The Effects of Femoral Nerve Blockade in Conjunction with Epidural Analgesia After Total Knee Arthroplasty

Abstract

Either epidural analgesia or femoral nerve blockade improves analgesia and rehabilitation after total knee arthroplasty. No study has evaluated the combination of femoral nerve blockade and epidural analgesia. In this prospective, randomized, blinded study we investigated combining femoral nerve blockade with epidural analgesia. Forty-one patients received a single-injection femoral nerve block with 0.375% bupivacaine and 5 microg/mL epinephrine; 39 patients served as controls. All patients received combined spinal-epidural anesthesia and patient-controlled epidural analgesia with 0.06% bupivacaine and 10 microg/mL hydromorphone. Average duration of epidural analgesia was 2 days. All patients received the same standardized physical therapy intervention. Median visual analog scale (VAS) scores with physical therapy were significantly lower for 2 days among patients who received a femoral nerve block versus controls: 3 versus 4 (day 1), 2.5 versus 4 (day 2); P < 0.05. Median VAS pain scores at rest were 0 in both groups on days 1 and 2. Flexion range of motion was improved on postoperative day 2 (70 degrees versus 63 degrees ; P < 0.05). No peripheral neuropathies occurred. We conclude that the addition of femoral nerve blockade to epidural analgesia significantly improved analgesia for the first 2 days after total knee arthroplasty.

Does Limb Preconditioning Reduce Pain After Total Knee Arthroplasty? A Randomized, Double-blind Study

“…All patients received intraoperative femoral nerve blocks with 30 mL bupivacaine 0.25% with epinephrine 1:200,000 for postoperative pain control as per institutional practice [22]. Patients were monitored according to American Society of Anesthesiologists guidelines [2].…”

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

“…However, of those studies, only nine of 21 (43%) explicitly reported blinding of patients, clinicians, and/or assessors to the participants' treatment arm allocation [4,12,15,20,24,27,29,47,48]. Only nine of 21 (43%) reported performing an a priori power calculation for the outcome of postoperative cognitive dysfunction [4,16,24,27,29,34,38,39,48], with one of these studies failing to recruit a sufficient number of patients [38]. Of the remaining seven studies, two used a prospective comparative design [2,41], two used a case-control design [33,44], and three used a retrospective comparative design [17,19,36].…”

“…This included eight studies of patients who underwent either TKA or THA [7,12,17,18,20,24,36,47], eight studies of patients who underwent unilateral TKA [15,19,26,35,39,41,45,48], two studies of patients who underwent unilateral THA [16,34], and one study of patients who underwent bilateral TKA [46]. The remaining nine studies encompassing 2426 patients investigated postoperative cognitive dysfunction in a mixed major noncardiac surgical population, which included patients who underwent elective joint arthroplasty.…”

“…Langford et al [27] reported decreased postoperative cognitive dysfunction on Postoperative Day 2 (1.8% versus 5%; p = 0.006) with the use of standing IV parecoxib as compared to placebo. YaDeau et al [48] reported decreased postoperative cognitive dysfunction in patients who received a single-shot femoral nerve block immediately before TKA (2.5% versus 0%), while Marino et al [34] found decreased postoperative cognitive dysfunction with the use of continuous lumbar or femoral block as compared to IV PCA alone (0%, 1.3%, and 10.7%, respectively). In contrast, intraarticular infusion of bupivacaine after TKA was not found to change the incidence of postoperative cognitive dysfunction as compared to placebo [15].…”

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

“…Common indications include knee arthroplasty, arthroscopy, ligament reconstruction, foot and ankle surgery, and management of femoral fractures. [4][5][6] The use of a FNB together with general anaesthesia reduces the required doses of general anaesthetic agents, and hence its side-effects, including nausea, vomiting, drowsiness, and respiratory depression. The FNB also confers superior pain control, decreases opioid requirement, and enables earlier ambulation and hospital discharge.…”