title: 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.
authors.affiliation: Departments of *Anesthesia, †Rehabilitation, and ‡Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Jacques T
authors.initials: JT
authors.lastname: YaDeau
authors.forename: Janet B
authors.initials: JB
authors.lastname: Cahill
authors.forename: Mark W
authors.initials: MW
authors.lastname: Zawadsky
authors.forename: Nigel E
authors.initials: NE
authors.lastname: Sharrock
authors.forename: Friedrich
authors.initials: F
authors.lastname: Bottner
authors.forename: Christine M
authors.initials: CM
authors.lastname: Morelli
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kahn
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D004091:Hydromorphone; D008297:Male; D009068:Movement / Q000502:physiology; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004091:Hydromorphone; D002045:Bupivacaine