Postoperative Fall after the Use of the 3-in-1 Femoral Nerve Block for Knee Surgery: A Report of Four Cases

Atkinson, Henry Dushan; Hamid, Imran; Gupte, Chinmay; Russell, R. C. G.; Handy, Jonathan

doi:10.1177/230949900801600324

Cited by 58 publications

(43 citation statements)

References 13 publications

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“…However, concerns remain that femoral nerve block will prevent early ambulation and increase the number of patient falls after surgery [1,7,10,12]. In our cohort, all patients were able to ambulate by postoperative Day 1 and 45% (35 of 77) of patients were able to ambulate on the day of surgery.…”

Section: Discussionmentioning

confidence: 78%

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

Beebe

Allen

Anderson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period. Questions/purposes This study sought to determine whether continuous femoral nerve block with a single-shot sciatic block prevented early ambulation after total knee arthroplasty (TKA) and whether the technique was associated with adverse effects.

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Section: Discussionmentioning

confidence: 78%

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

Beebe

Allen

Anderson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…But doing so, it will also result in a significant lower extremity weakness. The risk of fall with femoral nerve blocks (FNBs) has been cited as high as seven percent [3,4] but Memtsoudis et al [5] argued that this association may not completely be anesthesia related. Inpatient falls are categorized as "never events" by the Center for Medicare and Medicaid Services, which cost on average of $4000 per incident and are usually not reimbursed by Medicare [6,7] .…”

Section: Discussionmentioning

confidence: 99%

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

Yuan¹,

Meier²,

Kim³

2017

JAS

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An 83 year-old male with history of hypertension, complete heart block with a pacemaker, ankylosing spondylitis, prostate cancer, obesity and obstructive sleep apnea was scheduled for a right total hip arthroplasty (THA) for degenerative hip disease. His daily analgesic medications included oxycodone 5 milligrams (mg) every 3 hours, gabapentin 600 mg nightly, acetaminophen 650 mg every 6 hours and meloxicam 15 mg daily. A focused airway examination revealed a Mallampati III oropharyngeal exam, thyromental distance less than 6 centimeters, limited mouth opening and limited jaw protrusion. After a lengthy discussion regarding his anesthetic options, the patient elected for general endotracheal anesthesia and agreed to an obturator nerve block in the recovery room if postoperative analgesia proved difficult. The patient had taken his nightly dose of gabapentin and morning dose of acetaminophen prior to hospital arrival. In the preoperative area, he was given celecoxib 200 mg in addition as part of a comprehensive preoperative multimodal therapy.The patient was taken to the operating room where general anesthesia was induced with fentanyl 25 micrograms (mcg), propofol and succinyl choline intravenously (IV) and an endotracheal tube was placed without complication. General anesthesia was maintained with sevoflurane and a total of hydromorphone 0.8 mg IV. After successful completion of the surgery, the patient reported a pain numerical rating score (NRS) of 7/10 for generalized right hip pain upon arriving in the post anesthesia care unit (PACU). He was noted to have increased spasticity and pain with manipulation of the hip. The patient agreed to proceed with the previously consented postoperative obturator nerve block. He remained in the supine position with approximately 15 degrees of hip abduction. Skin cleansing of the medial proximal thigh and inguinal area was performed with 2% chlorhexidine and 70% isopropyl alcohol (Chloraprep). A selected obturator nerve block was performed with in-plane ultrasound-guided technique (Sonosite, M-Turbo, 6 to 15 MHz, Bothell, WA) with a 21G needle (Sonoplex). A 20-milliliter (mL) bolus of 0.5% ropivacaine was injected between the adductor longus and adductor brevis muscles to anesthetize the anterior division of the obturator nerve (Figure 1). Twenty minutes after block completion, the patient was re-evaluated. His NRS scores had decreased to 4/10 and he had significant improvement of mobility of his right hip. No opioid was given in the PACU. He was able to tolerate hip flexion and rotation without increased pain. Furthermore, hip adductions appear grossly equal bilaterally.The patient was transferred to an inpatient orthopedics floor for continued postoperative care and rehabilitation. Scheduled acetaminophen 650 every 6 hours and gabapentin 600 mg nightly was ordered. His NRS scores remained at 4/10 and required no additional opioid medication. At 11 hours post obturator nerve block, the patient received his first oral opioid dose of oxycodone 15 mg for an NRS of 6/10. On po...

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“…However, continuous femoral nerve block analgesia will prevent early ambulation and increase the number of patient falls after surgery [16,17].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Combined Intrathecal Morphine and Sonar-guided Singleshot Femoral Nerve Block vs. Either Technique Alone for Postoperative Analgesia in Patients Undergoing Total Knee Replacement Surgery

Mohamed¹

2016

J Anesth Clin Res

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IntroductionEnd stage knee arthritis is commonly treated with total knee replacement (TKR). As the population ages, the frequency of this surgery proportionally increases [1] bringing with it the challenge of managing older patients with frequent comorbid diseases and increased risk of complications. Poorly controlled pain immediately after surgery is still a key issue for this procedure that may influence the patient's participation in physiotherapy, time to discharge from hospital, and the long-term outcome. Optimal postoperative analgesia can lead to early mobilization, ambulation, and return to a normalized gait pattern. Traditionally, this has been managed by epidural analgesia, peripheral nerve blocks and parenteral or spinal opioids [2]. Multimodal analgesia protocols for TKR have been effective in decreasing requirements for narcotic medications in the early postoperative period. Consequently, decreasing the opioid adverse effects that can slow down rehabilitation such as nausea, vomiting, hypotension, respiratory depression, and constipation [3,4].The efficacy of femoral nerve block (FNB) as a part of a multimodal analgesic protocol has been well documented [3][4][5][6]. FNB has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay while avoiding many of complications associated with other techniques such as continuous epidural analgesia or intrathecal opioids [6]. We hypothesized that the combination of single-shot ultrasound-guided FNB and low dose intrathecal morphine (0.2 mg ITM) would improve the quality of postoperative pain control and decrease side effects of systemic opioid use. So, we designed this study to demonstrate the additive effect of combined femoral nerve block (FNB) and 0.2 mg intrathecal morphine (ITM) compared with either technique alone for postoperative analgesia in patients undergoing unilateral (TKR) under spinal anesthesia.

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Postoperative Fall after the Use of the 3-in-1 Femoral Nerve Block for Knee Surgery: A Report of Four Cases

Cited by 58 publications

References 13 publications

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

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

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

Comparison of Combined Intrathecal Morphine and Sonar-guided Singleshot Femoral Nerve Block vs. Either Technique Alone for Postoperative Analgesia in Patients Undergoing Total Knee Replacement Surgery

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