Continuous Femoral Versus Epidural Block for Attainment Of 120° Knee Flexion After Total Knee Arthroplasty: A Randomized Controlled Trial

Sakai, Norihiro; Inoue, T; Kunugiza, Yasuo; Tomita, Tadanori; Mashimo, Takashi

doi:10.1016/j.arth.2012.09.013

Cited by 58 publications

(38 citation statements)

References 45 publications

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“…[ 15] have suggested that continuous femoral nerve block is better pain management method for TKR, other studies have found that epidural analgesia is superior to femoral nerve block for pain control [16,17]. However, these studies did not combine sciatic nerve block with femoral nerve block.…”

Section: Discussionmentioning

confidence: 96%

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

2017

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A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3366, Fax: 82-53-626-5275, E-mail: apsj0718@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with singleinjection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR. Methods: Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 g/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects. Results: The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P ＜ 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation.

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Section: Discussionmentioning

confidence: 96%

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

2017

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“…Peripheral nerve blockade or intravenous patient-controlled analgesia is a good alternative for postoperative analgesia after total knee arthroplasty [15][16][17] . However, in this trial, we simply compared the efficacy of periarticular injection with that of epidural analgesia, without any regional analgesia regimens or intravenous patient-controlled analgesia regimens.…”

Section: Discussionmentioning

confidence: 99%

“…Three previous trials comparing epidural analgesia with periarticular injection also avoided blinding 6,21,22 . In a trial that compared epidural analgesia with femoral nerve blockade, the institutional review board did not permit blinding 16 .…”

Section: Discussionmentioning

confidence: 99%

Pain Control After Simultaneous Bilateral Total Knee Arthroplasty

Tsukada¹,

Wakui²,

Akiho

2015

The Journal of Bone and Joint Surgery

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“…In addition to effective analgesia, local anesthetics block the afferent neural stimuli from the surgical area, reducing endocrine-metabolic responses without any effects on inflammation (Kehlet and Dahl, 2003). Long-acting amide local anesthetics such as ropivacaine and bupivacaine provide a superior pain control over opioids and are commonly used in the postoperative period for infiltrative, regional, and neuraxial blocks (Ersayli et al, 2006; Kuthiala and Chaudhary, 2011; Sakai et al, 2013). Local anesthetics exert their effects via blocking the voltage-gated sodium channels on the cell membrane, thereby interfering with afferent signal propagation, thus reducing hyperalgesia and allodynia (Lai et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Safety of liposome extended-release bupivacaine for postoperative pain control

et al. 2014

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Background: Ideal postoperative pain management requires a multidisciplinary approach in combination with a variety of dosage regimens. Approximately 21–30% of patients experience moderate to severe pain in the postoperative period, which may have a significant impact on recovery rate, standard of living, psychological health, and postoperative complications.Objective: Analysis of the incidence and characterization of reported adverse effects with DepoFoam bupivacaine compared to conventional bupivacaine or placebo.Methods: A systematic review of prospective studies on the use of DepoFoam versus bupivacaine or placebo was performed in order to answer the clinically relevant question: is DepoFoam a safer formulation in place of bupivacaine single injection or continuous local infusion techniques for postoperative pain management? Inclusion criteria required randomized, controlled, double-blind trials in patients 18 years old or older, single dose used for postoperative pain control, and a primary procedure performed.Results: Six studies fitted the inclusion criteria for analysis, DepoFoam bupivacaine used in therapeutic doses was well-tolerated, had a higher safety margin, and showed a favorable safety profile compared to bupivacaine and control groups.Conclusion: Extended drug delivery system DepoFoam bupivacaine is a promising drug formulation that may significantly improve postoperative care and pain control in surgical patients.

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Continuous Femoral Versus Epidural Block for Attainment Of 120° Knee Flexion After Total Knee Arthroplasty: A Randomized Controlled Trial

Cited by 58 publications

References 45 publications

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

Pain Control After Simultaneous Bilateral Total Knee Arthroplasty

Safety of liposome extended-release bupivacaine for postoperative pain control

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