Single-injection or Continuous Femoral Nerve Block for Total Knee Arthroplasty?

Albrecht, Éric; Morfey, Dorothea; Chan, Vincent; Gandhi, Rajiv; Koshkin, Arkadiy; Chin, Ki Jinn; Robinson, Sylvie; Frascarolo, Philippe; Brull, Richard

doi:10.1007/s11999-013-3192-3

Cited by 42 publications

(36 citation statements)

References 26 publications

(44 reference statements)

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“…It might be argued that a 20 ml volume for interscalene brachial plexus block is excessive, and 10 ml and 15 ml may be sufficient in practice. However, the duration of analgesia is related to the total mass of local anaesthetic injected , and this volume or higher is widely used in the literature .…”

Section: Discussionmentioning

confidence: 99%

Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial

et al. 2019

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Perineural dexamethasone has a ceiling dose of 4 mg for prolongation of analgesia duration after injection of long-acting local anaesthetic for peripheral nerve block, but evidence for doses < 4 mg is lacking. This randomised controlled triple-blind trial tested the hypothesis that increasing doses of perineural dexamethasone between 1 mg and 4 mg would prolong the duration of analgesia in a dose-dependent manner. Eighty ASA physical status 1-2 patients scheduled for shoulder arthroscopy under general anaesthesia with ultrasound-guided interscalene brachial plexus block were randomly allocated to receive saline (control), dexamethasone 1 mg, 2 mg, 3 mg and 4 mg, together with 20 ml ropivacaine 0.5%. Postoperative analgesia consisted of paracetamol, diclofenac and oxycodone on request, using a pre-defined protocol. The primary outcome was the duration of analgesia, defined as the time between the block procedure and the first analgesic request. Secondary outcomes included rest and dynamic pain scores, and analgesic consumption at 2 h, 24 h and 48 h postoperatively. An analysis of the dose-response relationship was performed using multiple comparison procedure-modelling. The median (IQR [range]) duration of analgesia was significantly prolonged in a dose-dependent manner: control

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Section: Discussionmentioning

confidence: 99%

Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial

et al. 2019

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“…Although this meta-analysis did not capture any difference in rates of complications, the low number of trials that specifically sought these outcomes dictates caution.Total knee arthroplasty (TKA) causes moderate to severe postsurgical pain, 1 with femoral nerve block (FNB) considered by many as the gold standard analgesic therapy after this surgery. [2][3][4][5] Local infiltration analgesia (LIA) applies the concept of surgical wound infiltration with local anaesthetics 6 7 to joint surgery. 8 The technique was first reported for knee arthroplasty by Bianconi and colleagues 9 fewer than 15 years ago.…”

mentioning

confidence: 99%

The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis

Albrecht

Guyen

Jacot-Guillarmod

et al. 2016

British Journal of Anaesthesia

109

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Many consider femoral nerve block the gold standard in pain management following knee arthroplasty. Local infiltration analgesia is an alternate approach that applies the concept of surgical wound infiltration with local anaesthetics. This meta-analysis aims to compare both analgesic treatments for analgesia and functional outcomes after total knee arthroplasty. This meta-analysis was performed according to the PRISMA statement guidelines. The primary outcomes were cumulative i.v. morphine consumption, pain scores at rest and on movement on postoperative day one (analogue scale,0-10). Secondary outcomes included range of motion, quadriceps muscle strength, length of stay and rates of complications (neurologic events, cardiovascular events, falls and knee infections). Fourteen trials, including 1122 adult patients were identified. There was no difference in i.v. morphine consumption (mean difference: -2.0 mg; 95% CI: -4.9, 0.9 mg; I(2)=69%; P=0.19), pain scores at rest (mean difference: -0.1; 95% CI: -0.4, 0.3; I(2)=72%; P=0.80) and pain scores on movement (mean difference: 0.2; 95% CI: -0.5, 0.8; I(2)=80%; P=0.64) on postoperative day one (a negative mean difference favours local infiltration analgesia). The qualities of evidence for our primary outcomes were moderate according to the GRADE system. There were no clinical differences in functional outcomes or rates of complications. Complication rates were captured by three trials or fewer with exception of knee infection, which was sought by eight trials. Local infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. Although this meta-analysis did not capture any difference in rates of complications, the low number of trials that specifically sought these outcomes dictates caution.

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“…It is noteworthy, however, that none of these three trials performed proper testing for neuropathy . Although the characteristics of ultrasound‐guided regional blocks for both upper and lower limbs have been extensively investigated in patients without neuropathy, the time to onset and block duration in patients suffering from diabetic peripheral neuropathy (DPN) remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Comparison of peripheral nerve blockade characteristics between non‐diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study

et al. 2018

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Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy.

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Single-injection or Continuous Femoral Nerve Block for Total Knee Arthroplasty?

Abstract: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 42 publications

References 26 publications

Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial

Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial

The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis

Comparison of peripheral nerve blockade characteristics between non‐diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study

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