinical studies publishing the head-tohead comparison between 3-in-1 FNB and FIC-NB found no difference in the efficacy and safety of these two multi-modal analgesic techniques, 34 corroborating thus the current results.…”