J Korean Orthop Assoc.  2011 Jun;46(3):237-243. 10.4055/jkoa.2011.46.3.237.

Effectiveness of Pain Relief for Femoral Nerve Block in Multimodal Pain Control Protocols in Total Knee Arthroplasty

• Jeong MS
• Song EK
• Seon JK
• Byun JW
• Lee KJ
• Jung YW

• KMID: 2185457
• DOI: http://doi.org/10.4055/jkoa.2011.46.3.237

Abstract

PURPOSE
Authors evaluated the effectiveness of pain relief of the femoral nerve block in multimodal pain control protocols for patients with total knee arthroplasty in early postoperative period.
MATERIALS AND METHODS
Seventy-six patients who underwent TKA under general anesthesia were enrolled in this study. Preemptive analgesic medication, periarticular multimodal drug injection, and IV-PCA were used for pain control in all patients. This single-blind, randomized controlled trial included 43 patients in the nerve block group and 33 patients in the control group. In the former group, the femoral nerve block was done by one author with a nerve stimulator set using 0.5% bupivacaine 20 ml and 1% lidocaine 10 ml. Pain scale was measured at 6, 12, 24, 48, 72 hours and 7 days postoperatively. In addition, amount of IV-PCA consumption, numbers of using acute pain rescuer, range of motion, straight leg raising, first ambulation time, and complications related with drugs were evaluated.
RESULTS
Pain scale and the amount of IV-PCA consumption were significantly lower in nerve block group until 48 hours (p=0.04, 0.03), and the range of motion was better compared to the control group (p< or =0.02). The number of pain rescue medicines was significantly low in nerve block group within the first 3 days postoperatively (1.36 vs 2.58). The ability to raise a straightened leg was recovered more rapidly in the control group than in the nerve block group; this difference was statistically significant (12 vs 27.9 hours, p=0.02). There were no differences in first ambulation time and incidence of complications between the 2 groups.
CONCLUSION
Femoral nerve block in the early period after TKA under multimodal pain control protocols showed significant improvement in pain relief and in range of motion, as well as a significant decrease in the requirement of IV PCA and acute pain rescuers.

Keyword

knee; osteoarthritis; total knee arthroplasty; femoral nerve block; periarticular

MeSH Terms

Acute Pain
Anesthesia, General
Arthroplasty
Bupivacaine
Femoral Nerve
Humans
Incidence
Knee
Leg
Lidocaine
Nerve Block
Osteoarthritis
Passive Cutaneous Anaphylaxis
Range of Motion, Articular
Walking
Bupivacaine
Lidocaine

Figure

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  Figure 1 Photograph illustrating periarticular injection in posterior part of knee joint before implant placement.

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  Figure 2 Photographs illustrating procedure of a femoral nerve block after sterile preparation (A) and 5 cm, 22 gauge Stimuplex insulated needle (B).

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