Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty

Abstract

BackgroundTotal knee arthroplasty (TKA) generates severe postoperative pain in 60% of patients and moderate pain in 30% of patients. Because inadequate postoperative pain control can hinder early physiotherapy and rehabilitation, it is the most influential factor dictating a good outcome. The purpose of this study was to evaluate the effectiveness of continuous psoas compartment block (PCB) in comparison to intravenous patient-controlled analgesia (IVPCA) in TKA patients.Methods40 TKA patients were randomly divided into 2 groups. Group IVPCA (n = 20) received intravenous patient controlled analgesia (IVPCA) for 48 hours. Group PCB (n = 20) received continuous PCB for 48 hours at the fourth intertransverse process of the lumbar using the C-arm. Pain scores, side effects, satisfaction, the length of hospital stay, rescue antiemetics, and analgesics were recorded.ResultsPain scores (VNRS 0-100) were higher in Group IVPCA than in Group PCB. Nausea and sedation occurred more frequently in Group IVPCA than in Group PCB. There were no differences between the groups in the length of the hospital stay, satisfaction scores, and the use of rescue antiemetics and analgesics.ConclusionsContinuous PCB seemed to be an appropriate and reliable technique for TKA patients, because it provided better analgesia and fewer side effects such as nausea and sedation when compared to IVPCA.

Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia

“…Of note, the authors did not find any difference in length of hospital stay, satisfaction, or rescue emetic use. 66 These favorable outcomes have similarly been shown when compared to other regional blocks. In a study by Kaloul et al comparing lumbar plexus block with a three-in-one FNB, they found simi-lar reductions in 48 hour opioid consumption, similar pain scores at six and 24 hours post operatively, but a greater sensory and motor blockade of the obturator nerve in the lumbar plexus group.…”

“…64,65 In a paper by Lee et al, similar pain scores were recorded in comparison to patients with intravenous patient controlled analgesia, after a total knee arthroplasty until after 6 hours post-operatively. 66 Though the PCB group reporting statistically significant improvements on pain, nausea, and sedation after 6 hours post operatively. 66 The authors postulated this difference in time was due to the anesthetics need to fully infiltrate the compartment before achieving full and optimal effect.…”

“…66 Though the PCB group reporting statistically significant improvements on pain, nausea, and sedation after 6 hours post operatively. 66 The authors postulated this difference in time was due to the anesthetics need to fully infiltrate the compartment before achieving full and optimal effect. These findings were also highlighted by Touray et al in their review and metanalysis which found PCB when paired with a sciatic nerve block is superior than patient-controlled opiate administration.…”

Continuous Femoral Nerve Block versus Patient-Controlled Intravenous Analgesia for Patients Undergoing Unilateral Total Knee Arthroplasty: A Cost-Effectiveness Analysis and Cost-Utility Analysis

“…In clinical, we usually use PCIA, epidural analgesia and CFNB which owns different features. Lee et al (15) found that PCIA provided less better analgesia and more side effects such as nausea and sedation compared with continuous peripheral block. Patel et al (16) found peripheral nerve block was safe with a significant decrease in postoperative complications and provided adequate pain relief compared to epidural anesthesia CFNB and PCIA are two commonly used methods for postoperative analgesia after TKA.…”